Commentary on Livingston (2011): Alcohol outlets and domestic violence – acute effects and the social ecology of neighborhoods may both contribute to the relationship

‘Location, location, location’ are the three most important considerations in finding a place to live. This reflects the knowledge that the physical and social environment matter, that they both constrain and facilitate behavior. Research has linked the physical/social aspects of neighborhoods with exercise [1], body weight [2], inflammatory markers [3], stress [4], mental health [5] and drug use [6]. The study by Livingston [7] in the current issue adds to this literature, replicates the findings of linking alcohol outlets to violence and extends this literature in some important ways. Most importantly, it provides longitudinal evidence that changes in the number of alcohol outlets are associated with changes in police reports of ‘family incidents’. As with other studies of ecological data, the results may have been produced by several different processes. One explanation suggested by Livingston is that increases in alcohol outlets led to increases in heavy drinking episodes, and through the acute effects of alcohol increased the occurrence or severity of domestic disputes to the extent that they are reported to the police. There is a chain of evidence supporting this view. Experimental studies indicate that intoxication leads to increases in experimentally measured aggressive behavior, mainly in male dyads [8]. Other experiments show that alcohol increases the negativity of marital conflicts [9] and verbal expressions of aggressive intentions among maritally aggressive men [10]. Studies of partner violence episodes indicate that episodes are more severe when the man has been drinking [11,12]. Thus, factors that lead to changes in excessive use, either in individuals or in the community, should, through these acute effects, lead to changes in domestic violence. Notwithstanding my belief in the acute effects model [13], it seems unlikely that acute effects alone can account for the results. Perhaps one-third of domestic violence episodes in the community [14], but closer to 40% of police calls for domestic violence [15] involve alcohol. With a conservative estimate that 50% of the episodes did not involve alcohol, the observed rate of 4.76 events would then consist of 2.38 alcohol-involved events. If the estimated increase of 1.36 episodes consists of entirely alcohol-related episodes, this means that a one-packaged outlet increase per 1000 individuals led to a 56% increase in alcohol-related episodes, leading to the question: ‘Can the increase in heavy drinking that occurs with an increase of one packaged outlet account for this large of an increase in alcohol-related domestic violence episodes’?. I think the answer is ‘probably not’, which should lead us to think about other processes. Alternatively, if the estimated increase of 1.36 episodes per 1000 people consists of many episodes that do not involve alcohol, the conclusion is the same; we must think about other processes in addition to acute alcohol effects. The key problem in specifying other explanations for the results is that the processes linking physical/social structure in a neighborhood and individual behavior are not well understood and should probably be viewed in the context of the development of a social ecological system [16]. This perspective suggests that alcohol outlets represent one feature of a multivariate physical/ social space and changes in the number of alcohol outlets can shape and be shaped by these other characteristics of the area. For example, organized neighborhoods with high collective efficacy may be able to stem increases in alcohol outlets, and may have other normative effects on individuals in the area. Similarly, this perspective suggests that the number and nature of outlets and the consumption and characteristics of the drinkers can influence influence each other, depending in part on the history and maturity of the social ecosystem. So, for example, a stable neighborhood with long-standing alcohol outlets may have minimum changes in overall consumption resulting from an increase in the number of package stores. In contrast, a transitory neighborhood with few local outlets may experience a large increase in package stores with a relatively substantial increase in the easy availability of alcohol. Moreover, this increase in outlets may not alter substantially the size of the population in that neighborhood, but the characteristics of individuals may change. People who dislike the evolving neighborhood and have the means to move, may do so, leaving a younger, less socially conforming population, with the possible effect of increased police presence and possibly neighborhood fears. These factors could lead to increased police reports of family incidents, independent of the effects of outlets on consumption. COMMENTARY