Approximately one-fourth of participants reported they received physical violence in the past year, with the majority having been punched, kicked, slapped hard or choked in assaults by someone other than their partner. These figures are slightly higher than community-based studies cited by Chermack and his colleagues (2006)
in which past-year victimization ranged from 12–20% (Johnson & Elliott, 1997
; Porcerelli et al., 2003
; Schafer, Caetano, & Clark, 1998
; Straus & Gelles, 1995
). This is particularly of interest given national increases in stimulant availability and use (Booth et al., 2006
) in rural areas as well as widespread concerns about increased violence and criminal justice involvement by stimulant users (Cartier et al., 2006
; Stretesky, 2008).
In bivariate analyses, demographic, clinical and substance use variables differentiated participants with receipt of partner versus non-partner violence. For example, males disproportionately reported higher rates of non-partner violence, while females reported higher rates of partner violence. The results are consistent with findings of Cohen and colleagues (2003)
showing that women substance users are more likely to be physically victimized by partners or close family members, while men substance users are more likely to have received violence from friends or strangers. Intimate partner violence against women continues to be a huge public health concern. The National Crime Victim Study (Rennison & Welchans, 2000
) found that 85% of intimate partner violence incidents involved women as the victim with a large number killed by an intimate partner. Women with intimate partner violence experience 60% higher rates of health problems with costs from medical and mental health care exceeding $1.8 million. Received violence also influences subsequent abuse, which may be a problem in this group as well. In women, the likelihood of being physically victimized was significantly higher if they met criteria for alcohol, cocaine or methamphetamine abuse or dependence in the past year.
Women may be more vulnerable to physical abuse because of their significant substance use and associated problems, which may increase their exposure to risky situations and/or further exacerbate their ability to extricate themselves from abusive partnerships. On the other hand, these women may be more likely to abuse substances because of their victimization histories. Unfortunately, it is impossible to determine whether the received violence preceded, coincided with or followed the problems associated with misuse of these substances, yet either possibility has grave consequences for the physical and mental health of these rural women. Women were also more likely to receive partner violence if they were older than 23 but younger than 41. This would be the age range coinciding with bearing children and establishing a family, which may increase a woman’s risk for experiencing violence from a partner. Interestingly, a combination of abuse/dependence of alcohol, cocaine and/or methamphetamine was not associated with an increased risk of received violence in women. It is plausible that the substance use in this sample may be so problematic that a ceiling effect moderated the effects of multiple diagnoses.
Although the results were not statistically significant, the findings suggest that women who experienced partner violence were more likely to report carrying a weapon, which may reflect self-protective behavior in response to high victimization or a tendency toward aggressive behaviors that contribute to increased engagement in violence. Again, the lack of data regarding the temporal sequencing of these behaviors limits our interpretation of these findings. Although Siegal and his colleagues (2000)
found that carrying a weapon increased the risk for victimization of crack users, they did not differentiate between men and women in their study.
Interestingly, partner violence received by women was associated with their alcohol abuse/dependence but this was not a factor in non-partner violence received by men. Previous research on women’s self-reports about their own and their partner’s drinking shows that women and their partners who drink alcohol often have higher rates of physical violence compared to women and partners who drink less often (Temple, Weston, Stuart, & Marshall, 2008
). These higher rates for male-to-female physical aggression have also been observed in both female and male alcoholics compared to non-alcoholics (Cunradi et al., 1999
). In a separate study, females, but not males, were more likely to report verbal victimization or verbal combined with physical victimization if they were heavy episodic drinkers (Wells & Graham, 2007
). It is plausible that the interaction between alcohol use and received partner violence may be more pronounced among women, even in this sample of participants who concurrently use stimulants. Furthermore, the combined use of alcohol and cocaine in females may increase their exposure to risky interpersonal situations or may increase the likelihood that they would instigate physical attacks. It is also plausible that women who are victimized increase their use of substances to cope with the psychological and emotional sequelae of the trauma. Because we did not ask about expressed violence, we can not rule out either of these possibilities. However, the finding that women who used fewer drugs in the past six months
were less likely to experience received violence may suggest that women do not increase substance usage after such an incident but may, in fact, decrease their usage as a preventive measure.
We were not able to replicate the findings of Chermack and his colleagues (2006)
regarding the association between violence received and depression in females. This may be related to differences in samples (at-risk rural and urban drinkers versus rural stimulant users) and method of depression assessment (diagnostic assessment tool versus self-report screening tool). For example, about 20% of females and 10% of males met criteria for depression in Chermack’s study (2006)
, compared to 41% of females and 52% of males screening positive for depression in the current study. Women who are using substances such as alcohol and stimulants may also not be aware of their depressive symptoms due to masking effects of these substances or high levels of denial of any psychological or medical problems.
Unfortunately, research on help-seeking behaviors among victimized rural women is limited. In a comparison of rural versus urban females experiencing violence, Shannon and colleagues (2006)
found that rural women victimized by an intimate partner used fewer resources, contacted police and victim advocates less frequently, and were less likely to discuss the abuse with friends. Limited availability and access to services, fear of retaliation, lack of economic resources, feelings of embarrassment, blame and stigma, and concerns about confidentiality frequently prevent rural women from seeking and receiving help (Logan, Stevenson, Evans, & Leukefeld, 2004
), but these may be exacerbated if they are known in a rural community as a user of illicit drugs. Therefore, screenings, safety planning, and ongoing monitoring are essential for working individually with women with alcohol and/or cocaine abuse/dependence, while system-wide changes in healthcare, court and substance abuse treatment systems need to be implemented. Receipt of violence among women with cocaine and methamphetamine problems raises questions about the nature of the violence and types of partners with whom these women associate, particularly given the large number of children living with these women and their potential exposure to the violence.
For males, Caucasians were at greater risk for violence compared to African-Americans and other minorities. These findings are consistent with the report of Bachman (1992)
, who found that Caucasians were more likely than African Americans to be victimized in rural areas, whereas African Americans were more likely to be victimized than Caucasians in urban areas. Bachman attributed these differences to an increased likelihood of violence to resolve disputes and higher rates of domestic violence among rural Caucasians when compared to rural African Americans; however, we are unable to determine whether such patterns are applicable in this sample. As noted earlier, males with cocaine abuse or dependence were also at greater risk for victimization. This finding would suggest that as use progresses and becomes more problematic (thus meeting criteria for abuse or dependence), there may be a concurrent increased risk of victimization. For example, Siegal and his colleagues (2000)
found that daily crack users were more likely than non-daily crack users to report violence received. Longer duration of crack use was also associated with receipt of physical violence. Moreover, younger men were more likely to have received violence, perhaps because they are more likely to engage in physical altercations, generally, or they are more vulnerable to violence when substance use is first initiated.
Although previous studies have found a relationship between physical aggression and methamphetamine use, the populations studied included intimate partner violence reported to police (Ernst, Weiss, Enright-Smith, Hilton, & Byrd, 2008
), adults incarcerated for criminal behaviors (Cartier et al., 2006
) adolescents in a juvenile justice system (Miura, Fujiki, Shibata, & Ishikawa, 2006
) and men and women in treatment for methamphetamine dependence (Cohen et al., 2003
). These studies, which focused on expressed violence, may have also included methamphetamine users with more severe problems, including criminal behaviors.
There were several limitations in our sampling and methods that may have biased the findings. Most notably, participants were not randomly sampled from the general population or the drug-using population. Although other studies using this sampling strategy (Heckathorn, 2002
; Wang et al., 2004
) have shown that use of multiple referral waves resulted in increasingly few demographic changes in sample composition over successive waves and almost none after four to five waves (known as “convergence”), our sampling strategy through recruitment networks may not have reached certain potential sub-groups of stimulant users, including individuals from diverse socioeconomic backgrounds. Secondly, we asked participants whether in the past 12 months they had been physically attacked by someone and if they responded affirmatively, we inquired as to whether they were punched, kicked, slapped hard or choked; shot; stabbed; or held captive or kidnapped or sexually abused. We did not, however, ask for more than one incident within each of these four categories, suggesting that we may have actually underestimated the extent of violence in this population. We also did not ask in the interview about the context of the violence (i.e., whether the incident involved not only received violence, but also expressed violence). This would be important information to have when considering interventions for this group, particularly related to partner violence. An additional limitation is the methodology used to assess received victimization. Because we asked only about the most recent event, we may have omitted important information about other abuse experiences that would further contribute to our knowledge about substance use and received violence. This method may not necessarily represent participants’ broader experiences of violence received, including the type, context, perpetrator and other relevant details. Unfortunately, we were also limited in our analyses because of the small number of men and women reporting partner violence and non-partner violence, respectively. In addition, the temporality of our independent and dependent variables differed. For example, we asked whether participants had ever carried a weapon, which may have preceded or followed the violence episode. Thus, a prospective study would have provided more information about risk factors for received violence for both men and women. Finally, we based our findings on retrospective reports of stimulant users, many of whom reported they were high at the time of the incident. Thus, their recall for specific incidents may be inaccurate or distorted.
In summary, the study demonstrates a moderately high incidence of violence received among rural stimulant users in a community sample. Although there is a perception that stimulant users are more susceptible to victimization, this study suggests that the rates are not any higher than those observed among other drug-using samples. Furthermore, this study revealed important differences in the occurrence and correlates of violence received by females versus males. Notably, females were more likely to have experienced violence from a partner than males, and they were more susceptible to violence generally if they had more than one substance abuse/dependence diagnosis. By comparison, males were more vulnerable to receiving physical violence if they were Caucasian and/or met the criteria for cocaine abuse or dependence in the past 12 months. While some gender differences in the correlates of violence exist, the expansion of primary prevention and formal substance abuse programs aimed at rural cocaine users could contribute to reductions in the incidence of violence among both males and females. Formal screenings and assessments would constitute the first step, while specific interventions might mitigate the psychological distress and substance use that have been documented following victimization (Carbone-Lopez, Kruttschnitt, & Macmillan, 2006
; Coker et al., 2002
). These findings also support the need for special screenings in settings where stimulant users may seek health care (e.g., primary care, emergency departments, and other hospital settings), particularly when individuals present with injuries. Interventions aimed at reducing the incidence of cocaine abuse/dependence disorders, including primary cocaine use prevention programs and formal substance abuse treatment programs, may result in reductions in violence among rural male and female stimulant users.