She disappeared from our group therapy sessions. Other group members told me she was severely beaten by her husband and needed to be hospitalized. Later I would learn that her husband was under the influence of alcohol. I wish this was an isolated incident, but alcohol is common instigator of violence against others and self-harm.
This link between alcohol and violence been shown in multiple countries with robust evidence in the United States. Nearly two-thirds of intimate partner violence incidents in the United States occur in the context of alcohol abuse. Drinking increases physical and sexual violence perpetration. Alcohol use increases severity of violence as well. Such findings lead the World Health Organization to conclude that there is strong evidence that alcohol use increases intimate partner violence. The victims are overwhelmingly women.
Children are also harmed. Parents who drink heavily are more likely to physically abuse their child. Children who live in neighborhoods with more bars or liquor stores are more likely to be maltreated. In fact, one of out every 10 instances of child abuse reported to Child Protective Services in the United States involve alcohol use by the perpetrator.
The common depiction of gun violence in the United States involves drug dealers, terrorists, or a mentally deranged individual. But right under our noses, alcohol plays a substantial role in firearm violence. Men are as likely to die from alcohol-related firearm incidents as drunk driving accidents. For all the effort put into preventing drunk driving, we have utterly failed to appreciate that being intoxicated while in possession of a firearm is an equally dangerous situation. In fact, many states permit patrons to carry firearms into establishments that serve alcohol. It is hard to be lose permission or even be prohibited from acquisition of a permit to carry a firearm for being intoxicated or an alcohol-related criminal offense, while laws for driving under the influence are quite stringent.
As mental health provider, I commonly see patients under the influence of alcohol who contemplate or attempt suicide. Suicide is often an impulsive act and when sober, many patients regret their suicidal actions. Unfortunately, alcohol intoxication increases the risk that people will attempt suicide with a firearm, the most lethal suicide method in the United States. This type of impulsivity is an important reason why alcohol is associated with violence. Alcohol is disinhibiting and impairs judgment leading to poor choices. Clearly drinking alcohol does not always lead to violence and is not a prerequisite for violence to occur. But the link between alcohol and perpetrating violence is undeniable.
Moreover, there is compelling evidence that violence breeds future violence and substance abuse for victims of intimate partner violence and children whose parents who use alcohol. Both partners and children who experience violence who more likely to later abuse alcohol. Women exposed to domestic violence in childhood are more likely to enter abusive relationships as adults. This unfortunate consequence may lead victims into risky situations where they are more likely to be re-victimized.
But how to curtail alcohol consumption? As doctors should always ask about alcohol use, violence, and access to firearms. While these questions do not take long to ask and doctors have the right to ask, 58% of internists have never asked patients whether they have firearms in the home. Outside of provider reluctance, time constraints, patient’s lack of insight in problematic alcohol use, and secrecy are common barriers. At a minimum, health professional schools should incorporate screening and brief interventions for violence and alcohol misuse into their curricula.
Rather than rely just on individual doctor-physician interactions, research suggests that the broad measure of alcohol taxation is an effective solution. Alcohol taxes have not kept up with inflation, making alcohol the most affordable it has been in decades. Higher availability of alcohol, particularly bars, increases risk of both intimate partner violence and child maltreatment. Taxing alcohol decreases economic availability.
A meta-analysis summarizing results from 112 studies found that increasing the price of alcohol decreases alcohol consumption. People living in states with more comprehensive alcohol taxes are less likely to binge drink. In 2011, Maryland increased their alcohol sales tax by three percent. The tax was associated with decreased purchase of alcohol in the state. Compared to other states in the United States, there was a lot less drinking. Further, there were additional benefits such as decreased cases of gonorrhea in the state. Similar results were found in Illinois. Ultimately, less alcohol consumption leads to less violence. Indeed, the effect of increased taxes on curtailing violence has been evidenced in many studies.
Taxing alcohol is a lot more politically feasible than many other prevention efforts. Given the political climate, it is more likely to be passed than gun control measures, particularly in conservative states. Taxation is more effective than most other alcohol consumption interventions and increases government revenue for the local government, rather than costing money to implement. States can use generated revenue to support programs that aid victims of violence. Also, taxation has a larger effect on youth drinking, decreasing the chance that youth will have future problematic alcohol use. Importantly, a tax requires no active change in drinkers’ behavior such as improving their refusal skills. Common arguments against taxing alcohol include that it disproportionately affects poor people. This has been disproved. Also, in general less alcohol access does not lead people to use other drugs.
If we are serious about violence prevention, policymakers need to pursue alcohol taxation. Violence breaks bodies, psyches, and perpetuates itself. Taxing alcohol is not complicated and is one the best policy mechanisms to decrease violence. Neglecting to act is unacceptable.