Drug abuse and intimate partner violence in Edo State, Nigeria

Tijani Idris Ahmad Oseni; Benjamin Efi Aweh; Egbe Enobakhare; Isaac Osahogie Edeawe; Abudusalami B Lawal; Omowumi Adenike Ijika

doi:10.4103/jmwa.jmwa_3_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 7 | Issue : 1 | Page : 8-14

Drug abuse and intimate partner violence in Edo State, Nigeria

Tijani Idris Ahmad Oseni¹, Benjamin Efi Aweh², Egbe Enobakhare³, Isaac Osahogie Edeawe⁴, Abudusalami B Lawal⁵, Omowumi Adenike Ijika⁶
¹ Department of Family Medicine, Ambrose Alli University, Ekpoma, Edo State, Nigeria
² Department of Mental Health, Ambrose Alli University, Ekpoma, Edo State, Nigeria
³ Department of Family Medicine, Central Hospital, Benin City, Edo State, Nigeria
⁴ Department of Pharmacology, Ambrose Alli University, Ekpoma, Edo State, Nigeria
⁵ Department of Physiology, Edo University, Iyamho, Edo State, Nigeria
⁶ Department of Family Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria

Date of Submission	28-Jan-2022
Date of Decision	13-Jun-2022
Date of Acceptance	27-Jun-2022
Date of Web Publication	25-Aug-2022

Correspondence Address:
Dr. Tijani Idris Ahmad Oseni
Department of Family Medicine, Ambrose Alli University, Ekpoma, Edo State
Nigeria

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmwa.jmwa_3_22

Abstract

CONTEXT: Intimate partner violence (IPV) is highly prevalent among substance abusers globally. Cases of IPV and substance abuse have been on the increase in Edo State and Nigeria.
AIMS: The aim of this study was to determine the relationship between drug abuse and IPV in Edo State.
SETTINGS AND DESIGN: A community-based, descriptive cross-sectional study of 1227 systematically selected respondents from across the three senatorial districts of Edo State, Nigeria was conducted.
SUBJECTS AND METHODS: The Substance Use Brief Screen, Extended Hurt, Insult, Threaten, Scream (E-HITS), and the modified E-HITS questionnaires were used to assess the prevalence and pattern of drug abuse, IPV, and perpetration of IPV, respectively.
STATISTICAL ANALYSIS USED: Data were analyzed with epi info 7.1.2.0.
RESULTS: The prevalence of drug abuse among respondents was found to be 27.1%. Drug abusers were mostly males (odds ratio [OR] = 1.692, 95% confidence interval [CI]: 1.312–2.182); unmarried (OR = 1.353, 95% CI: 1.056–1.749) and resided in the northern part of the state (OR = 1.689, 95% CI: 1.238–2.311). Drug abusers were more likely to perpetrate IPV (OR = 1.433, 95% CI 1.113–1.845) and be victims of IPV (OR = 1.827, 95% CI: 1.414–2.359) compared to nondrug abusers.
CONCLUSIONS: IPV was significantly higher among substance abusers who were males, unmarried, with low levels of education and income. They were also mostly from the northern part of the state. There is a need for relevant stakeholders to institute measures that will reduce the high prevalence of drug abuse among residents in Edo State, particularly in Edo North and Nigeria to reduce IPV and improve family functionality.

Keywords: Couples, drug abuse, Edo State, intimate partner violence, Nigeria

How to cite this article:
Oseni TI, Aweh BE, Enobakhare E, Edeawe IO, Lawal AB, Ijika OA. Drug abuse and intimate partner violence in Edo State, Nigeria. J Med Womens Assoc Niger 2022;7:8-14

How to cite this URL:
Oseni TI, Aweh BE, Enobakhare E, Edeawe IO, Lawal AB, Ijika OA. Drug abuse and intimate partner violence in Edo State, Nigeria. J Med Womens Assoc Niger [serial online] 2022 [cited 2023 Sep 26];7:8-14. Available from: http://www.jmwan.org/text.asp?2022/7/1/8/354690

Introduction

Drugs/substance abuse is a worldwide hazard with dangerous complications that affect many countries globally, Nigeria inclusive.^[1] The challenges associated with this neuro-bio behavior varies from one geographical location to the other. Intimate partner violence (IPV) occurs worldwide and its occurrence is not affected by race, culture, religion, or socioeconomic status.^[2] IPV could be perpetrated against both sexes; however, women are more commonly victims rather than men. Where perpetrated against men, it is commonly in self-defense.^[3] It affects both young and older persons of reproductive age in the intimate relationship whether married or not.^[2],[3] IPV affects the victims' physical and mental health adversely causing physical injuries and long-term chronic medical conditions including severe depression and suicide.^[4] Studies have shown that victims remain in abusive relationships for fear of social stigma, economic losses, and concerns over the children.^[2]

IPV is highly prevalent among substance abusers globally.^[5],[6] Problematic drugs and alcohol use which ranges from abuse, dependence, and withdrawal syndromes have significant association with IPV perpetration.^[7],[8],[9] In addition, the attitude of the victim toward the partner may be predictor of IPV.^[7],[8] Victims of IPV are not left without psychological consequences which include depression, anxiety, posttraumatic stress disorder, substance abuse, impulsivity, and nonspecific physical complaints.^[10] Thus reducing the menace of IPV in our society would include measures aimed at limiting substance abuse.

IPV and drug abuse are high among Nigerians. However, data are lacking on the relationship between IPV and drug abuse in Nigeria. The aim of this study is to determine the relationship between drug abuse and IPV in Edo State.

Subjects and Methods

Study design

The study was a community-based, descriptive cross-sectional study.

Setting

The study was conducted in Edo State, Southern Nigeria. The State is divided into three senatorial districts, Edo North, Edo Central, and Edo South. The state is further divided into 18 local government areas, 6 in Edo North, 5 in Edo Central, and 7 in Edo South. The people are predominantly farmers.

Study population

Men and women between the ages of 18 and 65 years who were in an intimate relationship (married, cohabiting, dating, etc.) that has lasted for more than 1 year and consented to participate in the study were systematically selected for the study.

Study duration

The study was conducted from July to December 2020.

Sampling strategy

Stratified random sampling was used for the study. The state was stratified into the three senatorial zones from which two cities were randomly selected from each of the zones. Six cities and towns from six local government areas across the state were thus randomly selected for the study. These were Benin City and Uselu in Edo South Senatorial District; Auchi and Igarra in Edo North Senatorial District and Ekpoma and Irrua in Edo Central Senatorial District. Systematic sampling was then used to select 1227 respondents from the selected towns who were in a current relationship that have lasted at least 12 months. Four wards/quarters were selected through simple random sampling from each of the cities/towns through simple random sampling which was also used to select five streets from each of the wards/quarters. Systematic random sampling was then used to select households from each street and respondents who met the study criteria were then recruited from the households until the desired sample size was achieved. The minimum sample size was determined using the national demographic health survey 2018 IPV prevalence for Nigeria of 36%^[11] with anticipated 10% attrition and was determined to be 389 per city and 1168 total.^[11]

Data collection

The instruments of data collection were:

A semi-structured questionnaire to obtain sociodemographic information from respondents.
The Substance Use Brief Screen to assess the prevalence and pattern of drug abuse among respondents. This instrument is a validated tool for screening for Drug Abuse.^[12] Respondents were asked if during the preceding 12 months, on how many days they:

Use tobacco?
Have 4 or more alcoholic drinks in a day, including wine or beer? A drink here refers to a bottle of beer, a glass of wine, or a shot of gin
Use any illegal drug, including Marijuana?
Use any prescription medication recreationally? Recreation here means taking the drugs just for the feeling or experience they cause and the prescription could be for patient or someone else.

Respondents were to tick one of three boxes containing “Three or more days,” “1 or 2 days” and “Never.” For those who answered Never to any of the above questions, they were considered nondrug abusers. Others were considered drug abusers.

The Extended Hurt, Insult, Threaten, Scream (E-HITS) tool to assess the prevalence and pattern of IPV among respondents. This is a validated screening tool for IPV.^[13],[14] Questions in the E-HITS questionnaire were: in the past 12 months.

How often does your partner physically hurt you?
How often does your partner insult or talk down to you?
How often does your partner threaten you with physical harm?
How often does your partner scream at you?
How often does your partner force you to have sexual activities?

Responses were scored as follows: Never = 1 point, rarely = 2 points, sometimes = 3 points, fairly often = 4 points, and frequently = 5 points. Respondents with a total score ≥7 were considered to be victims of IPV while those with a total score of <7 points were considered to be nonvictims.^[13],[14]

The modified E-HITS questionnaire was used to assess the perpetration of IPV.^[15],[16] The questions in the E-HITS questionnaire were asked in reverse form to identify perpetrators of IPV among respondents, that is:

How often do you physically hurt your partner?
How often do you insult or talk down to your partner?
How often do you threaten your partner with physical harm?
How often do you scream at your partner?
How often do you force your partner to have sex or do sexual things?

Responses were similarly scored as in the E-HITS questionnaire. Respondents with a total score >7 were considered to be perpetrators of IPV while those with a total score of ≤7 points were considered to be nonperpetrators.^[15],[16] The questionnaires and other instruments were self-administered after they were pretested among respondents in a small town near Ekpoma.

Data analysis

Responses were entered into Epi-Info version 7.1.2.0 (Atlanta, Georgia, USA) and analyzed using simple percentages and proportions. Chi-square test was used to determine the association between drug abuse and IPV among respondents. Binary logistic regression was used to analyze and determine the factors associated with drug abuse and IPV. A value of P < 0.05 was considered statistically significant.

Ethical considerations

Ethical approval was obtained from the Research Ethics Committee of Irrua Specialist Teaching Hospital via ISTH/HREC/20193010/048.

Results

Substance abuse among respondents

Out of the 1227 respondents from across the state, 332 were found to abuse drugs given a prevalence of drug abuse among respondents to be 27.1%. Drug abuse was significantly higher in respondents who were males (P = 0.000), not currently married (P = 0.021), who resided in Edo North Senatorial District (P = 0.004) and low-income earners with a monthly income of less than the national minimum wage of N30,000 (P = 0.000). The relationship between sociodemographic characteristics and substance abuse among respondents is tabulated in [Table 1].

Table 1: Substance abuse among respondents (n=1227)

Click here to view

Association between substance abuse and intimate partner violence among respondents

There was a significant association between substance abuse and perpetration of IPV (P = 0.005). Furthermore, victims of IPV were significantly higher among respondents with substance abuse (P = 0.000). [Table 2] shows the association between substance abuse and IPV.

Table 2: Association between intimate partner violence and substance abuse among respondents (n=1227)

Click here to view

Substance abuse and characteristics of intimate partner violence perpetrators

Perpetrators who significantly abused substance were males (P = 0.012), not currently married (P = 0.000), resided in Edo North Senatorial District (P = 0.000), with little or no formal education (P = 0.008). The relationship between substance abuse and IPV perpetration among respondents is tabulated in [Table 3].

Table 3: Substance abuse and characteristics of intimate partner violence perpetrators (n=552)

Click here to view

Substance abuse and characteristics of victims of intimate partner violence

IPV was mostly perpetrated against substance abusers who were males (P = 0.003), resident in Edo North Senatorial district of the state (P = 0.000), who were nongovernment employees (P = 0.011) and earned between N30,000 and N100,000 monthly (P = 0.002). [Table 4] illustrates the characteristics of substance abuse among respondents who were victims of IPV.

Table 4: Substance abuse and characteristics of victims of intimate partner violence (n=462)

Click here to view

Logistic regression of associations between drug abuse and intimate partner violence

Multiple logistic regression was done to determine the association between drug abuse and IPV in Edo State while adjusting for associated sociodemographics (sex, marital status, location, monthly income, being a perpetrator or victim,). Males were 1.7 times more likely to abuse drugs than females (odds ratio [OR] = 1.692, 95% confidence interval [CI]: 1.312–2.182); those who were unmarried were 1.4 times more likely to abuse drugs than those who were married (OR = 1.353, 95% CI: 1.056–1.749). Furthermore, residents in Edo North Senatorial District were 1.7 times more likely to abuse drugs compared to residents from Edo South (OR = 1.689, 95% CI: 1.238–2.311).

Respondents who abused drugs were 1.4 times more likely to perpetrate IPV (OR = 1.433, 95% CI 1.113–1.845) and 1.8 times more likely to be victims of IPV (OR = 1.827, 95% CI: 1.414–2.359).

Perpetrators of IPV who abused drugs were 1.6 times more likely to be males (OR = 1.600, 95% CI: 1.107–2.313), twice more likely to be unmarried (OR = 1.984, 95% CI: 1.369–3.619), and 2.5 times more likely to reside in Edo North compared to Edo South (OR = 2.520, 95% CI: 1.591–3.992).

Victims of IPV who abused drugs were twice more likely to be males (OR = 2.02, 95% CI: 1.274–3.203), thrice more likely to be residents in Edo North compared to Edo South (OR = 3.027, 95% CI: 1.876–4.884) and twice more likely to be middle-income earners (earning between N30, 000 and N100, 000 monthly) compared to low-income earners who earned below the national minimum wage of <N30,000 monthly (OR = 1.858, 95% CI: 1.074–3.211). The results of Logistic Regression of Drug Abuse and IPV among respondents are tabulated in [Table 5].

Table 5: Logistic regression of drug abuse and intimate partner violence among respondents

Click here to view

Discussion

The study found the majority of respondents who abused drugs to be unmarried males resident in the Central and especially northern parts of Edo State. These parts of the state are predominantly rural, undergoing rapid social changes which are known to have an effect on the context of drug use and the risks of drug-related problems among different populations.^[17] The high prevalence of drug abuse in the northern part of the state may also be related to the fact that people in this area still engage in the production of traditional homemade drugs including alcoholic beverages which remain popular.^[17] Increased availability of these beverages has led to the pattern of use characterized as heavy episodic consumption, with attendant negative increasing consequences of drinking. Drinkers in rural areas also drink more alcohol per occasion than drinkers in urban areas.^[18] That males abuse drugs more than females as evident in this study and other studies may explain the increased level of IPV in male drug abusers.^[9]

IPV perpetration was significantly higher among respondents who abused drugs compared to those who did not. Males who abuse substances were more likely to be IPV perpetrators. This is similar to the findings of a meta-analysis which found a significant association between drug abuse and IPV perpetration.^[9] This may be because in most societies, including ours, drinking is a marker for masculine identity, and drinking practices like other standard practices such as fighting, cursing, and actualized feminine degradation are used to construct masculine hierarchies.^[19] The finding of IPV victims who abuse substances may not be unrelated to the fact that they are using it to cope with the IPV perpetrator and also as self-medication.^[20]

Victims of IPV were also higher among drug abusers. This is similar to findings by Cafferky et al. in their study which revealed that substance abusers are more likely to be victims of IPV compared to nonabusers.^[9] Males who abuse drugs were more likely to be victims of IPV compared to those who did not. This may be because people who abuse drugs tend to behave irresponsibly, thus making them a subject of verbal and physical abuse from their partners. Those drug abusers who were victims of IPV were middle-income earners is alarming and shows the amount of damage drug use could cause in relationships and families with fairly good incomes. There is, therefore, a need by appropriate authorities to put measures in place to reduce drug use through increased surveillance by the National Drug Law Enforcement Agency in Edo State, especially the northern parts of the state. Other measures like limiting the sale of alcohol in parks and other sensitive areas, increased taxation of alcoholic beverages and cigarettes as well as banning completely advertisement of alcohol and cigarettes could go a long way in reducing the menace associated with drug use as well as improving family life.

Conclusion

Drug abuse was found to be significantly associated with IPV and more common among unmarried men in Edo North. Both victims and perpetrators of IPV were mostly males who abused drugs. There was also a significant association between low education and income and IPV among drug users. To tackle this problem, the government must put in increasing awareness amongst people and increase surveillance of drug farmers who are having a field day in communities in Edo North. They should provide jobs with better remuneration, quality education, and toxicology laboratory should be readily available to screen those who are to be employed, admitted to the university so that culprits and drug abusers can be easily screened and rehabilitated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Fareo DO. Drug abuse among Nigerian adolescents strategies for counselling. J Int Soc Res 2012;5:341-7.
2.	World Health Organization. Violence against Women. Factsheet. WHO; Geneva, 2017.
3.	Umana JE, Fawole OI, Adeoye IA. Prevalence and correlates of intimate partner violence towards female students of the University of Ibadan, Nigeria. BMC Womens Health 2014;14:131.
4.	Aihie ON. Prevalence of domestic violence in Nigeria: Implications for counselling. Edo J Couns 2009;2:1-8.
5.	Kraanen FL, Vedel E, Scholing A, Emmelkamp PM. Screening on perpetration and victimization of intimate partner violence (IPV): Two studies on the validity of an IPV screening instrument in patients in substance abuse treatment. PLoS One 2013;8:e63681.
6.	Kraanen FL, Vedel E, Scholing A, Emmelkamp PM. The comparative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) and substance abuse treatment alone: A randomized controlled trial. BMC Psychiatry 2013;13:189.
7.	Owoaje ET, OlaOlorun FM. Women at risk of physical intimate partner violence: A cross-sectional analysis of a low-income community in southwest Nigeria. Afr J Reprod Health 2012;16:43-53.
8.	Mapayi B, Makanjuola R, Fatusi A, Afolabi O. Socio-demographic factors associated with intimate partner violence in Ile-Ife, Nigeria. Gender Behav 2011;9:3466-78.
9.	Cafferky BM, Mendez M, Anderson JR, Stith SM. Substance use and intimate partner violence: A meta-analytic review. Psychol Violence 2018;8:110.
10.	Stewart DE, Vigod S, Riazantseva E. New developments in intimate partner violence and management of its mental health sequelae. Curr Psychiatry Rep 2016;18:4.
11.	Nigeria Population Commission. Nigeria demographic and health survey 2018. NPC, ICF; Abuja, 2019.
12.	McNeely J, Strauss SM, Saitz R, Cleland CM, Palamar JJ, Rotrosen J, et al. A brief patient self-administered substance use screening tool for primary care: Two-site validation study of the substance use brief screen (SUBS). Am J Med 2015;128:784.e9-19.
13.	Chan CC, Chan YC, Au A, Cheung GO. Reliability and validity of the “Extended-Hurt, Insult, Threaten, Scream” (E-HITS) screening tool in detecting intimate partner violence in hospital emergency departments in Hong Kong. Hong Kong J Emerg Med 2010;17:109-17.
14.	Dichter ME, Haywood TN, Butler AE, Bellamy SL, Iverson KM. Intimate partner violence screening in the Veterans Health Administration: Demographic and military service characteristics. Am J Prev Med 2017;52:761-8.
15.	Portnoy GA, Haskell SG, King MW, Maskin R, Gerber MR, Iverson KM. Accuracy and acceptability of a screening tool for identifying intimate partner violence perpetration among women veterans: A pre-implementation evaluation. Womens Health Issues 2018;28:439-45.
16.	Davis M, Padilla-Medina DM. Brief intimate partner violence perpetration screening tools: A scoping review. Trauma Violence Abuse 2021;22:900-13.
17.	WHO. Global Status Report on Alcohol and Health 2014. Geneva: WHO; 2014.
18.	Van Bui T, Blizzard CL, Luong KN, Van Truong NL, Tran BQ, Otahal P, et al. Alcohol consumption in Vietnam, and the use of 'standard drinks' to measure alcohol intake. Alcohol Alcohol 2016;51:186-95.
19.	Hinnote BP, Webber GR. Drinking towards manhood: Masculinity and alcohol in former USSR. Men Masc 2012;15:292-310.
20.	Casswell S, You RQ, Huckle T. Alcohol's harm to others: Reduced wellbeing and health status for those with heavy drinkers in their lives. Addiction 2011;106:1087-94.