Secondary Data Analysis to Advance a Program of Research: Patterns of Alcohol Use Related to Intimat

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Secondary Data Analysis to Advance a Program of
ResearchPatterns of Alcohol Use Related
toIntimate Partner Violence

• When we try to pick out anything by itself, we
  find it hitched to everything else in the
  universe --John Muir

LTC Mark Chapin, Ph.D.
Assistant Professor
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Overview

• Knowledge Development in Alcohol and IPV
• Secondary Data Analysis Pros Cons
• Findings from Secondary Data Analysis
• Building a Research Strategy

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BACKGROUND

• History of inadequate coordination between
  Substance Abuse programs and Domestic Violence
  programs at all levels, from DoD to practitioner
  level
• 2. Lack of continuity in care, resulting in
• --service gaps
• --service duplication
• --poor communication and data sharing
• --rarely results in service enhancement
• 3. Age of Enlightenment 1983-1985
• --White Sands Missile Range Lone Ranger
  assignment
• --Chair of FACMT
• --Clinical Director of ADAPCP

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Progress in Alcohol and IPV Research

• Alcohol and marital violence linked by research,
  first reported by Futterman in 1953, Snell in
  1961
• 60-80 of spouse abuse involves alcohol
• 72 of shelter residents report alcohol abuse by
  husbands (Labell, 1977)
• 62 of AFAP male clients score 4 on MAST
  (Chapin)
• IPV common among alcoholic patients
• 45 in Scott Study (1974)
• 59 in Chapin Study (1991)
• Both populations have similar characteristics
  (Stith 1991)
• Research shows linkage, but causality is
  elusive--no firm empirical support- Lipsey
  Meta-analysis, 1997

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Primary Study

• Treatment Outcome Study at Ft. Bragg (Brannen, in
  press)
• N 168 (84 FAP Couples)
• Intake Assessment included MAST, MCMI, and
  several alcohol use/problem questions
• Aim was to measure treatment success comparing
  gender specific vs. couples group therapy for
  AFAP clients
• Secondary AIM was search for matching factors

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Secondary Analysis Pros Cons

• Pro
• No data collection hassles (IRB, distribution,
  data entry)
• Data usually coded already
• Full utilization of data set
• Outside investigator brings new perspectives
• Con
• Must make study parameters fit existing variables
• Must accepts limitations of sampling parameters
• Access to and ownership of data, authorship on
  pubs can be contentious, especially if analysis
  yields unexpected results
• Usually not possible to get further access to
  participants when findings generate more
  questions

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Secondary Data Analysis

• Secondary analysis of alcohol use, depression and
  violence severity by OQuinn for dissertation
• Interaction between childhood violence exposure
  and MAST Score is significant predictor of IPV
  severity
• Interaction effect stronger than main effects
• Secondary analysis of alcohol use data by Chapin
  (2002)
• Levels of alcohol pathology using screening
  instruments
• Overlap among IPV, alcohol use, and Axis II
  features
• Co-Authorship with primary study PI and Site
  coordinator

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N 156 Mean MAST 4.8 Range 0 to 42
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MAST Diagnosis in Sample of FAP Clients
Diagnosed Alcoholic 33.6
No Diagnosis 44.3
Probable Alcoholic 22.1
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Mast Diagnosis of FAP Clients by Gender
Diagnosed 25.0
Diagnosed 41.7
No Diagnosis 37.5
No Diagnosis 51.5
Probable 23.5
Probable 20.8
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Comparison of Husbands and Wives Reports of
Alcohol Use at the Time of the Violent Incident
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Overlap of Abuse, Alcohol Abuse,and Axis II
Findings
N 84 Abuse Only 8 Abuse Personality Factor
68 Abuse Alcohol Factor 46 All Factors 38
Physical Abuse
Abusive
Not Alcoholic
No Axis II
n 8
Abusive
Axis II Traits
Abusive
Not Alcoholic
Probably Alcoholic
Abusive
n 20
No Axis II n 1
Probable Alcoholic
Axis II Traits
Axis II Diagnosis
Abusive
n 10
Not Alcoholic
Alcoholic
Abusive
Axis II Diagnosis
Abusive n 10
No Axis II
Alcoholic
Probably Alcoholic
n 7
Axis II Traits
Abusive n 4
ALL
n 16
Axis II Features
Alcohol Abuse
Abusive Alcoholic Axis II Diagnosis n 8
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Building a Research Strategy

• Publication of Research Findings from Current
  Study
• Advisory Group to RTI study
• Presentations at USAF Community Prevention
  Research
• Classes at US Army FAST Course
• VTC for US Army ASAP Counselors
• Prospectus for Themed Journal Issue/Book
• Research on Temporal Overlap
• Primary Data Collection

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SPECIFIC AIMS

• Describe the juxtaposition of temporal
  patterns of
• alcohol use and domestic violence incidents
• Provide quantitative validation of Walkers
  Cycle
• of Violence and variants
• Superimpose a template of alcohol use on the
  Cycle
• of Violence and variants
• Develop empirical support for
  trans-theoretical
• mechanisms explaining the role of alcohol at
• different time points within violent marriages

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A Trans-Theoretical Model Alcohol Use Within
the Cycle of Violence
Alcohol used to cope with stress
Alcohol used for relaxation and re-romance
1. Tension Building
Deviance Disavowal The Alcohol made me do
it!
3. Respite
Alcohol used as stress management
Drinking behaviors add to marital conflict
Anesthetize primary feelings, experience
only anger
Cognitive Distortion
Development of Drinking Script
Association with
violence
Deviance Disavowal Not accountable
Lowered Impulse Control
2. Acute Battering
Arguments during drinking
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Research Design

• Trans-theoretical model based on stages of change
  theoretical work (Prochaska and DiClementi)
• Structured interview format for data collection
• Data entry form for entering timing of alcohol
  use and marital stress levels
• Alcohol Use and Marital Stress entered on same
  column
• Variable Scale for entry of time data
• Will be piloted at Ft. Richardson, Alaska as part
  of doctoral dissertation

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METHODOLOGY

• DESIGN Descriptive Study
• SAMPLE 100 couples enrolled in FAP for IPV
• 100 couples where one is enrolled in intensive
  outpatient level of ASAP
• DATA COLLECTIONStructured interview and written
  instrumentation incorporated into routine
  assessment at ASAP and FAP clinical sites
• ESTIMATED PROJECT DURATION 2 years

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METHODOLOGY (Continued)

• INSTRUMENTATION
• -Structured Interview Schedule (Alaska Pilot)
• -Alcohol Use and Marital Stress Template (Alaska
  Pilot)
• -Michigan Alcoholism Screening Test
• -Beck Depression Inventory (II)
• -Modified Conflict Tactics Scale
• -Revised DVHIP BIF, including Alcohol Use items
• -Alcohol Use Quantity-Frequency Index 
• -Marlowe-Crown Social Desirability Scale

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Alcohol Use and Marital Stress Template
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METHODOLOGY (Continued)

• DATA ANALYSIS
• -Qualitative Analysis of interview data, coding
  for patterns of alcohol use related to timing of
  IPV incidents
• -Quantitative Analysis
• -Descriptive statistics of sample demographics
  and study variables.
• -Correlation between drinking level and marital
  stress, MAST and MCTS scores
• -T Test and MANOVA examining differences
  between Alcoholism clients and Family Advocacy
  clients

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FEASIBILTY

• PROS
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• 1. Infrastructure already exists in both FAP and
  ASAP clinics to perform data collection as part
  of routine assessment of all clients.
• 2. Use of clinic staff and military investigators
  minimizes cost.
• 3. Standardization of instruments between ASAP
  and FAP provides first opportunity to compare
  characteristics and risk factors for both groups
  of clients.
• 4. Combines data collection with first steps at
  providing continuity of care between ASAP and FAP
• 5. Adds to basic knowledge about role of alcohol
  use in intimate partner violence.
• 6. Correlation of assessment inventory results
  with abuse severity and recidivism will add to
  current knowledge of risk predictors.
• ESTIMATED COST 175,000

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FEASIBILTY

• CONS
• In service researchers reduce external
  objectivity (Co-PI is retired Army Social Work
  Officer)
• Military-only population limits generalizability
  to larger civilian community.

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Questions?

• How well does this research match the data needs
  from possible funding agencies, specifically the
  USAF Community Prevention Division?
• Can this methodology provide useful data to
  assist in policy planning?
• If there are discontinuities, can this
  methodology be adapted to provide useful answers
  which match the organizations research agenda?