Dating Violence and Substance Use

Abstract

The connection between adolescent dating violence (ADV) and substance use is important to consider because of the serious consequences for teens who engage in these behaviors. Although prior research shows that these two health problems are related, the context in which they occur is missing, including when (i.e., the timeline) in the relationship these events occur. To fill this gap, eight sex-specific focus groups were conducted with 39 high school–aged teens, all of whom had experienced prior relationship violence. Adolescents discussed using alcohol and/or drugs at the start of the dating relationship and after the relationship ended as a way to cope with the break-up. Alcohol and drugs were also used throughout to cope with being in an abusive relationship. The intersection of ADV and substance use occurred during instances when both partners were using alcohol and/or drugs, as well as when only one partner was using. These findings provide support for prevention and intervention programs that consider the intersection of ADV and substance use.

Keywords

adolescent dating violence substance use qualitative methods

Adolescent dating violence (ADV) consists of physical, sexual, and emotional violence, including monitoring and controlling behaviors (Centers for Disease Control and Prevention [CDC], 2014; Mulford & Giordano, 2008). Prevalence rates of ADV vary across studies; however, there is a general consensus that dating violence is a significant public health problem for adolescents. When examining the prevalence of ADV, rates of physical violence range between 10% and 20%, with rates of emotional violence and monitoring and controlling behaviors much higher (Ackard, Neumark-Sztainer, & Hannan, 2003; Foshee, Reyes, & Wyckoff, 2009; Halpern, Young, Waller, Martin, & Kupper, 2004; Marquart, Nannini, Edwards, Stanley, & Wayman, 2007; Olshen, McVeigh, Wunsch-Hitzig, & Rickert, 2007; Sears, Byers, & Price, 2007). Furthermore, a majority of adolescents reported that the violence was reciprocal (O’Leary, Smith Slep, Avery-Leaf, & Cascardi, 2008; Swahn, Alemdar, & Whitaker, 2010). Consequences of ADV include depression, suicide ideation and attempts, posttraumatic stress, eating disorders, and risky sexual behaviors (Ackard & Neumark-Sztainer, 2002; Banyard & Cross, 2008; Belshaw, Siddique, Tanner, & Osho, 2012; Silverman, Raj, Mucci, & Hathaway, 2001; Swahn et al., 2008).

With high prevalence rates and negative consequences associated with ADV, the need for prevention is clear. However, only a few prevention programs have been found to be effective in reducing ADV (see Foshee et al., 1998 and Wolfe et al., 2003). Additional prevention programming is needed that represents the dynamic and complex issues that teens face. One such issue is substance use. Results from past research have shown that adolescence is a time when youth experiment with cigarettes, alcohol, and drugs (Johnston, O’Malley, & Bachman, 2006; Substance Abuse and Mental Health Services Administration, 2013). According to a nationally representative survey of youth in Grades 9 to 12, 45% have tried tobacco, 70% have tried alcohol (with 20% reporting that they had tried alcohol before the age of 13), and 3% to 23% have tried illicit drugs (e.g., marijuana, cocaine, inhalants, heroin, ecstasy, and hallucinogenic drugs; CDC, 2012).

Furthermore, research findings have consistently shown significant relationships between ADV perpetration, ADV victimization, and substance use, including recent literature and meta-analytic reviews (Epstein-Ngo et al., 2013; Lormand et al., 2013; Rothman, McNaughton Reyes, Johnson, & LaValley, 2012a; Rothman et al., 2011; Temple & Freeman, 2011; Zaha et al., 2013). A majority of these studies, however, were cross-sectional, and therefore, the direction of the relationship could not be determined. When ADV and substance use have been explored longitudinally, directionality depended on whether the focus was on victimization or perpetration. Findings from longitudinal research suggest that victimization is a risk factor for later substance use (Exner-Cortens, Eckenrode, & Rothman, 2013). The opposite has been found when considering perpetration; substance use is a risk factor for later ADV perpetration (Temple, Shorey, Fite, Stuart, & Le, 2013; Vagi et al., 2013). As an indication of the complexity of this relationship, yet another study found no prospective relationship between ADV and substance use, in either direction (Reyes, Foshee, Bauer, & Ennett, 2012).

To move past examining ADV and substance use as separate sets of variables that are later included in quantitative analyses, Rothman and colleagues (2012b) used the Timeline Followback interview technique to connect experiences of alcohol use and dating violence retrospectively using a calendar to prompt participants. Participants were asked to report their experiences of alcohol use, dating violence victimization, and dating violence perpetration starting with the present day and going back each day for 6 months. Results showed that dating violence victimization and perpetration were significantly more likely to occur on heavy drinking days compared to nondrinking days. Epstein-Ngo et al. (2013) extended these findings by using this same technique to examine both alcohol and drug use, and dating violence. Results showed that alcohol use, cocaine use, and sedative/opiate use often preceded severe dating violence aggression.

With recent longitudinal research and the use of innovative techniques, we begin to see how ADV and substance use co-occur, but the context of these events is still largely missing. Some researchers have posited theoretical explanations for how the two experiences are related. One explanation is that alcohol and drugs have an impact on cognitive functioning, and can lead to a decrease in a person’s ability to read cues appropriately. The person may then react aggressively (Phil & Hoaken, 2002). Another explanation is that using alcohol and/or drugs by one or both partners can affect relationship quality, resulting in increased arguments and potential for violence (Fischer et al., 2005).

Findings from a recent qualitative study begin to shed light on the context of this intersection, at least in terms of substance use and ADV perpetration, by asking substance users about the connection between their substance use and their own dating violence perpetration experiences. In interviews with 18 adolescents, aged 14 to 20 years, results showed that alcohol exacerbated feelings of anger and tended to escalate minor conflicts. Interestingly, study findings also suggested that, in a few cases, perpetrators drank alcohol or used marijuana to cope after the incident (Rothman, Linden, Baughman, Kaczmarsky & Thompson, 2013).

The Present Study

The overwhelming majority of research in the field comprises quantitative associations between two sets of variables calculated from survey responses; however, moving forward, the field would benefit from research that adds to our contextual understanding of how these two experiences are related. In fact, the inability to establish the context of ADV and substance use has been listed as a limitation in previous studies (e.g., Reyes et al., 2012). In all but one study, it is unclear as to what was happening when the violence occurred and how substance use played a role in that event. Although the Rothman et al. (2013) study begins to address this gap in the literature, additional research is needed to build on these preliminary findings. More information is needed to understand teens’ experiences with substance use and ADV, both as victims and perpetrators of violence. It would also be helpful to know when (i.e., the timeline) in the relationship these events occurred. As such, an examination of the different stages (e.g., beginning, middle, and end) of a relationship is important, and how substance use and ADV intersect at each stage. The present study begins to fill this gap by presenting the findings from a series of focus groups with high school–aged teens, all of whom had experienced violence in a prior dating relationship. Teens talked openly about dating violence and substance use, and how these two experiences were intertwined.

Method

Recruitment Strategy

Prior to initiating participant recruitment, the project received approval from the University of Hawai‘i Committee on Human Studies. The author had previously conducted ADV workshops with service providers from community-based organizations across the State of Hawai‘i, and chose to utilize these relationships in the recruitment of teens for the current study. Providers who attended the workshop were provided with a description of the project, timeline, participant eligibility criteria, and assent/consent forms. Providers unable to assist with participant recruitment suggested other organizations and points of contact who could serve as liaisons for the project.

Providers and other community liaisons introduced the project to teens in their programs. Youth who met the following eligibility criteria were invited to participate: (a) high school age (14-19 years), though they did not need to be enrolled in public school; (b) had prior dating relationships in the past year they characterized as having been problematic, though not necessarily abusive; and (c) were not currently in a relationship involving abuse or dating violence.

Participants

Participants were recruited from a range of community-based organizations, including a peer mentoring program, an alcohol support program, a youth career center, and court-ordered temporary group homes for boys and girls. Eight sex-specific focus group interviews were conducted with a total of 39 participants: four focus groups with boys (n = 21, 54%) and four focus groups with girls (n = 18, 46%). Focus group participant numbers ranged between three and eight, with an average of four per group. Youth under the age of 18 (ages 14-17, n = 31; 17 boys and 14 girls) obtained parental consent and completed an assent form on the day of the focus group. Participants 18 or 19 years of age (n = 8; 4 boys and 4 girls) completed a consent form on the day of the focus group. Given the complexity of race and ethnicity in Hawai‘i, youth were not asked to report their race and/or ethnicity. Rather, all participants are identified as “local.”¹ Each participant was given a US$10.00 gift card as compensation.

Data Collection Procedure

Experienced interviewers facilitated the focus groups, with assistance from a note taker. A male facilitator, assisted by a male note taker, conducted the focus groups with boys while a female facilitator, assisted by a female note taker, conducted the girls’ groups. Each focus group was voice recorded and pseudonyms were used to maintain participant confidentiality. The focus group guide included the following topics: (a) how relationships begin, progress, and end; (b) the use of social electronic media in dating and dating problems; (c) the role of peers in relationship development and dating problems; and (d) the role of substance use in dating relationships.

Data Management and Analysis

More than 500 min of audio were transcribed verbatim, with an average focus group time of 63 min. This resulted in 388 pages of transcripts (ranging from 24-63 pages, averaging 43 pages per transcript). With these transcripts, the research team then began the process of analysis. We used a computer assisted qualitative data analysis software, NVivo, to ensure a systematic approach to data management and analysis, while also allowing for the emergent nature of the analysis to occur (Miles, Huberman, & Saldana, 2014). As a first step, transcripts were read several times by the author and one member of the research team, and coded using a priori categories that matched the interview questions. For this article, we focused on the different themes surrounding substance use, dating, and dating violence.

Next, we used grounded theory and included open, axial, and selective coding procedures to determine whether there were patterns to teen’s discussions of substance use and ADV (Corbin & Strauss, 2008; Ponterotto, 2010). During this phase, we inductively identified patterns in the narratives during open coding. In particular, teens discussed substance use at different stages of the relationship (e.g., the break-up stage), as well as how substance use created problems in the relationship. These patterns were then elucidated further through axial and selective coding, which sought to clarify the participants’ statements of how substance use was associated with dating and dating violence. Building on the initial codebook to capture the details of these patterns, we added specific codes related to substance use for “getting in,” “both using,” “discrepancy in use,” “coping,” and “getting out.” Two focus group transcripts were used as practice for coders to become familiar with the revised codebook, and to determine whether additional coder training was needed.

Finally, each transcript was coded using the revised codebook and added to the database (NVivo, Version 10). The categories were not mutually exclusive; data could be coded within multiple categories, as appropriate to the content of the narrative. Narrative segments that were not identically coded by research team members (final coding was done by two research team members independently and then checked by the author) were discussed until consensus was reached.

Results

Before turning to the intersection of ADV and substance use, it is helpful to establish the general context of teens’ dating relationships. It was clear from the start of the focus groups that teens’ relationships were filled with anxiety, distrust, discord, and violence. Boys and girls talked extensively about cheating and trying to keep track of their partners (or their partners keeping track of them) to ensure that they were not cheating (the first excerpt is from a girls group; the second is from a boys group):

Anna: He always texted me . . . He’s really protective so then he checked my messages at times. Or like, he caught me once talking to a guy. But, he’s my friend and he still doesn’t want to believe. And, he texted that guy and was like, “Back off, this is my girlfriend,” and I’m like, “Why’d you text him that, that’s my friend,” and he was like, “I’m sorry,” But, then he did it again, so I was mad, so I ignored him for like a week.

Mike: And, basically you get so controlling, yeah? And then, to the point where you don’t even want somebody talking to your girl.

Teens also described constant arguments and verbal abuse. In fact, monitoring and controlling behaviors, along with verbal abuse, were the most often endorsed types of violence.

Jen: I have had a lot of verbal abuse, from all of my boyfriends. All of them I have had so much, and I would just, I would just deal with it; I’d bite my tongue until I yell “Okay, I love you. So I’m going to stay with you, but if you really love me why are you telling me this?”

Verbal abuse extended to instances where one partner would threaten not only to harm the other, but would also threaten self-harm:

June: But he used to like rage out at random points and like say “I wanna go kill myself! And, if you leave me I’m gonna kill myself!” And then we fought after.

Although instances of physical violence were reported less often, participants did describe occasions when they were victims or perpetrators of physical violence. Most often these instances involved one of the partners slapping or hitting the other (although in several cases the violence was mutual). For example, Jen’s relationship (see quote above) was both verbally and physically abusive. She described an instance when her partner came for a visit, told her that she could not go out without him, and then slapped her for questioning him. Consistent with Jen’s experiences, the physical violence that teens described was most often a result of anxiety around cheating, when one partner would become frustrated with suspicions of the other partner cheating (in some cases, these suspicions were confirmed) that he or she would verbally and physically lash out at his or her partner.

It was within this relationship context that participants discussed substance use. Discussions centered on alcohol and a variety of drugs, including crystal methamphetamine (referred to as Batu in the focus groups), heroin, cocaine, ecstasy, and marijuana. Adolescents described using alcohol and/or drugs at the start of the relationship as well as at the end of the relationship as a way to cope with the break-up. The intersection of ADV and substance use is illustrated during instances when both partners were using alcohol and/or drugs as well as when only one partner was using.

Getting In

When asked to describe how their relationships began (or, how relationships in general get started), boys spontaneously described the role of alcohol and drugs. For boys, the discussion centered on how alcohol and drugs helped them feel more confident about asking a girl out:

Kai: I think alcohol saves people too. When you like this girl and you know when you’re drunk, you don’t know what you’re saying and then it’s like you can just be texting her when you’re drunk and you can ask her.

Tyler: You can tell her, oh, I like you, do you like me?

David: And, if she says no, like the next day, you go back and talk to her and say I don’t know what I was saying last night, I was drunk.

Kai: But you actually do like her, but she doesn’t know that because you were drunk. It’s like a cover up.

By contrast, although girls did mention the presence of alcohol and/or drugs during the getting in stage, there was a definite difference in what role substance use played at the start of their relationships. Whereas boys described using substances intentionally to help them “hook up,” girls described the process passively, more from the standpoint of having something (doing drugs) in common, and not that this was something they were actively doing to meet a guy (see differences in excerpts from a boy and girl):

Lucas: Like, you know this girl in school, and you know that she “chongs” and you go smoke with her. And, then you guys want to go drink, party, bang. Hook up.

Amanda: If you guys have, like when two people have the same interests, they usually stay on the same places. Like, you guys both looking for weed, and you guys both smoke weed, you guys usually going to be on the same place. So, that’s how we met, cause we both smoked weed. So, we had something in common. And, it started from there, I guess.

Although most boys discussed using substances intentionally to try to hook up with a girl, there were some who referred to substance use at the outset of a relationship in the same way as girls—as being present when the meeting happened but not used to instigate the meeting. Even in this passive description, boys seemed to understand that alcohol (in this case) speeds up the getting in process:

Charlie: Alcohol got me into three relationships. Cause, I guess like you’re at a party and friends introduce you to their friends. And, then from there, you just start talking to them and then you like them and then you give them your number and call the next day. And, then you start drinking again.

Frank: It’s like you get together no longer as strangers but acquaintances or friends and then it just builds up . . . I think drugs and alcohol, that’s like adding steroids to the process, like it just goes faster.

Both Using

Participants acknowledged the role that alcohol and/or drugs played at the start of a relationship; however, they also described the problems that it caused. Several boys mentioned that having alcohol and/or drugs in common at the start of a relationship might be fine at first, but that it is likely to lead to problems later:

Jake: But that’s the start of a bad one, cause you meet and if you think about it, it’s like, you met there all messed up, you know? And, if you do find a common interest from there, you’ll always revert back to that.

Another boys group described a common scenario where both partners drink. It starts out when “people in a relationship, they are having a good time just drinking.” Then, later in the evening, “they’re all emotional” and “drunk.” So, fights start because one partner is “making stupid little comments” or “saying one wrong thing” that “pisses” off the other partner. One boy described the effect of alcohol and drugs this way: “I love you and then I hate you.”

A girls group described a similar scenario: “Ho, yeah. When you both are drinking. Like all it takes is one wrong thing to come out of your mouth and, game over, it’s World War II.” Then, it becomes a downward spiral with more fighting, not only at that time, but the fighting continues the next day because of what was said and done while they were both drunk. As a result, teens became more and more frustrated and unhappy with their relationship:

Madeline: I wish there could be a time where, if we were both drinking, we weren’t fighting. But, it never is like that nowadays. It’s literally you say one wrong thing and you do one wrong thing or you take one more drink. And, it just takes the other person off to the point where it’s like “I hate you. You hate me. Well, let’s break up.” And then the next morning, “I’m sorry, I’m sorry.” And, it’s like “if you were going to apologize to me, you shouldn’t have even caused the fight with me last night.”

In some cases, participants mentioned their attempts to try to stop using. However, these attempts often led to either more fighting or continued (and sometimes increased) use of alcohol and/or drugs. Similar to a girl’s reference to World War II, a boys group also described it as a war, but this time, “Like you’re at war against her drug use for her.” In this case, one of the boys discussed his past relationship in which they were both using drugs but he tried to initiate a compromise by getting his partner to agree to stop using ecstasy and he would stop using cocaine. Unfortunately, it ended badly, when she called him one time at 12:00 in the morning to let him know that she was “rolling balls right now.” He felt betrayed, but he still could not end it. Instead, when he saw her the next day he started yelling and swearing at her, and then he got together with his friend and “got stoned.”

Interestingly, although most participants believed that when both partners use alcohol and drugs, it can lead to problems, one girl discussed how drug use (specifically, weed) actually had the opposite effect, and made her and her partner “more mellow.” Others in the group agreed. She went on to say that “I think he would listen more, if he was on something.” She also “wouldn’t be upset, if I was stoned.” This “calming” effect of marijuana was also mentioned in one of the boys groups.

Discrepancy in Use

In addition to the problems associated with both partners using alcohol and drugs, teens also described how the discrepant use of substances between the partners was equally problematic. Problems fell into two categories: when one partner was using before the relationship began and continued using while in the relationship, and when both partners were using and then once in the relationship, one partner decided to stop. In the first category, the partner who is not using might ignore his or her partner’s drug use in the beginning because he or she is “all lovey dovey” and does not want to tell his or her partner to stop using. But then, the partner’s alcohol or drug use begins to wear on the nonusing partner (first excerpt is from a girls group and the second is from a boys group):

Elle: And, he was selling Batu and stuff, and he was smoking it, too. Like, he’d be high and then I’d be like trying to talk to him, but since he was so high he cannot understand me. I get so mad. Yeah, drugs was a big problem between us. Like, he pick his drugs over me and I didn’t like that, I guess.

David: Because, like so, if your girlfriend doesn’t want you to have drugs, then you’re going to get mad about it. Argue with her, because “why I gotta stop this to be with you?” There are always going to get problems with that. Then, you’re going to have to follow. If you don’t want to follow, then, maybe that’s not a good relationship.

Often, these scenarios included verbal arguments, but there were a few instances when the partner who was using became physically violent while under the influence. Adele did not drink or use drugs; however, her boyfriend was constantly trying to get her to use. When she refused, he would become violent; in fact, anytime she refused to do something he wanted while he was drunk, he would react with verbal or physical abuse:

Adele: He used to drink a lot. When he did drink, he would call me at like 2 a.m. and like tell me, “Oh, I am at my place. Come over.” And, if I refused, he would start screaming over the phone. And, when I’d go to see him, he’d be drunk. Well, sometimes he’d be passed out, but then sometimes he’d be pushing or like be aggressive.

In the second category, at the start of the relationship, both partners are using; in fact, substance use actually brought these couples together. But then, one person decides to stop using or reduce their use. According to one of the boys groups, problems begin when one partner eventually comes to the realization that “you can’t be doing the same thing, you know? You gotta grow.” Then, this partner decides to stop using alcohol and/or drugs, while the other partner continues using. Once that happens, the relationship is likely to end because “it can’t grow from there if one person is lagging behind” and “gets too hardcore” with drugs.

It is important to note that in these situations it was not only the “hardcore” partner who perpetrated the violence but also the partner who had stopped using or reduced his or her use. For example, there were instances when teens described arguments stemming from their concern of their partner’s safety after he or she had been drinking or using drugs:

Jessica: He was a pot head, he smokes marijuana all of the time . . . and I get mad if he drives when he’s high. And, he doesn’t listen to me. And, that makes me mad because I don’t want him to get in an accident . . . that leads to arguments [where we are] swearing at each other in front of people.

Coping

Often, teens would describe situations when they would use alcohol and/or drugs to either cope with an abusive or noncaring relationship or to cope with a break-up. According to one boy, “They run to that [alcohol and drugs]. So it will take their mind away for a few hours, or however long.” For example, for the boy who discussed his attempt to try to get his girlfriend to stop doing ecstasy (referenced above) and his subsequent disappointment and anger when she went back on her promise, when asked by the facilitator how he managed the situation he said, “I coped with it by doing more drugs. Like, I broke my side of the compromise and just did a load of drugs.” Later in the conversation, he commented that “Relationships in general are just crazy [Others in the group agree]. It’s like a really hard video game. I wish there were cheat codes to that shit, you know.”

In addition to coping with abusive and noncaring relationships, teens also mentioned using alcohol and/or drugs to cope with a break-up. As an example, one of the girls described her relationship as verbally and physically abusive, but she could not bring herself to break up with her boyfriend because “to see him with someone else would kill me.” To cope, she admitted to using alcohol and drugs all throughout the relationship, even though she knew it was not healthy:

Lisa: Snorting “Glang.” Drinking so much alcohol; it wasn’t even OK. And, like he just broke me. And, then when he broke up with me, that’s when it just went more worse.

Getting Out

As described above, often substance use was connected with coping in conjunction with the dissolution of a relationship. This pattern was referred to most often by girls. Sometimes, the substance use was just a continuation of a common practice, but in one instance a girl mentioned that she started using drugs because of the break-up:

Cecilia: I started using drugs, when, well like frequently, like a couple times a day, when me and this guy broke up. I just used it to cope with what happened, because I really liked that guy. Cause he made me feel like I was important, I guess.

Interestingly, substance use was also identified, only by boys, as a way to instigate a break-up. In a discussion where all boys contributed, one boy made a comment about how alcohol influences relationship dissolution: “I don’t know. When you’re drunk, you can break up with a girl like that” [snaps fingers]. Other boys in the group agree, and the first boy goes on to say that boys could use alcohol or drugs to get out of a relationship that they wanted to end but could not do it (for whatever reason). Along these lines, several boys mentioned that alcohol and drugs provided opportunities for them to meet other girls, and when that happened “you end your relationship” and then “just go for the other girl.”

Discussion

The present study examines the intersection of ADV and substance use at different stages of the relationship. Findings show that teens’ relationships were filled with distrust, discord, and violence. Violence typically consisted of emotional violence, including ignoring and/or yelling at each other, and monitoring and controlling behaviors in the context of suspected cheating. Although physical violence was not commonly endorsed, there were instances when teens reported slapping their partners (or their partners slapping them); these episodes were usually out of frustration related to suspicions of cheating.

Within this relationship context, teens described how alcohol and drugs were often present at the start and throughout the relationship. In particular, alcohol and drugs helped them “get in” a relationship; in these instances, teens were drinking or using drugs, and since they were in the same place (e.g., at a party), at the same time, they would just get together. Although this passive description of the connection between alcohol/drugs and relationship initiation was shared by boys and girls, several boys across focus groups related that they would intentionally use alcohol or drugs to “hook up” with a girl.

Teens admitted that having a common interest such as drinking or using drugs might be fine in the beginning but that it would likely lead to problems later on. In fact, violence between the couple usually occurred after the relationship had been established, when both partners were under the influence. These findings are consistent with previous studies suggesting that ADV victimization and perpetration are more likely to occur on days when youth are drinking or using drugs (Epstein-Ngo et al., 2013; Rothman et al., 2012b). There were also problems when one partner was using and the other was not; in these cases, the partner who was using felt pressured by the other to stop using, which ultimately led to arguments and fighting. Importantly, boys and girls reported substance use and dating violence equally, thus giving support to findings in the literature suggesting that both are at risk for these experiences (Reyes et al., 2012). Furthermore, the violence was often mutual or reciprocal, a finding that is also consistent with previous literature (O’Leary et al., 2008; Swahn et al., 2010). Therefore, prevention programming should be targeted at both genders.

In addition, the present study provides support for one of the theoretical explanations in the literature for how alcohol and drugs are related to ADV. This explanation posits that substance use can lead to a reduction in a person’s ability to read cues (Phil & Hoaken, 2002). This was endorsed by teens who said that in cases when they were both using or when only one partner was using, they would react more quickly to “stupid little comments,” which would lead to fights. These fights would inevitably lead to increased drinking or drug use, thereby causing more fights.

One contradiction to these findings occurred in the case of marijuana use. Boys and girls in our study described how marijuana made them mellow and less likely to argue with their partners. This finding is consistent with a recent qualitative study with adolescents, in which marijuana was reported to have a calming effect for perpetrators of ADV after a violent episode (Rothman et al., 2013). In the present study, it seemed that marijuana reduced discord and violence more generally in the relationship, and was not referred to as a method for dealing with the aftermath of violence. Studies with adults, however, show a positive relationship between marijuana use and partner aggression (Moore et al., 2008; Shorey, Stuart, & Cornelius, 2011). With these contradictory findings, additional research is needed. Given that teens may be using multiple substances (as was the case in our study), innovative methods are needed to ascertain how one substance, in isolation of others, is related to ADV. Moreover, the nuances of marijuana use versus marijuana withdrawal may be important in understanding the differences between adult and adolescent samples (Moore et al., 2008).

With the exception of marijuana use, these findings support the concept of a downward spiral in the relationship, which is consistent with a second theoretical explanation posed in the literature for the connection between substance use and ADV. Namely, that using drugs and alcohol by one or both partners can affect relationship quality, resulting in increased arguments and potential for violence (Fischer et al., 2005). For most youth in this study, this scenario is an accurate depiction of their experiences. Several participants commented on how alcohol and drugs made things worse, not only at the time that partners were using but also in the days following because of what was said and done while they were using. Interestingly, this finding contradicts Florsheim and Moore (2008), who suggest that adolescents may not actually view substance abuse as a problem in their relationships because they have not yet experienced negative consequences associated with long-term use. For teens in the present study, however, the issue was not in identifying substance use as a problem in their relationship (they did), but in terminating the relationship. Even with all of the fighting, most teens could not bring themselves to terminate the relationship.

The inability to terminate a relationship, especially one that includes substance use and violence, is certainly a cause for concern. Researchers have reported that teens remain in abusive relationships for multiple reasons, including feelings of shame, feeling alienated or alone, not recognizing the abusive behavior, and seeing violent acts as indications of love and caring (Amar & Alexy, 2005; Banister, Jakubec, & Stein, 2003; Chung, 2007; Johnson et al., 2005; Jouriles, Garrido, Rosenfield, & McDonald, 2009). However, much of the research on staying in abusive relationships has been conducted with female victims. We have shown that boys also struggle with abusive relationships and the inability to terminate them, and that these struggles are confounded by alcohol and/or drugs.

In fact, both boys and girls admitted to turning to alcohol and drugs as a way to cope not only with a noncaring relationship but also the break-up of the relationship. Therefore, it may be that universal prevention programming is needed to help teens more generally navigate the dissolution of relationships. In relationships where there is ongoing violence and substance use, more targeted programs may be necessary. Given the association of these experiences, it will be important to change the current practice of health programming that highlights one topic and presents it in isolation because such distinct programs fail to raise awareness among teens of how risks are interrelated.

In addition to the need for comprehensive prevention programming aimed at teens, we recommend that interventions be implemented with practitioners. Practitioners in settings, such as emergency departments and community-based health clinics, could benefit from an increased awareness of the connection between substance abuse and ADV. In fact, early identification and referral are fundamental aspects of substance abuse prevention, which includes screening, brief intervention, referral, and treatment (SBIRT; Substance Use and Mental Health Services Administration, 2011). By raising awareness and improving the capacity of practitioners, through education and training, to understand the importance of screening for these intersecting health risks among the youth with whom they come in contact with, it may be that repeat occurrences of dating violence and the consequences that youth face from these experiences are reduced.

Limitations

There were several limitations to the study. First, the sample was not representative of a universal population of teens. Rather, teens were recruited based on their prior experiences of dating violence. That said, by including youth who had prior relationship problems, we were able to gain a deeper understanding of the context of these relationships as it was a salient topic for them. A second, interrelated, limitation is that teens were engaged in community-based services such an alcohol support program, and court-ordered temporary group homes for boys and girls. Recruiting from these programs resulted in a skewed sample than would be typical if recruitment occurred in other settings. However, by talking with youth who had already engaged in violence and substance use, we now have a better idea of how these two issues are connected. This understanding will aid in the development of contextually relevant interventions for youth with similar levels of risk.

Third, although we chose to use a focus group format for data collection, there are other formats, such as individual interviews, that may have worked better for an investigation of these issues. For the most part, teens seemed comfortable sharing their stories in a group setting, but there were times when it seemed as if one or two participants were holding back. For boys, it seemed as if a few participants did not want to admit perpetrating violence against their partners, though others were more straightforward about their actions. For girls, there were a few instances when girls seemed to skirt around their own substance use as well as their reasons for continuing in a relationship that was abusive. Future studies should explore multiple formats to gather information. For example, we believe that combining focus groups with follow-up individual interviews would have been helpful. In this way, the focus group is used to build rapport and provides entre for more in-depth individual discussions.

Conclusion

Findings from this study provide a glimpse into the context of teen relationships in which violence and substance use co-occur. We answer the question of how the two are related and at what point in the relationship substance use occurs. Teens described their use of alcohol and drugs at the beginning and all throughout their relationships. In particular, they discussed their reliance on alcohol and drugs as a way to cope with unhealthy relationships and relationship dissolution. Given these findings, intervention programs must target select populations of teens who are using substances and report experiences of ADV. We also need to extend these interventions to practitioners who work with youth in different settings. By considering the intersection of ADV and substance use, teens’ risk for entering and staying in abusive relationships may be reduced, as well as their reliance on alcohol and/or drugs to cope with such relationships.

Footnotes

Acknowledgements

I would like to thank Susana Helm, Justin Ramos, James Charisma, Jaclyn Khil, Katie Gray, Lorraine Coffinet, and Kaela Teilhaber for their help with data collection and analysis. Special thanks to Jeffrey Berlin for all of his help in coordinating this project. In addition, I would like to thank the providers for their help with recruitment, and, most of all, the youth who participated in the focus groups for sharing their experiences.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Support for the research was received through a University of Hawai‘i College of Social Sciences Research Award.

Notes

Author Biography

Charlene K. Baker, PhD, is an associate professor of community and cultural psychology in the Department of Psychology at the University of Hawai‘i at Mānoa. Her research interests include working in collaboration with communities to develop and evaluate culturally appropriate prevention and intervention programs aimed at reducing the prevalence and impact of intimate partner violence. Her work also emphasizes the need to understand the context of violence as well as the intersections of violence with other social and health issues such as homelessness and substance use. She advocates for policy and programmatic solutions to address these intersections.

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