Hien, Honeyman

JOURNAL OF INTERPERSONAL
/ DRUG ABUSE–MATERNAL
VIOLENCE /AGGRESSION
May 2000
This study examines the relationship between drug abuse and maternal aggression (MA) among
low-income women, controlling for a number of factors that often obscure the nature of the links
between these two behaviors. Drug abusers (n = 87) and nonsubstance abusing normals (n = 75)
were recruited from public hospital treatment programs and received extensive clinical evalua-
tions for salient factors including psychiatric disorder, trauma history, domestic violence, cop-
ing, and MA. Findings indicated that drug abuse was consistently associated with more severe
disciplinary practices and a higher potential for punitiveness than nonsubstance abuse. Further
examination revealed the following two factors that predicted MA more powerfully than drug
abuse: (a) being in a violent couple and (b) the use of avoidant coping strategies. Discussion
includes recommendations for use of parenting interventions with drug-using women that
address not only abstinence from drug abuse but also anger management and coping strategies.

A Closer Look at the Drug

Abuse–Maternal Aggression Link
DENISE HIEN
Adelphi University
St. Luke’s/Roosevelt Hospital Center
TOYE HONEYMAN
Beth Israel Medical Center

The Department of Justice reports that the number of arrests of women for
offenses against family and children increased by 196% between 1982 and
1991. During the same time period, drug abuse violations increased for
women at rates greater than those for men. Although these figures suggest a
link between drug abuse and maternal aggression (MA), it is equally plausi-
ble that increases both in drug abuse and family violence are due to a third
factor such as stresses of living in poverty and related factors; for example,
high rates of violent interpersonal trauma (Burns & Burns, 1988; Ryan,
1993). Although few empirical examinations have explored the relationship
between drug abuse and mother-to-child violence, fewer still control for
many other potential confounds.
Moreover, what we do know has come primarily from restricted and
extreme samples such as criminal justice statistics; studies of community or
clinical samples are few. Existing empirical studies of aggression and drug
abuse have typically examined only men, specifically excluding women as
participants (e.g., Malone, 1989, as cited in White & Humphrey, 1994; Trus-
cott, 1992). Yet, the data that do exist, gathered from child abuse statistics and
JOURNAL OF INTERPERSONAL VIOLENCE, Vol. 15 No. 5, May 2000 503-522
© 2000 Sage Publications, Inc.
503
504 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

national family violence surveys, suggest that women may also be violent in
partner relationships and perhaps even more so than men toward their own
children (Gelles & Straus, 1988).
This study examined the drug abuse-MA link, considering how it may be
influenced by salient contributing factors such as trauma history, domestic
violence, female aggression in other contexts, and coping styles. Only when
we account for the many factors related to a drug-abusing mother’s potential
for violence toward her child may we begin to understand how to develop
more effective prevention strategies aimed at helping both women and their
children.

WHAT WE KNOW ABOUT THE RELATIONSHIP

BETWEEN SUBSTANCE ABUSE AND MA

Parental substance abuse has been found to significantly contribute to

family dysfunction (see Davis, 1990) and may greatly increase the risk of
child abuse and neglect. In a court-identified sample of child abusers, Famu-
laro, Kinscherff, and Fenton (1992) found that 67% of cases involved parents
who were substance abusers. Similarly, in a large study of child abuse cases,
43% of the sample had at least one parent with a documented substance abuse
problem (Murphy et al., 1991). According to this study, besides being more
likely to have been previously referred for child protective services,
substance-abusing parents were also more likely than nonsubstance abusing
parents to be rated as a high risk and neglectful to their children. In one study
of mother-child interaction (Fanshel, 1975), comparisons between substance
abusing mothers, psychiatrically-ill mothers, and child-abusing mothers
revealed that substance abusing mothers were significantly more deficient in
parenting skills than the other two groups (Fanshel, 1975).

The Cycle of Violence

Furthermore, there appears to be a strong association between a mother’s

having a history of childhood trauma herself and subsequently developing a
substance use disorder (Dembo et al., 1987; Downs, Miller, Testa, & Panek,
1992; Miller, 1990a; Miller, Downs, & Testa, 1993). Thus, childhood abuse
in the mother’s life can be a confounding variable in attempting to understand
how drug abuse affects mother-to-child violence.
Referred to as the “cycle of violence,” this theory poses an intergenera-
tional transmission of violence (Cole, Woolger, Power, & Smith, 1992; Koch &
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 505

Jarvis, 1987; Downs et al., 1992; Jouriles & LeCompte, 1991; Kashani, Dan-
iel, Dandoy, & Holcomb, 1992; Miller, 1990a; O’Keefe, 1994; Truscott,
1992). Derived from the social learning model, the cycle of violence theory
suggests that children learn to become abusive through socialization experi-
ences in their families. Support for the cycle of violence theory has been
found studying samples of those with physical abuse histories (e.g., Caliso &
Milner, 1992; White & Humphrey, 1994) as well as sexual abuse histories
(e.g., Cole et al., 1992; Cole & Woolger, 1989).
Although there is some empirical support for this notion, it is equally clear
that not all girls go on to become abusive mothers. In an extensive review of
empirical work on the cycle of violence, Widom (1989) found estimates of a
history of abuse among abusing parents to range from 7% to 70%. Such a
wide range suggests that for many victims of child abuse, other mediating
factors may be at play.

Other Related Factors

Psychiatric Disorders
Trauma in childhood has been linked to symptoms of posttraumatic stress
disorder (PTSD) and high levels of dissociation (Strick & Wilcoxon, 1991),
which all may be involved in the pathway to aggressive action. Similarly, the
notion that depression can lead to increased MA is supported by studies dem-
onstrating the relationship between depression and negative child-rearing
approaches (e.g., Raugh et al., 1990; Rutter & Quinton, 1984).

Domestic Violence in the Family

Other research suggests that contemporary violence in a woman’s life
may lead to increased likelihood of her abusing her children. The rate of child
abuse by mothers who had been beaten by their partners was reported to be
double those of nonabused mothers (Gelles & Straus, 1988). O’Keefe (1994)
specifically studied mother-to-child aggression in a sample of battered
women residing in shelters and found that 90% of the women directed some
form of aggression toward their children. The types of aggressive behaviors
most commonly used were spanking and slapping, although hitting with an
object (such as a belt) was also cited. Similarly, Gelles and Straus (1988) have
reported that women who hit their partners have a 120% higher incidence rate
of child abuse than those who do not.
506 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

Coping Skills
There is some evidence to suggest that avoidant coping skills can be
related to increased aggression. In a sample of substance abusers, McCor-
mick and Smith (1995) reported that those scoring higher on aggression used
coping styles characterized by escape/avoidance, confrontation, and distanc-
ing. Impaired coping may significantly contribute to MA, although empirical
studies that examine this issue directly are scanty.
Therefore, although the association between drug abuse (DA) and MA has
been documented empirically, it is clear that a number of other important fac-
tors such as trauma history, psychiatric disorders, domestic violence, and
coping are related to both substance abuse and MA. This study will compare
a group of low-income drug-abusing women with a normal control group to
examine the hypothesis that drug abuse will predict higher rates of MA. Fur-
thermore, we ask the following question: How will the direct relationship
between DA and MA change with consideration of trauma history, psychiat-
ric disorders, partner-to-partner violence, female-to-partner violence, and
coping strategies?

METHOD

Study Design and Recruitment Procedures

A case-control design was employed to investigate the questions for this

study. Participants were recruited from a large, urban, public city hospital
serving a primarily poor (Medicaid), minority (African American and
Latino) population. Samples were drawn from the following two settings: (a)
DA were recruited from inpatient and outpatient treatment settings, and (b) a
comparison group of normals was recruited from an obstetric and gyneco-
logical clinic. The reason to select DA who presented in both inpatient and
outpatient services was to ensure a sample with adequate variability and gen-
eralizability. Because we were targeting high-risk behaviors, we chose to rely
both on those who were more stable and those who might be experiencing
acute symptoms. In addition, we chose to identify a group of crack or
cocaine-using women as our target drug of abuse. Although a majority of the
drug-abusing women reported dependence on more than one drug of abuse,
we selected crack/cocaine to focus on as the drug of choice for the following
two reasons: (a) its use has been associated with violent behavior in men, and
(b) it is currently highly available and being used in epidemic proportions in
urban settings such as New York City. The normal control group was
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 507

recruited from the hospital’s general gynecology clinic population. This site
was chosen because of the similarity in income status to the drug-using
women and because the clinic serves women with typical gynecological
problems rather than severe or chronic physical illnesses. The following spe-
cific procedures were used for recruitment.

Drug Abusers
Of women presenting for drug abuse treatment within the hospital-based
inpatient (detoxification) and outpatient (drug free) drug and alcohol treat-
ment programs for more than a 3-year period, 192 met our eligibility criteria.
Of them, a random selection of 115 women (60%) were approached and
asked to participate in a 3-hour interview study about the lives of women with
drug problems. Eligibility criteria included (a) positive prescreens for heavy
lifetime crack or cocaine use, (b) willingness to participate, (c) having a mail-
ing address or family contact person, and (d) aged between 18 and 45 years.
Exclusion criteria were (a) a clear-cut history of severe organic symptomatol-
ogy and (b) AIDS. Of the patients, 109 approached (95%) agreed to partici-
pate. Of these potential participants, 87 (80%) reported having at least one
child and were included in this study. Patients who agreed signed informed
consent and were paid $25 in the form of a food voucher for their time at the
completion of the interview. All participants (N = 87) completed the entire
interview.

Nonsubstance Abusers (NSA): The Normal Group

A brief prescreening was conducted at the gynecological clinic on recruit-
ment days to determine whether participants met eligibility criteria. Inclu-
sion criteria were (a) willingness to participate, (b) having a mailing address
or family contact person, and (c) aged between 18 and 45 years. Exclusion
criteria were (a) a clear-cut history of severe organic symptomatology, (b)
active AIDS, (c) a history of lifetime drug abuse, (d) a history of lifetime psy-
chiatric disorder, and (e) any serious physical ailment or chronic disease. A
total pool of 600 women presenting for treatment at the gynecological clinic
were screened. Two hundred-forty women (40%) met our eligibility criteria.
A random sample of 132 women (55%) were approached and asked to par-
ticipate in the study. Of these, 95 (72%) gave informed consent to be inter-
viewed. Of these potential participants, 75 (79%) had at least one child and
were included in this study. All completed the interview process (N = 75) and
were paid $25 for their time. Statistical examination of those who consented
and those who did not on basic demographic characteristics revealed no sig-
508 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

TABLE 1: Demographic Characteristics for Drug Users Versus Non–substance Users

Drug (n = 87) Non–substance (n = 75) Total (N = 162)

M (SD) M (SD) M (SD)

Age 33.5 (6.4) 33.4 (8.3) 33.4 (7.3)

Number of days
paid employment 5.8 (17.2) 4.5 (12.3) 5.2 (15.1)
Number of children 3.0 (1.7) 2.6 (1.6) 2.8 (1.7)
a
Number of pregnancies 5.5 (2.8) 4.1 (2.4) 4.8 (2.7)
b
Age at first pregnancy 18.2 (3.1) 20.2 (4.1) 19.1 (3.7)
c
Ethnicity n Percentage n
Percentage n Percentage
Caucasian 1 1.1 2 2.7 3 1.9
African American 56 64.4 18 24.0 74 45.7
Latina 26 29.9 54 72.0 80 49.4
Other 4 4.6 1 1.3 5 3.1

a. t(159) = 3.27(159), p < .001.

b. t(133) = –3.46, p < .001.
c. χ (3) = 30.7, p < .0001.
2

nificant differences between those who participated and those who chose not
to participate.

Participants

Table 1 displays comparisons between the DA and normal group on

demographics revealing some significant differences between the two
groups. Ethnicity differed statistically such that the drug users were 64%
African American and 30% Latina, whereas the normals were 24% African
American and 72% Latina, χ (3) = 30.73, p < .0001. In addition, the DA
2

reported significantly more pregnancies than the normals (M = 5.5, SD = 2.8

vs. M = 4.1, SD = 2.4) t(159) = 3.27, p < .001, and were significantly younger
at first pregnancy than the normals (M = 18.2, SD = 3.1 vs. M = 20.2, SD =
4.1), t(133) = 3.46, p < .001. Thus, ethnicity and number of pregnancies were
entered first in all multivariate analyses as statistical controls. A univariate
analysis of the drug and alcohol use characteristics in the DA’s revealed that
48% (n = 42) met criteria for lifetime cocaine dependence, with 20% (n = 17)
meeting criteria for current dependence in the past 6 months. See Table 2 for a
display of the frequencies of lifetime and past 6 months DSM-IV (Diagnostc
and Statistical Manual–Fourth Edition) (American Psychological Associa-
tion [APA], 1994) alcohol and other drug use disorders in the sample.
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 509

TABLE 2: Lifetime Frequency of DSM-IV Drug and Alcohol Use Disorders for
Substance-Abusing Women (n = 87)

DSM-IV Abuse DSM-IV Dependence

Lifetime Past 6 Months Lifetime Past 6 Months
Substance of Abuse n Percentage n Percentage n Percentage n Percentage

Cocaine 12 14 6 7 42 48 17 20
Crack 3 3 2 2 68 78 53 61
Alcohol 14 16 9 10 31 36 20 23
a
Other drugs 27 31 9 10 28 32 17 20

a. Other drugs included sedative hypnotics (n = 5), cannabis (n = 15), stimulants (n = 1), opioids
(n = 12), hallucinogens/PCP (n = 5), and polydrug (n = 2).

Measures

Predictors

Group (DA vs. normal). The structured clinical interview for DSM III-
R/IV-SAC (Nunes et al., 1996) version of the Structured Clinical Interview
for DSM-IV Substance Abuse Comorbidity (SCID-SAC) is a modified ver-
sion of the SCID developed for detection of mood and anxiety disorders
among substance abusers based on life history. The SCID is a semistructured
clinical interview for making the major Axis I DSM-IV (APA, 1994) diagno-
ses (Spitzer, Williams, Gibbon, & First, 1992). It is administered by a clini-
cian and includes an introductory overview followed by nine modules, seven
of which represent the major Axis I diagnostic classes. Because of its modu-
lar construction, it can be adapted for use in studies in which particular diag-
noses are of interest. Using a decision tree approach, the SCID guides the cli-
nician in testing diagnostic hypotheses as the interview is conducted. The
output of the SCID is a record of the presence or absence of each of the disor-
ders being considered, for current and lifetime occurrence. The following
modules were used in the study: Alcohol disorders, psychoactive substance
use disorders, posttraumatic stress disorder, antisocial personality disorder
and a psychotic screen. A multisite reliability study for the DSM III-R version
of the SCID was conducted on 592 participants in patient and nonpatient sites
(Williams et al., 1992). Interrater reliability is adequate (K = .68 for patient
lifetime diagnoses and K = .51 for nonpatient lifetime diagnoses). These val-
ues are roughly equivalent with those obtained for other structured diagnostic
instruments such as the Schedule for Affective Disorders and Schizophre-
nia/Research Diagnostic Criteria (SADS/RDC), and the Diagnostic Inter-
510 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

view Schedule (DIS). Field trials with this instrument have shown evidence
of good interrater and test-retest reliability (Nunes et al., 1996).

Depression. The Hamilton Depression Rating Scale (Hamilton, 1960) is a

widely used, 15-item Likert-type rating scale that assesses degree and range
of symptoms of depression including mood, sleep disturbance, agitation, and
appetite. Administered as a semistructured instrument, this measure provides
a rating of current levels of depression. Other studies have demonstrated its
reliability and validity (Guelfi & Corruble, 1997; Riso et al., 1997). The total
score is calculated by adding all items.

Trauma

Sexual abuse. The Childhood Sexual Abuse Interview (CSAI) (Miller,

1990b; modified from Finkelhor, 1983) consists of a series of questions for
adults that evaluates history of specific sexual experiences prior to the age of
18. Sexual experiences ranging from exposure to intercourse are scored by
presence or absence of each item, and information is obtained concerning
perpetrators, numbers of experiences, age of onset, and duration. Based on
responses to the CSAI, participants were classified as having been sexually
abused if they report a yes to any of the sexual contact items of the scale be-
fore the age of 16 with an adult 5 or more years older.

Physical abuse. The physical and emotional abuse subscale of the Child-
hood Trauma Questionnaire (CTQ) (Fink, Bernstein, Handelsmann, Foote, &
Lovejoy, 1995) is a 23-item, Likert-type scale that assesses the frequency of
occurrences of physically or emotionally abusive experiences during child-
hood. This scale has demonstrated strong reliability and validity among pa-
tients in treatment for drug or alcohol abuse. Based on our participant’s re-
sponses to the CTQ, participants were classified as having been physically
abused if they indicated that during childhood they were hit or beaten so
badly that it was noticed by someone else or they had to see a doctor, or if they
indicated that they were often punished with a belt, a board, a cord, or some
other hard object.

Domestic violence and female aggression. The Conflict Tactics Scales

(Partner Version) (CTS-Partner; partner-to-participant violence, couple vio-
lence, and participant-to-partner violence) (Straus, 1979) is a structured in-
terview designed to evaluate the history of partner-to-partner violence in
adults. For moderate to severe violence, questions are asked about alcohol
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 511

and drug use during incidents as well as consequences of violence. Based on

responses to the CTS-Partner and according to Straus and Gelles’s (1986)
scoring conventions, a moderate-to-severe partner-violence subscale denot-
ing was calculated for participants based on their indication that they had
been kicked, bit, hit with a fist, hit with an object, beaten up, choked, threat-
ened with a knife or gun, or if a partner had used a knife or gun on them or
raped them. Couple violence scores were also generated. Participants were
classified as having perpetrated partner violence if they indicated that they
had used any of these tactics with their partners. All classifications followed
conventions set by Straus & Gelles (1986, 1990): Indexes xc 12l, “partner
violence level”; xc 21l “couple violence level”; and xc 15l, “respondent vio-
lence level” were the indexes used. Reliability and construct validity, conver-
gent and divergent validity data of the scale, which has been extensively used,
have been provided in Straus (1979).

Coping strategies. The Coping Orientations to Problems Experienced

Scale (COPE) (Carver, Scheier, & Weintraub, 1989) is a 60-item scale that
measures 15 coping strategies. These strategies are divided into the following
three styles of coping: (a) internalizing, problem-focused coping (e.g., active
coping, planning, suppression of competing activities, restraint coping, and
seeking of instrumental support); (b) externalizing, emotion-focused coping
(e.g., seeking of emotional support, positive reinterpretation, acceptance, de-
nial, and turning to religion); and (c) avoidant, maladaptive coping (e.g.,
venting of emotions, behavioral disengagement, and alcohol and drug use).
Humor is an additional subscale that was added more recently to the COPE
and currently remains separate from the three established styles of coping.
The COPE is scored by summing the scores on a 4-point Likert-type scale
(I don’t do this at all to I do this a lot) for each subscale. Internal consistency
(Cronbach’s alpha) ranges from .62 to .92, with the exception of the mental
disengagement scale (.45). Test-retest reliability varied from .51 to .86. (See
Carver et al., 1989, for a description of psychometrics and of studies demon-
strating construct validity.)
Although the COPE is a very widely used reliable and valid instrument, it
has less often been used with a lower-income population. Therefore, to test
that the scale could be applied to use with our population, a number of psy-
chometric analyses were conducted. The following is a description of our
approach to assuring the scale appropriateness for our sample. First, we cal-
culated alpha coefficients for each of the 15 subscales. Similar to Carver et al.
(1989), our coefficients ranged from .6 to .94 (mental disengagement was .3).
Next, we conducted a principal components analysis with a rotated factor
matrix of the 15 subscales and extracted three orthogonal factors, corre-
512 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

sponding to Carver et al. (1989). They include problem-focused coping

(internalizing), emotion-focused coping (externalizing), and maladaptive
coping (avoidant). For all analyses, we used the factor scores generated by
our own factor analysis as the three coping variables under examination in
our study.

Outcomes

Maternal aggression. The Parental Punitiveness Scale (PPS) (Blane,

Miller, & Leonard, 1988) is a 21-item self-report measure that is designed to
assess disciplinary styles and the potential for parental violence. This instru-
ment was modified from a child version of the PPS (Epstein & Komorita, 1965).
In this version, the respondent is required to estimate her most frequent re-
sponses on a Likert-type scale given a number of hypothetical situations in
which the child misbehaves or acts aggressively. They include a wide range
of situations in which the child may display verbal, physical, or indirect ag-
gression toward parents, other authorities (i.e., teachers), siblings, or peers.
These situations include disobeying, stealing, damaging property, or display-
ing disrespectful behavior. The scale offers a description of seven discipline
techniques that range in degree of punitiveness from doing nothing to severe
physical punishment (e.g., hit child with fist). Options for respondents are the
following: Do nothing, have a long talk with them, take away television or
things they like, yell at them, spank them with an open hand, spank or hit with
a belt or switch, and hit them with a fist. In this study, a sum total of scale
items was used to generate a total severity score (PPTOT), with a lower score
indicating more severe punishments.
Because this scale has relatively few demonstrations of its psychometric
properties, some preliminary analyses were conducted to assure its internal
consistency and to ascertain how it might best be applied for use with our
sample. A principal components analysis with a rotated factor matrix
revealed only one factor with all items loading above .8. Therefore, the total
score was used as the main outcome variable. A further examination of the
total score revealed a wide range of responses from 60 to 126 (M = 104.6,
median = 106). One of the concerns was that participants would underreport
uses of more severe forms of punishment, but our preliminary analysis did
not bear this out. In addition, to support the construct validity of the measure,
we calculated a correlation between a self-reported measure of child welfare
involvement measure (Child Welfare Agency involvement, see below) and
PPTOT, finding that a high score on the PPS was significantly related to a
reported history of child abuse or neglect (p < .05).
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 513

Child Welfare Agency (CWA) involvement. Participants were interviewed

about their involvement with CWA, and by self-report indicated whether they
had a history such that a formal case had been opened due to detection of
child abuse or neglect.

RESULTS

A number of variables under study revealed skewed distributions (number

of pregnancies, depression, avoidant coping, and parental punitiveness). In
each case, appropriate logarithmic and exponential transformations were
conducted to correct the distributions to meet basic statistical assumptions.
Exploratory bivariate analyses were conducted to examine all predictor vari-
ables and their independent association with the outcome measure of MA.
After bivariate examination, multivariate procedures were used to examine
which of the individually significant predictors contributed most to the vari-
ance in the outcome measures. Thus, this section presents first the general
findings of the results of the bivariate analyses followed by the multivariate
analyses with corrections for multicollinearity.

General Findings for MA

Total scores for all participants on the PPS ranged from 60 (more severe)
to 126 (least severe). The number of situations in which a mother would react
by hitting with a fist, spanking or hitting with a belt or switch, or spanking
with an open hand ranged from 0 to 14 (total number of situations = 21). A
total of 72% of the sample endorsed one of the previous reactions to at least
one hypothetical situation of a child’s misbehavior. No ethnic differences
were found for either the overall level of severe punishments or for the total
number of situations in which participants endorsed the use of violence.
CWA involvement occurred for 44 of the 162 mothers in the study (27%).
Table 3 presents a summary of the results of the bivariate analyses con-
ducted between each of the individual predictors and the outcome measure
(PPTOT).

Individual predictors of Parental Punitiveness (PPN) group. DA (M =

100.6, SD = 13.8) were significantly more likely than NSA (M = 109.2, SD =
10.9) to endorse the use of harsher punishments with their children, F(1,
161) = 18.76, p < .00001. Of those mothers with CWA, 95% were diagnosed
with a Substance Use Disorder (SUD), whereas for those with no CWA, only
36.8% received an SUD, χ2(1) = 43.8, p < .0001.
514 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

TABLE 3: Associations Between Individual Predictors and Maternal Aggression

(n = 162)

Outcome
Predictor Total Parental Punitiveness Score (PPTOT)

Drug abuse/dependence ***

Trauma
Physical abuse ns
Sexual abuse *
Posttraumatic stress disorder *
Domestic violence
Partner violent **
Couple violent **
Depression
Lifetime **
Current level *
Female aggression
Female-to-partner violent *
Antisocial disorder **
Coping strategies
Externalizing ***
Avoidant *

NOTE: Individual chi-square and t tests denoted statistically significant differences at the *.05,
**.01, and ***.001 levels; ns = not significant.

Depression. Depressed women were more likely to endorse severe vio-

lence with their children (M = 100.8, SD = 13.7) than were nondepressed
women (M = 106.7, SD = 12.5), F(1, 161) = 7.6, p = .006.

Trauma. Women with a history of child sexual abuse were also more likely
to endorse the use of severe violence with their children (M = 102.4, SD = 13),
F(1, 161) = 3.64, p = .058, compared with those without a history of child sex-
ual abuse (M = 106.4, SD = 13.23). Similarly, women with PTSD were more
likely to endorse violence with their children (M = 102.8, SD = 12.8) than
were those without PTSD (M = 106.84, SD = 13.5), F(1, 161) = 3.77, p = .05.

Domestic violence. Women with mild and severe partner violence in their
lives were found to endorse more severe violence toward their children than
were those without partner violence, F(1, 161) = 4.4, p = .01. Women in se-
verely violent couple relationships also endorsed the use of more severe vio-
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 515

lence with their children (M = 99.64, SD = 13.8) than those not in violent rela-
tionships (M = 106.9, SD = 12.8), F(1, 161) = 4.51, p = .01.

Female aggression. Although the relationship of female-to-partner vio-

lence and punitiveness was not statistically significant, there was a trend for
women who were severely violent toward their partners to be more punitive
with their children (M = 100.1, SD = 14) than those who were mildly physical
with their partner (M = 106.8, SD = 11) or those who did not use any physical
violence with their partner (M = 105.5, SD = 13), F(1, 161) = 2.4, p = .09).
Women with antisocial personality disorder were significantly more likely to
use harsher punishments (M = 98.9, SD = 15) than those without (M = 105.8,
SD = 13), F(1, 161) = 6.4, p < .01.

Coping. Analysis of the cope factor scores with PPS revealed that both
higher scores on the externalizing coping subscale (r = –.26, p < .001) and the
avoidant coping subscale (r = –.16, p < .05) were significantly associated
with harsher punitiveness.

Multiple Predictors of MA

Tables 4 and 5 present the findings of the multivariate analyses with theo-
retically meaningful blocks of individual predictors entered stepwise for the
outcome measure (PPTOT). Because of concerns about the multicollinearity
of variables, a Bonferroni estimate of experiment-wise error was obtained
(seven block variables, .003 = .021). Findings revealed that even with the cor-
rection, our results continued to exceed the p < .05 level of significance. The
block linear regression was conducted to determine the contribution of each
factor in predicting the parental punitiveness outcome (PPTOT). Blocks of
variables were entered based on theoretical assumptions about the impor-
tance of each of these blocks of variables in understanding maternal punitive-
ness, with a particular emphasis on examining the unique contribution of DA
when other related variables such as depression, trauma, domestic violence,
female aggression, and coping were also considered in the equation.
Two control variables were entered on Step 1. Based on the results of our
bivariate analyses, ethnicity and number of pregnancies were determined to
be significant covariates (r = .17, p < .05; r = .20, p < .01, respectively).
Entered in Step 2, after controlling for the demographic variables, the analy-
sis revealed that a history of drug dependence significantly predicted PPTOT
2
(β = .29, r change = .07, p = .0008). Steps 3 (depression), 4 (trauma), 5
(domestic violence), and 6 (female aggression) were not significantly associ-
516 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

TABLE 4: Block Linear Regressions for Predictors of Parental Punitiveness (n = 182)

Total Parental Punitiveness Score (PPTOT)

F Significance D
2 2
Predictor Entered r r∆

Block 1: Controls .04 .04 .05

Block 2: Drug dependence .11 .07 .0008
Block 3: Depression .11 .004 ns
Block 4: Trauma .12 .006 ns
Block 5: Domestic violence .12 .006 ns
Block 6: Female aggression .16 .03 ns
Block 7: Coping .21 .05 .01

NOTE: F(13, 139) = 2.89, p < .001.

TABLE 5: Block Linear Regressions for Predictors of Parental Punitiveness: Results

(n = 182)

Predictor β

Ethnicity .02
Number of pregnancies –.07
Drug dependence .18 ns
Depression –.00
Physical abuse .06
Sexual abuse .00
Posttraumatic stress disorder .07
Partner violent .13
Couple violent –.54*
Female-to-partner violent .40*
Antisocial disorder .06
Externalizing –.07
Avoidant –.23**

NOTE: F(13, 139) = 2.89, p < .001.

*p < .05. **p < .01.

ated with PPTOT overall. However, the final entry of the coping variables
revealed that avoidant coping style was positively associated with PPTOT
2 2
(β = –.23, r ch = .05, p = .004). In summary, the overall r for the seven blocks
of variables entered was .21, F(13, 139) = 2.89, p = .001. After entry of all
these variables and in addition to avoidant coping style, those that were
revealed to be significantly associated with PPTOT were a positive relation-
ship for couple violence (β = –.54, p = .03) and a negative relationship for
female-to-partner violence (β = –.40, p = .02). Of note, in the final analytic step,
drug dependence no longer remained significantly associated with PPTOT.
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 517

DISCUSSION

As anticipated, the findings from this study revealed that inner-city moth-
ers with crack or cocaine dependence disorders were significantly more
likely to endorse the use of harsher disciplinary practices than normal
mothers. Crack- and cocaine-dependent mothers were significantly more
likely than normal mothers to choose severe punishments when presented
hypothetical situations requiring disciplinary action. Similarly, crack- and
cocaine-dependent mothers more frequently endorsed the use of physical
punishments such as hitting with a belt, open hand, or closed fist than did the
normal mothers. These findings clearly support existing literature that con-
sistently indicates that MA and abuse is linked to substance abuse.
However, on closer examination, when crack/cocaine abuse and demo-
graphic factors were statistically controlled, two alternative factors also
emerged as more powerful predictors of MA than drug-abuse alone. They
were (a) involvement in violent partnerships (couple violence) and (b) the use
of avoidant coping strategies. A third factor was significantly associated with
lower levels of MA: the use of physically-violent conflict resolution strate-
gies by the woman toward her partner when her partner did not reciprocate
with any physical violence.
From the data we can infer that MA may be more likely in homes where
there is ongoing violence between a woman and her partner. These results are
consistent with family violence literature (Gelles & Straus, 1988), which
suggests that the use of physical violence as a strategy for resolving conflicts,
rather than reliance on verbal conflict resolution, is a characteristic that
extends beyond the parental couple. Thus, in this family type, the use of vio-
lence characterizes all relationships in the family (from executive [parental]
to parent-to-child to sibling-to-sibling) and is presumed to be caused by
structural factors, modeling, and social learning that affect the entire family’s
behaviors in times of conflict. Thus, all members in such a family rely on
physical violence as a means of resolving conflicts.
The use of avoidant coping strategies was a significant predictor of higher
levels of maternal punitiveness. Avoidant coping strategies are those that
involve failing to acknowledge emotional reactions associated with or taking
a more active problem-solving approach to dealing with general life stresses.
An avoidant woman might endorse “I put it out of my mind” or “I try not to
think about it” as a typical way of coping with stress. Use of such strategies
was associated with significantly higher levels of punitiveness when demo-
graphics and drug abuse was controlled. This finding may be better under-
stood by turning to the clinical literature on the process of dissociation as a
defense mechanism for coping with aggressive impulses. A common psycho-
518 JOURNAL OF INTERPERSONAL VIOLENCE / May 2000

logical defense used by trauma survivors (see Davies & Frawley, 1994), dis-
sociation involves the internal avoidance of violent impulses by splitting off
conscious awareness of such impulses. The use of dissociation does not,
however, necessarily protect a woman from acting on her impulses. In the
case of a punitive mother, the use of avoidant coping strategies (conceived as
a form of dissociation) may either impair her judgment or keep her unaware
of just how angry she may be. Because awareness of anger may actually pro-
tect a woman from acting on it, an avoidant woman might be more likely to
take her anger out on her own child than a mother who does not use avoidant
coping strategies.
In support of the idea that awareness and direct expression of anger may
actually reduce the likelihood of maternal-to-child violence, the third predic-
tor, female violence in the absence of partner violence, was significantly
related to lower levels of punitiveness. Thus, when a woman reported use of
some form of physical aggression with her partner and her partner did not
respond in a violent fashion, she was significantly less likely to endorse the
use of physical discipline with her child. In contrast to the violent-family
example described above of both partners hitting each other, the case of the
woman expressing her anger to her partner in a physical form with no retalia-
tion may serve a protective function in her relationship with her children.
When a woman is able to express her anger directly, she will be less prone to
use violence as a disciplinary approach with her child.
The implications of all the above findings suggests that a fruitful area of
further investigation would be that of anger management in women. The fact
that the measures of current violence and the use of avoidant coping in a
woman’s life were more salient than drug abuse in predicting harsher disci-
plinary choices suggests the importance of helping women, those with and
without drug problems, to become aware of and manage their anger in their
most significant relationships (with their partners and their children). Our
findings underscore the need for and importance of investigations and theo-
ries that strive to understand more about the psychology of female aggression
and women’s strategies for managing anger and stress.
One set of nonsignificant findings in the current investigation is also note-
worthy. Once demographic variables and drug abuse were controlled for, nei-
ther a history of physical nor sexual abuse revealed a direct relationship to
maternal punitiveness. With respect to the cycle of violence notion, our find-
ings concur with the analysis of Widom (1989), raising some doubts about
the clear and direct relationship between histories of abuse and later child
abuse. Although childhood trauma history, PTSD, and depression may play a
mediating role in the relationship between drug use disorders and MA, in this
study no direct relationships between trauma and punitiveness were found.
 Hien, Honeyman / DRUG ABUSE–MATERNAL AGGRESSION 519

In conducting this study, some limitations in the design of this investiga-

tion suggest potential areas for refinement in future research endeavors.
Because of the ethical issues inherent in directly asking about specific inci-
dents of child abuse, a measure of potential perpetration was chosen to pro-
vide participants with confidentiality with the hope that they would more
candidly reveal their behavioral tendencies toward their children. Although
we were able to establish some evidence of the validity of the measure by cor-
relating it with reports of child welfare involvement, this method can only
estimate the constructs of true MA, punitiveness, or child abuse. Additional
problems exist with the accurate reporting of a participant’s experience of
childhood trauma as, for example, some events may be forgotten due to early
age of onset. Furthermore, trauma and dissociation have been linked and
could account for inaccurate recall and self-report of the experience of
trauma as well as of descriptions of coping strategies. It is also possible that
there is a group-specific self-report bias for the NSA control respondents
such that they perceived a potential legal risk for disclosing either drug use or
any indications of abusive behavior toward a child. Gender of the child may
also be a determining factor in aggression and punitiveness toward children,
with boys possibly more often the victims of aggression (Jouriles & Nor-
wood, 1995). Future studies should control for gender and birth order of chil-
dren as well as psychopathology in the child as potential confounds in under-
standing MA. Another issue to incorporate in future studies is the analysis
of single parent versus two-parent households. As Slater and Power
(1987) found, the demands on parents in the two types of homes appear to
vary greatly. Given that 73% of this sample was never married, divorced,
or separated, although nearly all have been pregnant, the issue of parental
roles would be an important one to explore in subsequent studies of this
population.
Extrapolating from our findings to implications for intervention, the
reduction of drug use in mothers may lessen neglectful behaviors toward her
children, but interventions that focus only on decreasing drug abuse and
maintaining abstinence do not adequately address a woman’s risk for child
maltreatment. The need for future studies to explore the ways that healthy
and abusive mothers manage their anger and the variables that affect MA,
including drug abuse, is clear.

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Denise Hien, Ph.D., is an assistant professor in psychology at the Derner Institute of

Advanced Psychological Studies, Adelphi University, and a lecturer in clinical psychia-
try (psychology) at Columbia University College of Physicians and Surgeons. She is cur-
rently the director of the Women’s Health Project at St. Luke’s/Roosevelt Hospital Center
in New York City and the principal investigator of two National Institute on Drug Abuse-
funded studies; a FIRST award investigating predictors of interpersonal violence and
cocaine disorders for inner-city women and an RO1-randomized clinical trial of two psy-
chotherapy interventions for women with cocaine use disorders and traumatic stress dis-
order. She has 10 years of clinical research experience, largely focused on diagnostic
and treatment issues in women’s health and violence. Her expertise in the study of
women, violence, and drug abuse is recognized nationally in the authorship of numerous
peer-reviewed journal articles and book chapters as well as in regular presentations at
national and international conferences.

Toye Honeyman, Ph.D., is a clinical psychologist in the Internal Medicine Department at

Beth Israel Medical Center in New York City. She graduated from the Derner Institute of
Advanced Psychological Studies in 1999 where she studied the effects of childhood
trauma and dissociation on maternal impairment. She recently completed a postdoctoral
fellowship at New York University.