Individual-level interventions for alcohol-related violence: a rapid evidence assessment

Alcohol-related violence is of major concern to society. Around half of all violent crimes are alcohol related, and yet interventions for alcohol-related violence are under-developed. Often, offenders receive treatment for substance use or violence, but not the two in nexus.

My aim was to conduct a Rapid Evidence Assessment of interventions with a focus on treating established nonsexual violence in the context of alcohol use, to describe the content of these interventions, where they take place and their effectiveness in reducing alcohol problems and/or violence.

The electronic databases Embase, Medline, National Criminal Justice Reference Service, Cumulative Index to Nursing and Allied Health Literature were searched together with the Campbell Collaboration; Cochrane Reviews and selected government websites using terms for alcohol, violence and treatment/interventions. The search excluded sexual and intimate partner violence. The focus was on psychosocial interventions with people already in difficulties, not prevention. All empirical study types with people of any age and in any setting (criminal justice, health, social services or education) were included. The principal outcomes of interest were change in alcohol use, violence and alcohol-related violence.

Only four studies of two different interventions were identified. Control of Violence for Angry Impulsive Drinkers has been evaluated with small samples using a nonequivalent comparison group and a single case methodology. Changes were evident on measures of alcohol-related aggression. In a randomised controlled trial, SafERteens participants showed greater improvements in attitudes to alcohol and violence compared with a leaflet only condition.

Directions for developing interventions based on alcohol and aggression research are discussed. Interventions targeting primarily alcohol consumption, primarily violence and alcohol-related violence in nexus should be compared. In evaluating these interventions, robust outcome measures should be used across studies to allow comparisons to be made.

Skills for coping with perceived provocation may be taught, so that nonviolent options are available and so that they become more accessible when people are under the influence of alcohol. Alcohol's effect on reducing self-awareness may be counteracted by teaching mindfulness techniques and the ability to 'act sober' in provocative situations. Setting individual implementation intentions may facilitate harm avoidance in high-risk social situations through preplanning of specific sensible behavioural strategies.