Drug and alcohol abuse have complicated effects on the human mind and human behavior; as far back as 1995, the Journal of Health Care for the Poor and Underserved described the relationship between substance abuse and violence as a case of “cause and consequence.” The connection between drug addiction, alcoholism, and violence crosses many thresholds (individual psychology, public health, and domestic violence, to name a few), and is vitally important in understanding the scope of how controlled substances can affect people.

Drugs and Violent Behavior

The correlation between substance abuse and violent behavior has been well documented. For example, the Journal of Substance Abuse Treatment noted that more than 75 percent of people who begin treatment for drug addiction report having performed various acts of violence, including (but not limited to) mugging, physical assault, and using a weapon to attack another person. Examining gender differences, the Journal of Studies on Alcohol and Drugs found that before seeking treatment for substance abuse, the rate of violent acts was as high as 72 percent among men and 50 percent among women. People enrolling in treatment were referred by family members because of violent behavior carried out while under the influence. Furthermore, researchers found that aggression between two people in a romantic or sexual relationship was “associated with heavy drinking episodes and cocaine use.”Why is there a link between alcohol abuse and violence? In 2010, Live Science reported the results of a Scandinavian study that found the risk for violent behavior increases with intoxication, but only among individuals who are prone to suppressing their feelings of anger while they are sober. Testing people who reported that they were prone to burying their angry feelings, researchers observed a 5 percent increase in violent behavior that followed a 10 percent increase in drinking to the point of getting drunk. People who didn’t work their anger out were more likely to get drunk, and that state of drunkenness was connected to a rise in the chance of engaging in violent behavior. People who did not suppress their angry feelings did not show a similar association.

Addiction and Suicide

The compulsion toward risky behavior accounts for the connection between alcohol abuse and the risk of suicide, which also overlaps with the propensity for violence. Alcoholism, Clinical and Experimental Research noted a perception among people who seek treatment for substance abuse problems that the inability to control their violent behavior was connected with an increased chance of a past suicide attempt. Researchers writing in that journal theorized that people who struggle to control their anger are more likely to act on impulse and may thus be more violent to themselves than to others.To that point, the World Health Organization defines suicide as a form of “self-directed violence,” and studies on the topic of how substance abuse influences violence have found a strong connection between addiction and “self-directed violence.” The European Archives of Psychiatry and Clinical Neuroscience journal wrote of how people with histories of alcoholism and past aggressive behavior “are more likely to report suicidal thoughts or past suicide attempts.” People who had attempted to commit suicide tended to report higher instances of depressive disorders, which they may have tried to cope with by abusing alcohol or drugs as a form of self-medication, thereby deepening the spiral. In 2010, scientists writing in the Addictive Behaviors journal noted that people who had a psychological dependence on alcohol, and also had a history of suicide attempts, showed “higher impulsive and aggressive behavior.” In a study of over 6,000 people enrolled in treatment for their addiction, participants who had committed acts of serious violence (such as rape, murder, or assault that resulted in serious injury) were more than 50 percent more likely to report multiple suicide attempts. The statistic was unaffected even when demographics, mental health, and past instances of victimization were taken into account.

Drug and Alcohol Dependence simply noted the “large empirical literature” that connects alcohol abuse to suicide, while also mentioning that other research has determined a link exists between opioid abuse, intravenous drug abuse, and self-directed violence.

Suicide Attempts

According to the Archives of General Psychiatry, people who have a diagnosis of abuse of or dependence on drugs, alcohol, or both are six times more likely to have attempted suicide when compared to those who have no such diagnosis.

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Domestic Violence and Substance Abuse

Of all the forms of violence influenced by drug addiction or alcoholism, violence toward a domestic partner may be one of the most concerning and serious. The U.S. Department of Justice explains that the abuse in a domestic arrangement is not limited to physical acts, such as hitting, punching, slapping or pulling hair; “domestic violence,” as a legal term, can also cover sexual abuse (rape, marital rape, treating a partner in a sexually abusive and demeaning way, and molestation), emotional abuse (intentional and malicious attacks on a partner’s self-worth), and psychological abuse (controlling the partner, blackmail, threatening harm to children, violence toward pets, and intimidation).As explained by the American Society of Addiction Medicine, violence against an intimate partner can also include stalking, social isolation (not letting an intimate partner leave the house, for example), and depriving resources and necessities. Various studies have identified substance abuse as a factor in 40-60 percent of incidents of domestic violence, either in precipitating the abuse or exacerbating it.

Some research has indicated that spousal abuse could be a predictor of the development of a drug addiction. Further to that point, women in abusive relationships often report that their abusive partner coerced them into engaging in alcohol and drug consumption. The American Journal of Public Health noted that substance abuse tends to be more prevalent among women who suffer domestic abuse, even among pregnant women who were victims of violence. Such is the extent of the influence of drugs and alcohol on violence that on days when abuse occurs, physical violence was 11 times more likely to take place.

More than 20 percent of male perpetrators of intimate partner abuse use alcohol or drugs immediately before the most recent and severe incidents of violence. Many studies have found a strong connection between excessive alcohol use and the action of partner violence, although there is not yet a consensus on the cause and effect – whether the drinking causes such men to be violent or whether the alcohol abuse is used as a way to excuse (or justify) the violence.

Unsurprisingly, the victims of intimate partner violence tend to be mostly female – 85 percent, according to the United States Bureau of Justice Statistics. Compared to men, women have a 5-8 times higher chance of being abused by an intimate partner. Most of the partner abuse takes place in the home.

Violence fueled by drug and alcohol consumption also takes place in same-sex relationships. Lesbian, gay, bisexual, and transgendered individuals have higher rates of substance abuse than the general population, often due to the prejudice that many of them face in their lives, and this may manifest in violence carried out within their domestic unions.

Among Native American communities (where rates of substance abuse are “worse than we thought,” according to the National Institute of Drug Abuse), almost 50 percent of women experience intimate partner violence in their lifetimes. This is the highest rate of domestic violence among US population groups.

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Unhealthy Coping Mechanisms

In 2002, the Department of Justice reported that most of the victims injured by their domestic partner did not seek professional medical treatment for their injuries, either because of shame, because they did not want their abuser to get arrested, or because they did not want the drug and alcohol abuse to come to light.

As a result of the violence, the victims of domestic abuse are at a higher risk for suffering mental health problems. Fifty-six percent of women who experience partner violence are diagnosed with a psychiatric condition; women in general are twice as likely as men to develop a mental health disorder. Victims of domestic abuse are more likely to use tobacco and marijuana, as well as engage in other compulsive behaviors, such as eating disorders. Compared to people who do not experience domestic violence, victims are 70 percent more likely to abuse alcohol.

Contrary to popular belief, it is not only the perpetrator of the violence who is the substance-abusing partner; in many cases, both members of the relationship engage in alcohol or drug abuse. Sometimes, only the victim of the violence is a substance abuser (perhaps driven to abusing drugs and alcohol as a way of coping with the physical, psychological, and emotional trauma of the violence).

The confluence of domestic violence and substance abuse creates a very dangerous situation for the victim in the relationship, for a couple of major reasons. The presence of drugs and alcohol in the victim’s system may make resisting the attacker unfeasible – for example, if the victim is drugged to deliberately reduce inhibitions and resistance to sexual advances. A victim may not be able to fully assess the danger being posed and may be compelled to remain in a threatening situation because of the effects of drugs or alcohol.

Victims may be unwilling to seek help or report the attacks for fear that the substance abuse will lead to arrests, shame, or accusations of unreliability. For example, studies show that in a number of cases, the victims of domestic violence are substance abusers themselves. While the substance abuse may be a direct result of being exposed to the violence, the situation could also dissuade victims from calling the police.

Substance Abuse and Intimate Partner Violence

For example, the National Criminal Justice Reference Service shows that in one study out of Memphis, Tennessee, 42 percent of 72 victims of domestic assault admitted to using drugs and alcohol on the day of their attack, with 15 percent alone using cocaine. Most of the 72 people had been assaulted by the same person repeatedly. As much as 92 percent of the assailants in the report were drug and alcohol users, and two-thirds of them consumed alcohol and cocaine together. Fifty percent of the assailants either used drugs, drank, or did both every day for the entire month before the study. Nine percent of them were receiving treatment or had received treatment in the past for their addiction.

In 1996, the Annals of Emergency Medicine examined 134 murders of women in New Mexico. The crimes took place between 1990 and 1993, and in 62 percent of the homicides, the male domestic/intimate partner was the perpetrator. Among the victims, 33 percent were legally drunk when they died; almost 25 percent had drugs in their system at the time of their death.

Effects on Children

The Livestrong Foundation looked at how violence driven by substance abuse impacts the rest of the family unit, explaining that the factors that connect violence toward family members and drug addiction do not necessarily come to an end when the abuser discontinues the drug intake. Trauma and reduced happiness can last for years after the last instance of violence or drug consumption, with the relationship between the family members and each person’s individual psychological wellbeing permanently damaged as a result of their abuser’s behavior.The greatest effect is often seen in the children of the relationship (if there are any). According to the National Coalition Against Domestic Violence, children who grow up with drug-addicted parents have a greater likelihood of experiencing physical, sexual, or emotional abuse (all forms of domestic violence) than children who grow up in stable homes. Those children who experience violence at the hands of a parent or guardian (either firsthand, or by seeing or hearing a drug-using parent abuse another member of the family or a beloved pet) have a high chance of developing their own alcohol and drug problems when they reach adulthood. Evidence further suggests that children who run away from violent homes also risk becoming substance abusers.

Growing up in an Abusive Home

Children have been called “the silent victims” of domestic violence because they are often unable to properly understand (and therefore talk about) what they see, hear, and experience at the hands of an abusive parent. Furthermore, the younger a child, the more vulnerable and defenseless the child’s mind, so the anxiety and stress disorder that can develop in the aftermath of a violent event can be lifelong.

The Center for Nonviolence and Social Justice writes that children who see parents or siblings being violent toward one another, or who are exposed to this violence firsthand, grow up with brains that form differently than children who grow up in households where there is no such violence.

Research published in the Neuropsychopharmacology journal (and reported on in TIME magazine) showed that teenagers who experienced domestic violence and other trauma during their childhood grew up with problems in specific areas of their brains – namely, the regions of the brain that connect emotions to thoughts and that regulate behavior. As a result, the children grow up into teenagers, and then adults, who struggle with depression and post-traumatic stress disorder, have difficulty maintaining healthy relationships, and ultimately continue the cycle of alcohol and drug abuse as an expression of the risky and impulsive behavior that develops as a result of the brain abnormalities.

One of the results of this is that as many as 20 percent of the child and teen arrestees in state juvenile justice systems were high or drunk when they committed their crimes. Some were arrested for committing an offense related to drug or alcohol consumption or acquisition.

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Running away from Violence

Sometimes, the impulsivity takes the form of running away. The Drug and Alcohol Dependencejournal explained that when children and adolescents run away from home, they usually do so for a number of reasons; chief among those reasons is abuse by family members, which creates a dysfunctional (and possibly violent) home environment. As many as 80 percent of the homeless youths in America, aged 12-21, use drugs or alcohol to cope and survive on the streets. For many of these people, they would rather remain outside than return to homes where violence and trauma await them. The substance abuse may be voluntary, or it may be forced upon them by gangs and human traffickers who see the confused, lonely youths as a medium for sexual exploitation, and who use drugs as a form of coercion and payment. Tragically, the addiction feeds the circumstances surrounding the violent past and current homelessness, and vice versa.According to the National Runaway Safeline, as many as 70 percent of teenagers left their home with no planning or preparation, usually because they had reached a point because the abuse to which they were subjected (whether physical, emotional, or sexual) had become unbearable, and leaving home was a preferable risk to staying. The Journal of Drug Issues studied substance abuse among adolescents who were runaways, and researchers concluded that teenagers who suffered high levels of violence from their parents or guardians had a higher chance of being dependent on drugs and alcohol when they left home. The shock of being on their own, exposed to the elements without comfort or shelter, and still nursing the physical and psychological wounds of the violence they received played a role in compelling the substance abuse.The world that the teenagers enter is a dangerous one of rampant drug trafficking (and human trafficking), where drug and alcohol consumption is a way of life. In the past, street drugs like heroin or cocaine might have been the poison of choice, but in an era where prescription medication is a highly prized commodity on the black market, drugs like OxyContin and Vicodin are the new products. The potent painkillers numb physical pain and induce such strong states of tranquility and drowsiness that many people suffering stress or trauma lose themselves in the narcotic daze. Almost a quarter of the youths forced out of their homes in Los Angeles in 2011 abused prescription medication.

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Socioeconomic Factors

According to the Aggression and Violent Behavior journal, “most alcohol and drug use occurs among persons who are not violent,” but alcohol and drugs tend to be found in people on both sides of a violent event (whether victim or aggressor). The researchers writing in the journal point out that there is far more to violent behavior than simply drugs and alcohol; there are widespread socioeconomic factors to consider (such as the systemic violence of drug distribution networks, or the economic compulsive violence of using force to obtain drugs or the money to buy drugs), the setting and environment in which people obtain and use drugs, and the unique biological and psychological processes that drive every aspect of human behavior and interpersonal interactions.

Laboratory and research studies suggest that alcohol has a causal role to play in violent behavior, but the degree of that role is significantly varied. The same applies to stimulants like cocaine and amphetamines. That being said, the relationship between alcohol, stimulant drugs, and violent actions is “exceedingly complex” and dictated by dozens of conditions (some of them even contradictory) in the real world.

Some of the socioeconomic factors include crime. The National Council on Alcoholism and Drug Dependence points out that since alcohol use is both legal and pervasive, the substance “plays a particularly strong role in the relationship to crime.” The Department of Justice estimates that alcohol is involved in almost 40 percent of violent crimes, and of the 2 million convicted offenders currently serving time for their crimes, as many as 37 percent admit that they were drunk when they were arrested. Similarly, the Bureau of Justice Statistics noted in 1998 that approximately 3 million violent crimes take place every year where the offenders were drinking at the time of the incident. Other statistics show that half of all murders and assaults take place when the perpetrator or the victim (or both) was drinking.

More than any illegal drug, alcohol was found to be “closely associated” with violent crimes, such as murder, assault, rape, and abuse of (marital) partner and children. Alcohol also tends to be a factor in violence when the attacker and the victim are acquainted with one another. As much as 66 percent of victims who were assaulted by an intimate partner (a term that includes a current or former spouse, boyfriend, or girlfriend) told police and emergency services that alcohol was consumed before or during the attack. By contrast, only 31 percent of violent attacks involving alcohol were carried out by strangers. Figures show that almost 500,000 cases of violence between the intimate partners of a relationship involve attackers who had been drinking before the abuse started; 118,000 episode of family violence (not counting spouses) and 744,000 such instances with acquaintances involved alcohol.

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Drug Addiction and Violent Crime

In talking about the complex relationship that exists between drugs and crime, the National Council on Alcoholism and Drug Dependence expands on the point made by the Aggression and Violent Behavior journal; “crime” can cover may dimensions, such as use-related crime, economic-related crime, and systems-related crime.

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Driving while Impaired

Perhaps the most well-known form of drug- or alcohol-fueled violence is driving while intoxicated, the third most frequently reported crime in the United States. Every year, over 1 million people are arrested for getting behind the wheel while impaired; driving under the influence is the number one cause of death, injury, and disability for people aged 21 and under. Almost 30 percent of all traffic deaths are related to one or more drivers being drunk at the time of the accident, according to the Centers for Disease Control; the National Institutes of Health notes that the figure was as high as 60 percent in the mid-1970s.

In 2007, the National Highway Traffic Safety Administration reported that one in eight nighttime drivers tested positive for having illegal drugs in their system while behind the wheel; a 2010 survey found that one in eight high school seniors admitted to driving after smoking marijuana. The rising popularity of marijuana, lax enforcement standards, and recreational legality in some jurisdictions have pushed state and local transportation departments to come up with various ways to ensure that drivers who are too high do not pose a threat to other motorists, even as some research has shown that states with some measure of marijuana regulation have lower rates of traffic deaths.

Marijuana is not the only drug that some drivers are consuming before driving. Many patients who are on courses of opioid or benzodiazepine medication (prescribed for anxiety, chronic pain, or insomnia) make the mistake of driving while feeling the sedative effects of the drugs. Police are stymied because prescription medication affects different people in different ways, so there is no consensus on how much of a drug a person can have before driving becomes too dangerous. Furthermore, “prescription medication” is a massive umbrella term, encompassing drugs that dull alertness and reaction time, and drugs that compel taking risks that endanger pedestrians and other motorists.

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Drug-Induced Violence on College Campuses

Drug use is a significant problem on college campuses, but when it comes to students aged 18-24, alcohol is still the number one poison. More than 600,000 students every year are assaulted by a drunk student, and 95 percent of all the violent crime that takes place on college property involves either the attacker, the victim, or both being drunk at the time. Similarly, 90 percent of all the cases of rape and/or sexual assault on college campuses involve all relevant parties being intoxicated at the time of the attack. The National Institute of Justice warns that “alcohol use increases the risk of sexual assault,” writing that alcohol use by a potential attacker can cause increased aggression, hostile behavior, and, crucially, “an inability to interpret another person’s sexual interest accurately.” Many victims of sexual assault report that their intoxication made them inclined to take risks that they would otherwise avoid; many women also reported that their intoxicated state reduced their ability to mount resistance to the sexual advances and, ultimately, the assault carried out by the assailant.For this reason, many colleges have redefined and refocused their alcohol consumption and serious crime laws, stepping up enforcement and punishment of alcohol-related offenses that directly threaten the wellbeing of their students.