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Question 2

What kinds of drugs cause violent outbursts?

We know guns are associated with increased risk for lethality yet we hear the NRA say ‘guns don’t kill people, people do.’ Drugs don’t cause violent outbursts, people do. While alcohol and other drugs are associated with episodes of violence many people use substances without engaging in violent behavior regardless of their drug use.

When violence and alcohol or other drug use co-occur the following risk factors may exist:

1. Alcohol can lead to euphoric recall or blackout which can have a negative impact on memory. Blackout is a form of amnesia for a specific period of time whereas euphoric recall is a distortion of perception. While both conditions impact memory neither is considered sufficient to cause a person to engage in violent behavior. Those experiencing blackout and euphoric recall can choose to engage in violence or NOT. The only thing they can’t choose is accurate recall of what choice they made. Alcohol is also associated with distortions in perception that may lead one to believe people are hostile towards one. Alcohol use is also associated with depersonalization and can inhibit empathy. A batterer may use these distortions as an inappropriate excuse to justify violent behavior.
2. Methamphetamine/Cocaine can lead to feelings of power. Additionally, use of these drugs is associated with paranoia. Paranoid people who feel powerful may try “BS” or they may choose to engage in violent behavior. Uppers such as speed and coke are associated with poor impulse control, jumpiness and hypervigilance. Paranoia and suspicion may contribute to a person’s choice to leave shelter without saying a word or can contribute to a person’s choice to lash out if feeling threatened. Usually signs of agitation, pacing, nervousness, rapid and pressured speech etc. precede threats and other forms of violence.
3. PCP is a drug that can lead to hallucinations and paranoia. Since it is used as an animal tranquilizer for surgery people on it are often paranoid and tend not to feel pain which makes them particularly dangerous if they decide to engage in violent behavior. People hallucinating on PCP (unlike people on LSD) cannot generally be talked down. Call the police if you are concerned about your safety or the safety of others.
4. Victims of domestic violence who are asked about drugs they associate with violence in their relationships often tell us marijuana is a factor in violent episodes BUT not when their partners are using it. Individuals report more concern when their abusive partners can’t find any marijuana. When the chronic marijuana user has no access to more marijuana the user may become irritable and have sleep difficulties as well as experience loss of appetite. These are minor problems unless the person rebounding from marijuana use is abusive. Batterers may use irritability associated with withdrawal as a trumped up phony excuse to engage in emotional or physical abuse.
5. Nicotine is an anti-hostility agent. Chronic smokers unable to use tobacco may become hostile and irritable. This does not mean individuals unable to smoke will become violent but batterers denied access to cigarettes may use this as another phony excuse to justify their choice to engage in abusive behavior. The greatest dangers from nicotine use are long-term health consequences (e.g. lung disease, heart disease and various forms of cancer, etc.) which kill more people than alcohol and all the other illegal drugs combined. Also nicotine is associated with low-birth weight babies (as is domestic violence) and other health consequences for children. Some advocates report seeing smokers who are building up a head of steam and ready to ‘blow’ occasionally being diverted from choosing to engage in aggressive behavior by choosing to smoke. Shelter workers should ensure program participants have access to pamphlets and information pertaining to health risks for women and children associated with nicotine use as well as options for a safer coping tool than smoking.
6. Heroin/Opiates (e.g. “Ox,” prescription painkillers, morphine) are associated with the need to continue feeding a costly habit to kill pain. While overdose can be lethal, withdrawal symptoms are generally not usually life threatening. Withdrawal can be seriously uncomfortable and does pose risk for individuals with fragile health or who may be dehydrated. Addiction to opiates is not so much associated with physically violent behavior as it is associated with irritability, flu like symptoms, diarrhea and runny nose.
7. Methadone. Of concern here are safety risks for program participants who may be on methadone maintenance. People on methadone can do very well in Methadone programs. Risk stems not from their dose but from the requirement for them to get their dose at a set time and place daily which makes them a sitting duck for a batterer or stalker. Safety planning and advocacy are essential for these individuals who are often denied access to services and also face unwarranted societal stigma.
8. Prescription Medications – A major concern here is the onset of withdrawal symptoms. Withdrawal from prescription medication such as sedative/hypnotics e.g. Valium, Xanex, Librium, etc. can be dangerous much as alcohol withdrawal is very serious. Program participants fleeing abusive partners may be unable to bring their medications with them. This can increase risk (e.g. no access to insulin, an asthma inhaler or other critical medication can rapidly lead to a medical emergency). Lethality or other health risk occurs if alcohol and medications are mixed or combined. Barbiturates are particularly lethal when combined with alcohol and the overdose potential can be high. Also possible is misuse associated with multiple prescriptions for similar pain medications, misuse of old medications, or misuse of someone else’s medications when prevented from seeking medical help. Batterers may deny partners access to medication and/or divert their partners’ medication for their own use. Coercion, theft, faked prescriptions and doctor s/hopping may increase problems and lead to legal troubles or arrest.

Note: Theft is sometimes an issue in shelter. When the money runs out to feed an addiction or to take care of other pressing problems, desperation may set in. A desperate individual may decide to steal to survive or to maintain the addiction whether that addiction is to cigarettes, crank, alcohol, heroin, prescription medications or any other substance. When we recognize this is happening in shelter we should ask for the behavior to stop in a non-judgmental way and offer alternatives that support both accountability and safety.

Getting Safe and Sober: Real Tools You Can Use ©Alaska Network on Domestic Violence and Sexual Assault 2005

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