The links between alcohol, crime and the criminal justice system: explanations, evidence and interventions.

Many studies indicate that alcohol abuse and dependence are closely linked with the criminal justice system (CJS). Alcohol was consumed prior to about half of all homicides and assaults, and nearly 40 percent of state prisoners report committing their current offense under the influence of alcohol. Alcohol abuse cost approximately $13 billion in 1992 non‐health related costs. This article seeks to address this burden on the CJS and society. It presents a conceptual framework for explaining the alcohol‐crime nexus, reviews empirical evidence of the complex associations between alcohol consumption and crime, and links these with promising intervention strategies to reduce alcohol‐related crime.

Hundreds of articles and studies have shown that alcohol abuse is closely associated with violent and other criminal offenses. For example, alcohol was found to have been used in more than half of homicides and assaults,[1] about 40 percent of violent offenders in state and local jails in the United States had been drinking at the time of the offense for which they have been incarcerated,[2] and about a quarter of state prisoners were found to be alcohol dependent.[3] Nevertheless, there is a gap between alcohol‐related research on crime, violence, and the criminal justice system and other research addressing these issues. The former seeks to determine whether the association of alcohol and violence is causal or models the mechanisms through which alcohol affects criminal behavior. Other alcohol researchers evaluate interventions designed to delay the onset or reduce the amount of drinking (particularly among youth), with little attention to the broader impact of these programs. Criminal justice system (CJS) research, conversely, largely ignores the contributions of alcohol. Rather, it emphasizes the connection between illicit drugs and crime or describes the drug‐related treatment needs in the offender population. Consequently, important issues related to assessing and reducing the burden of alcohol‐related crime often are not addressed by either the criminal justice or public health communities, and there is limited communication and cooperation between them.

This article seeks to bridge that gap. In the first section, the scope and costs of alcohol‐related crime and offenders' alcohol dependence are briefly noted. These data clearly indicate the heterogeneous nature of alcohol‐related crimes and their perpetrators and victims, and thus the need for a wide range of interventions to address these problems. The next section provides a conceptual framework for examining the multiple factors that may contribute to an incident of alcohol‐related crime. Because most drinking does not result in crime or violence and most criminal offenses involve persons that have not consumed alcohol, there does not appear to be a single or simple direct pharmacological effect of alcohol that "causes" alcohol‐related crime. Rather, multiple factors at several levels of analysis are involved in a variety of combinations. The framework identifies and links these factors, including the characteristics of the individual (ie, physical, psychological, attitudinal and social factors) as these interact with the effects of alcohol in a specific drinking context. These in turn are located within and influenced by the larger societal and cultural context. Based on this conceptual framework, the next section explores the empirical evidence supporting the diverse associations between drinking and crime. It reviews research focused primarily on the association of alcohol with violent crime and explores how the pharmacological effects of alcohol might increase the likelihood of aggression by interacting with personal, situational, and cultural factors in which drinking occurs. The final section identifies promising intervention strategies and specific programs that might reduce and prevent alcohol‐ related crime, based on the conceptual model and research findings. It also suggests additional research on the alcohol‐ crime nexus that may serve as a basis for the next generation of interventions.

Given the number of reviews of the vast literature on alcohol and aggression and/or violence (the form of behavior most closely associated with crime),[[1], [4]] these will not be duplicated here. Instead, the present article focuses on linking these findings with their implications for interventions, drawing on findings from a wide variety of disciplines and methodologies.

Several recent reports make clear the enormous burden of alcohol abuse and dependence on the criminal justice system. That burden arises both from high rates of intoxication at the time of the offense (including many offenses that probably would not otherwise have occurred if the offender, victim, or both had not been drinking) and from high rates of alcohol dependence among criminal offenders. The burden of alcohol includes costs incurred by victims, by offenders and their families, and by the larger society, including the criminal justice system expenses.

Many studies have documented offenders' use of alcohol prior to the offense. For example, the National Crime Victimization Survey (NCVS) is an ongoing survey of a nationally representative sample of households in the United States. Based on aggregated NCVS data from 1993 through 1998, a recent report indicates that about one quarter of the approximately 10 million annual victims of violent crime perceive their offenders to have been drinking. This includes 26 percent of incidents where the offender used alcohol only, seven percent where the offender was under the influence of both alcohol and other drugs, and two percent where the victim knew the offender to be under the influence but was unsure if the offender was using alcohol, another drug, or both. In contrast, victims reported that their assailant was solely under the influence of other drugs in only eight percent of the incidents, and the remaining 60 percent were not believed to be using alcohol or drugs.[9] Even the presence of alcohol in about one third of violent offenses probably is an underestimate, because homicides, which are not included in the NCVS data, consistently show a higher proportion of alcohol involvement than less serious violent crimes.[[1], [5], [7], [10]] There also is variation among these less serious offenses in the use of alcohol by offenders. Drinking offenders committed nearly 40 percent of the rapes or sexual assaults, more than a quarter of the aggravated and simple assaults, but only 16 percent of the robberies.[9]

Data compiled from surveys of adults on probation, inmates in local jails, and inmates in State and Federal correctional facilities indicate that 38 percent of the nearly 5.7 million convicted adult offenders under the jurisdiction of correctional authorities reported that they had been drinking at the time of the offense for which they were convicted. As shown in Table 1, this includes more than 40 percent of violent offenders, about one third of property offenders, a quarter of drug offenders, and more than half of public order offenders (including DWIs).[9]

1 Percent of Offenders Drinking at Time of Offense by Offense Type

1 * Too few cases for estimates to be made.

2 From Greenfeld LA, Henneberg MA. Alcohol, crime, and the criminal justice system. Commissioned paper presented at Alcohol and Crime: Research and Practice for Prevention Conference, June 11–14, 2000.

Calculations of those offenders' blood alcohol concentrations (BACs) at the time of the offense, based on self‐reports of the amount of alcohol consumed in the eight hours before their crime and the offender's weight, clearly indicate that most of the drinking offenders were quite intoxicated.[2] The average estimated BAC was 0.16 for probationers, 0.19 for jail inmates, and 0.27 for state prisoners. Interestingly, the BAC levels for property offenders were higher than those of violent offenders. The high BACs of the property offenders may have contributed to their apprehension for the crime (in contrast to the sober thieves who were less likely to be caught).

Given these high BAC levels, it is not surprising that 24 percent of state prisoners were found to be alcohol dependent (i.e., gave 3 or 4 positive responses on the 4‐item CAGE screening instrument).[9]

Drunk driving often is considered a "junk" crime.[12] Nevertheless, in 1997, the nearly 1.5 million arrests for drunk driving or driving while intoxicated (i.e., DWI, the term that will be generically used for several alcohol‐related driving offenses) accounted for about 10 percent of all police arrests nationwide. Although the number of DWI arrests has declined since peaking in 1983, the number of DWI offenders under correctional supervision has grown to an estimated 513,200 offenders in 1997. That year, DWI offenders accounted for nearly 14 percent of probationers, 7 percent of jail inmates, and 2 percent of state prisoners.[13]

The most recent estimate of the costs of crime attributed to alcohol abuse, based on 1992 data, is $12.8 billion. This includes total public expenditures of $6.2 billion for criminal justice system costs, including police protection, legal and judicial services, and correctional institutions at all levels of government. The remaining $6.6 billion in costs include lost productivity arising from offenders' reduced earnings due to incarceration and the costs to victims in the form of lost earnings, legal defense, and property damage. However, the figure does not include their medical costs and health consequences or the intangible costs from heightened fear of crime and changes in their quality of life.[14] Given the financial and other burdens that alcohol‐related crime imposes on society, it is important to better understand the nature of the alcohol‐ crime connection in order to identify malleable targets and opportunities for intervention.

Despite ample evidence of the frequent association of alcohol consumption and criminal behavior, the ways in which drinking and crime are linked and the extent to which the association is a causal one is a matter of considerable debate. Disagreement over whether the alcohol‐ violence relationship is a causal one hinges, in part, on different meanings attributed to "causation." [[4], [8], [10], [15]] In a meta‐analysis of studies of alcohol and violence, despite evidence "consistent with a causal interpretation," Lipsey and colleagues conclude that "the causal issue is still cloudy and uncertain."[8](p.277) In contrast, Room and Rossow[17] note that their epi‐demiological approach for attributing causality does not require a "main effect." Even in the absence of an overall causal association, there may be a causal relationship for some types of persons and/or in certain circumstances that need to be identified empirically. Fuller understanding of the relationship between alcohol consumption and crime, therefore, requires identifying those individuals, situations, and circumstances likely to increase the chance of violent or other criminal behaviors (i.e., mediators) and those that reduce their likelihood (i.e., moderators). It also requires examining how these factors interact with each other and the pharmacological effects of alcohol.

Figure 1 presents a multi‐level framework for understanding the alcohol‐ crime connection, based on the model proposed by Graham and West.[18] In the figure, the outer dark rectangle represents the broad cultural context for drinking and criminal behavior. This includes socio‐cultural attitudes, expectations, and norms that shape how and how much people drink; how they behave when they drink; the frequency of crime; and the forms of social control over both drinking and crime, all of which vary across cultures.

Graph: 1 Factors contributing to alcohol related crime and their implied intervention strategies. GrahamK, West P. Alcohol and Crime. In: Heather N, Peters TJ, Stockwell T, eds. Handbook of Alcohol Dependence and Alcohol‐Related Problems. Sussex, England: John Wiley &Sons. In press. © John Wiley & Sons Limited. Reproduced with permission.

Within any particular cultural or societal context, there remains wide variability in alcohol‐related behavior, depending on the situational context in which drinking occurs. This is depicted in the figure by the nested smaller rectangle. For instance, people moderate their behavior depending on the norms of a particular drinking setting. Thus, the particular social and physical context within which people drink also affects behavior, including crime.

Within any given situation, location, or drinking context, the characteristics of individuals within that setting also affect whether crime will occur. As shown by the three smallest rectangles representing different individuals, people within a single drinking setting vary with respect to demographic characteristics, attitudes, expectations, and personality characteristics, such as impulsivity.

The effects of alcohol also play a role in that most people are likely to behave differently when intoxicated, as well as vary among themselves and intrapersonnally under the effects of the same amount of alcohol depending on the situation or setting. The effects of alcohol interact with a person's characteristics and may affect the likelihood of the occurrence of a crime by altering his/her assessment of risks or judgment. In addition, as indicated by the double arrows between the individuals, alcohol‐related violence involves the interaction of two or more individuals who act and react to each other within any given context.

In sum, the relationship between crime and alcohol is subject to many factors that operate simultaneously, although for any individual crime certain factors may contribute more than others. Based on this framework, the various aspects of drinking that may account for an increased likelihood of criminal behavior can be explored, and the avenues for intervening to prevent or treat this problem, which also are indicated on the right in the figure, can be explored.

Where once a simple "pharmacological" theory competed with a "disinhibition" explanation of the effects of alcohol on behavior,[19] increasingly it is recognized that it is possible that alcohol intoxication may contribute to some portion of alcohol‐related aggressive and criminal behavior through its mediating effects on the physiological, cognitive, affective, or behavioral functioning of the drinker. The extent of alcohol's effects also may vary, depending on the drinker and the amount of alcohol consumed.

Evidence supporting an intoxication effect comes from emergency room (ER) studies. Using representative samples of patients, several studies have found that persons with violence‐related injuries are two to five times more likely to be intoxicated at the time of the ER visit than persons injured from other causes.[[20]] In addition, drinking prior to the event was a more powerful predictor of violent (as compared with non‐violent) injuries seen in the emergency room than was the usual amount of alcohol consumed.[22] An overview of experimental studies also suggests that there is some basis for assuming that the effects of alcohol on the drinker contribute to the likelihood of engaging in violent behavior.[23]

Efforts to understand the effects of alcohol on aggression have suggested that it intensifies violence or contributes to its escalation. One study[4] found that more severe incidents (e.g., kicking and punching) were more likely than less severe incidents to involve alcohol. Another study[24] found women (but not men) were significantly more likely to sustain an injury in an assault by an intimate partner (but not in other assaults) if the man was drinking. Variation in the effect of alcohol on violence, depending on the victim‐perpetrator relationship, also is found in NCVS data. According to those victims of violence who could describe the offender's substance use, between 1993 and 1998, 63 percent of persons victimized by an intimate (i.e., current or former spouse, intimate partner, or boyfriend/ girlfriend), but only 37 percent victimized by an acquaintance, and 29 percent victimized by a stranger perceived the offender to be using alcohol alone or in combination with other drugs.[9]

One explanation for these findings is alcohol's effects on physiological processes. For example, alcohol has been found to affect the GABA‐benzodiazepine receptor complex in the brain.[[25]] This may result in reduced anxiety about the consequences of aggressive behavior.[27] Alcohol also affects the dopaminergic system, leading to an increase in psychomotor stimulation, which, in turn, may increase the intensity and level of aggression.[28] Other studies have found that drinking initially increases serotonin but then decreases it, thereby increasing the effects of dopamine.[29] This then results in reduced impulse control, which increases the likelihood of aggression.[30]

Alcohol also affects perception and motor skills, which may in turn increase the likelihood of criminal behavior or victimization. Alcohol appears to reduce pain sensitivity, and thus may result in aggression due to reduced concern about painful consequences of action.[31] Impaired motor functioning may result in increasing the risk of provoking others by bumping into them and eliciting an aggressive response. It also increases the likelihood of erratic/dangerous driving observable by the police when intoxicated persons drive a car.

Consuming alcohol impairs cognitive functioning,[[16], [19], [32]] which may reduce the drinker's ability to think of peaceful solutions when difficult situations arise in a social setting, as well as affect attention and emotions. For example, alcohol consumption results in a narrowing of the perceptual field,[15] which subsequently was described as alcohol myopia, defined as "short sightedness in which superficially understood, immediate aspects of experience have a disproportionate influence on behavior and emotion."[33](p.923) This myopia tends to result in more extreme responses. It thus appears to prevent consideration of alternative inhibitory responses, as the individual both perceives fewer situational cues and is less aware of internal values and cues. One of the few studies to actually test the effects of cognitive impairment involved an experiment that used a balanced placebo design. Four groups of students were asked to respond to a videotaped situation involving a provocative interaction. The two groups of intoxicated individuals were less able to find a non‐aggressive solution to the provocation than those in the non‐alcohol groups.[34]

An observational study of naturally‐occurring incidents in bars frequented by young adults also supports both cognitive and attentional effects of alcohol.[35] Analyses of observational data that detailed aggressive incidents in bars found that being "focused on the present" was rated by observers as contributing to 84 percent of incidents, followed by reduced anxiety or fear (73 percent of incidents), and impaired problem‐solving (more than 60 percent of incidents).

Studies of marital conflict also suggest that alcohol affects the cognitive‐emotional aspects of couples' interaction processes.[[36]] For example, in an experimental study, maritally aggressive and nonaggressive couples first were asked to discuss an important conflict in their marriage (baseline). They then discussed their most serious conflict after the husbands had received either no alcohol, an active placebo, or an intoxicating dose (0.10 BAC) of alcohol. Alcohol led to increased husband and wife negativity over baseline, while the interactions in the couples in the placebo and no‐alcohol conditions did not change. This suggests that alcohol had a deleterious effect on the husband's problem solving.[37]

Alcohol use also may increase concerns with power and dominance issues that have been linked to male violence generally[38] and to spousal violence in particular.[39] This may arise from gender role strain promoted by an unattainable masculine ideal[40] or from a male‐dominated social structure that devalues feminine qualities and ideals.[41] In The Drinking Man, McClelland and his colleagues examined the fantasies of university students and working class men when they were sober and intoxicated.[42] They noted that the fantasies were more likely to have themes of power and domination when the men were under the influence of alcohol and that heavy drinkers were more likely to have power fantasies than men who were not heavy drinkers. The authors concluded that men drink to compensate for unconscious feelings of deficiency, avoid intimacy, and evade responsibility.

Comparative studies of alcohol‐abusing wife assaulters support the power theory. Kantor and Straus [3] found that approval of violence interacted with a pattern of heavy drinking as a significant predictor of wife assault. In their bar observation study, Graham and colleagues[35] found empirical support for the proposition that alcohol increases the likelihood of aggression by increasing power concerns among some men. Power concerns may also interact with impaired cognitive function. For example, alcohol‐impaired cognitive appraisal may result in an inappropriate sense of mastery, control, or power.[15]

The amount of alcohol consumed appears to influence the effects of drinking on cognitions and affect. Experimental studies have found that higher levels of aggression are related to higher doses of alcohol (BAC of.08 or more).[44] Husband‐to‐wife violence was found to be highest among husbands who were binge drinkers (ie, consumed five or more drinks at one sitting), followed by "high" drinkers (ie, those who consume from three times a week to daily and drink three or more drinks a day).[43] Dawson found that fighting after alcohol use in a representative sample of over 18,000 current drinkers was significantly associated with overall volume of alcohol consumption as well as the proportion of drinking days resulting in intoxication.[45] High quantity drinking additionally has been associated with drinking and driving. For example, Liu and associates[46] observe that persons who reported drinking five or more drinks in a day during the past month were 30 times more likely than other survey respondents to report driving after having "had perhaps too much to drink."

The relationship between alcohol and crime varies with factors related to the characteristics of the drinker, including demographics (ie, gender and age), the drinker's normative expectations, temperament, or personality predisposition, and general deviant attitudes. Most crimes, including alcohol‐related offenses, clearly are committed by men. Bushman's[23] meta‐analysis found larger effects of alcohol on aggression for men than women, suggesting that men may respond differently to alcohol than women. Similarly, age has been consistently related to crime,[47] marital violence,[48] and drinking and driving.[46] For example, although persons 13 through 29 years of age comprise 17 percent of the U.S. population, they made up 58 percent of the persons arrested in the United States in 1997.[47]

There are a number of general explanations for young people's deviance, including substance abuse, delinquency, and other behaviors among young persons defined as "problem behaviors" by the larger society.[[49]] For example, Jessor's problem behavior theory (PBT)[50] accounts for such deviant behaviors as substance use, aggression, delinquency, and precocious sexuality by addressing three systems of psychosocial influence: the personality system, the perceived environmental system, and the behavioral system. Within each, the explanatory variables reflect either instigations to problem behavior or controls against it. Jointly, these factors generate a dynamic state labeled "proneness" that specifies the likelihood of occurrence of normative violations or problem behavior. Thus, deviance arises through the joint role of personality and environmental systems in shaping the individual's propensity to be less controlled by social convention.

Much empirical research, based on cross‐sectional and longitudinal studies from both a community sample and national samples of adolescents (reviewed elsewhere[[51]]), supports PBT theory. These studies generally find substantial correlations among the various problem behaviors, suggesting that both alcohol use and aggression in adolescence are linked through common causes. Among the psychosocial risk factors that tend to correlate with measures of problem behavior are low value on academic achievement, high tolerance of deviance, high friends' approval for problem behaviors, and low parent‐friend compatibility.[52] Which form of deviance is manifested, however, is less predictable. It is likely to be influenced by the number and specific combination of distal risk factors, the individual's stage of development, and proximal influences arising out of specific opportunities (eg, alcohol being more readily available than marijuana or vice versa). The emergence of problem behaviors from combinations of risk factors in the personality and environment suggests that it would be advantageous to intervene as early as feasible with children by targeting malleable distal risk factors from several systems. For example, parent training programs when the children are young might improve family management practices, enhance parental and children's values on academic achievement, and increase the child's perception of parental support. These would be most appropriate for families in which there is an alcoholic parent and families in poverty and/or disorganized neighborhoods, and thus might subsequently have positive outcomes on a variety of deviant behaviors.

White's related common‐cause model postulates that substance use and crime are not directly linked but are related because they share common causes.[[50], [54]] Both are predicted by childhood risk factors, including hyperactivity, impulsivity, poor parenting, problems in school, and familial criminal behavior also identified by PBT. For example, young males account for a disproportionate share of crime and are the heaviest drinkers. Being male thus is a common link, regardless of whether this is due to biological or social factors or the subcultural norms that may reinforce both criminal behavior and substance use.

In a refinement of the common cause model, Zhang and colleagues[55] used the Buffalo Longitudinal Survey of Young Men to test the moderating role of alcohol use on four predictors of aggravated assault in adolescent males: deviant attitudes, aggression and hostility, impulsivity, and problem‐solving abilities. They found that deviant attitudes and aggression were very strong predictors of the prevalence of assault in the predictive model. However, these two main effects became non‐significant when interaction terms were added. Additional analyses showed that the relationships between deviant attitudes and the prevalence of assault were significant for heavy drinkers but not light drinkers. Similar findings were obtained for the interaction of aggression/ hostility and alcohol consumption. These findings support the argument that alcohol is linked to violent crime through an interaction effect of heavy drinking with a deviant or hostile predisposition.

Attitudes and expectations also appear to be important factors in predicting violence after drinking. Leonard and Senchak[56] found that heavy drinking was associated with higher premarital aggression, but only for men who expected alcohol to facilitate aggression. Abbey[57] identified a number of attitudinal variables that might be implicated in male sexual violence against women. These include expectancies about the effects of alcohol on sexuality, the belief that intoxication can serve as an excuse, and the stereotype that women who drink alcohol invite sex. Kantor and Straus[43] found that alcohol consumption was more strongly associated with husband‐to‐wife violence among men who approved of violence than among those who did not.

Some research has focused attention on the role that settings, situations, and circumstances play when violence occurs, and how these interact with the characteristics of the person, such as attitudes and personality factors. Experimental studies have found that some situational factors increase aggression among persons who have been of drinking, whereas other situational factors reduce or moderate the likelihood of alcohol‐related aggression. For example, situations involving high anxiety, frustration, and inhibition conflict increase aggressive responses.[58] Conversely, third‐party interventions that provided an explicit nonaggressive norm[59] and those providing monetary incentives not to aggress[60] both reduced the likelihood of alcohol‐related aggression.

Naturalistic studies provide evidence that other people in the drinking setting may play a key role in contributing to escalation of the violence through a dynamic interaction process. Particularly when both parties are intoxicated, the chances are increased that one will perceive the other s comment or look as a slight and react in a way that further escalates the tension or increases miscommunication.[[6], [61]] These findings additionally support the observation that alcohol‐related violent crimes often involve drinking by the victim as well as the perpetrator. Because the person who ends up being the "victim" often is the initiator of the aggressive interaction,[1] interventions need to reduce the likelihood of victimization without "blaming the victim."

Bars and other licensed premises have been identified as high risk drinking environments that foster both violence and drunk driving.[62] One review of factors associated with violence in public drinking contexts[44] found that the type of drinking establishment, the physical and social environment, the type of patrons, and the role of bar workers each are related to violence. For example, bars with a reputation for violence, skid row bars, and discotheques are more likely to experience violence than others,[63] as are bars that are unclean, poorly ventilated, dimly lit, and patronized primarily by groups of males rather than solo males and couples.[64] Violence in barrooms also is more likely in those bars in which there is unrestricted swearing, sexual activity, prostitution, drug use and dealing, crowding,[65] and an "anything goes" atmosphere.[63] A lack of control by bar management and staff also affects violence, in that violence is more likely to occur when there is a low staff‐to‐patron ratio and a failure to engage in responsible serving practices.[[62], [64]]

One theme found throughout the alcohol‐related crime literature is the specific social context of young men drinking in bars.[[6], [44], [62], [66]] For example, Stockwell and colleagues' household survey of alcohol‐related harm found that both violent incidents and drunk driving occurred most commonly among heavy drinking young men who drank at licensed premises.[62] Pernanen linked this to power concerns among men, proposing that in certain settings frequented by groups of young men, "the greater proportion of people displaying power concerns and resulting attitudes and behavior, the smaller will be the probability of compliance with anyone s wishes."[15](pp. 406–407)

Neighborhoods and communities also may be "hot spots" for violence. Initially, criminologists studying the geographic distribution of violence found that alcohol availability is a key factor in identifying such "hot spots." Roncek and Maier[67] found that in one medium‐sized city, city blocks with bars had higher rates of assaults, robberies, and rapes than other blocks, even after accounting for the impact of unemployment, poverty, and racial composition. Three recent studies focusing on the effects of the physical availability of alcohol on violence have found that outlet density appears to have negative consequences on communities when measured at the neighborhood level. A study of 74 cities in Los Angeles County found that the rate of assaults reported to the police was significantly associated with the density of both on‐sale and off‐sale alcohol outlets. After controlling for a variety of neighborhood factors, a 1 percent increase in the density of outlets was associated with a 0.62 percent increase in the rate of violent offenses.[68]

Using the same methodology to analyze data from 223 municipalities in New Jersey with populations greater than 10,000, Gorman and colleagues[69] found no significant association between outlet density and violence after the introduction of sociodemographic control variables. Puzzled by the inconsistent findings, the investigators conducted another study limited to Newark, NJ. They examined the relationship between sociodemographic characteristics, alcohol outlet densities, and violent crime at two smaller levels of analysis: the census tract and census block group.[70] At each level, alcohol outlet densities were significantly related to violent crime rate. This led to their conclusion that alcohol outlet densities have negative consequences on communities that only can be detected at the neighborhood level. This finding is supported by the observation that if alcohol outlets dominate a location, this feature of the local environment stimulates crime by attracting certain types of people and activities, such as drug sales, prostitution, and gang activities.[71] Thus, it appears that "broken bottles" are symbolic of neighborhood social disorder and invite crime in much the same way as "broken windows."[72]

Alcohol consumption patterns, crime rates, and the extent to which drinking is associated with aggressive or criminal behavior all differ widely across cultures as well as among subcultures within them. Cross‐cultural studies documenting this variability suggest that there is no simple causal association between alcohol and crime.[[73]] Two main aspects of cultural framing have been identified as being associated with a higher rate of alcohol‐related aggression: defining a drinking occasion as a "time out" period in which controls are loosened from usual behavior[73] and a willingness to hold a person less responsible for their actions when drinking than when sober by attributing the blame to alcohol (termed "deviance disavowal").[75] Key elements in both time out and deviance disavowal are the belief that alcohol is a cause of violent behavior, the view that the individual who is violent while intoxicated is regarded as less deviant than one who is violent without drinking, and the expectation of lessened blame, all of which influence behavior.

Some expectancies research has sought to better understand the extent to which different cultures and subcultural groups accept alcohol as an excuse for aggression and as a way of mitigating blame for crimes committed while drinking. For example, several studies have found that people in North America believe that aggression is one effect of alcohol consumption, although there is variability in expectations depending on such factors as the type of drink and gender of the drinker.[[76]]

Public opinion polls suggest that there is a widespread belief that alcohol is causally related to aggression and crime. However, being intoxicated is not necessarily accepted by the general public as an excuse for violent behavior.[79] Ironically, although the general rule in our legal system is that "intoxication is no excuse" in the determination of guilt, the U.S. legal system allows several limited exceptions. Because intoxication may be taken into consideration in sentencing,[80] the result may not be very different from a "discount for drunkenness. [81] However, empirical data are lacking on the effects of intoxication on criminal justice system outcomes, including police willingness to make an arrest, prosecutorial decision making, and judicial sentencing for various types of offenses.

As the ample empirical evidence above suggests, multiple factors contribute to the complex pathways through which alcohol affects deviant or criminal behavior. These factors include the effects of alcohol, the characteristic of the person, the drinking situation, and the cultural framing of both drinking and deviant behaviors. How might understanding of the relationships among these factors guide the implementation of preventive and treatment interventions more effectively to reduce this burden? The next section briefly sketches directions for interventions, their evaluations, and other research.

Because many factors contribute to alcohol‐related crime, effective inter‐ ventions to reduce it need to include a broad spectrum of prevention and treatment programs. It is desirable to design preventive interventions that simultaneously aim at the environment (society or community), the drinking situation, and the individual at risk of offending. Such interventions need to specify which aspects of the culture/society, situations or settings, and individuals (or the entire population) they are targeting. A related issue that remains even when targets are identified is whether prevention efforts should give priority to changing particularly high‐risk offenders involved in the CJS or the general population.

McClelland and Teplin[82] suggest focusing on those at highest risk, including the relatively small group of persons involved with the CJS. In contrast, others[[7], [83]] point to the importance of general population approaches to prevention but note that within this broader framework locally‐oriented programs may be implemented. As Mosher and Jernigan observe, "interventions at the level of the entire population have the potential to address the multiple and interactive causes of alcohol‐related violence. [83](p.11)

Population or environmental approaches rest on the understanding that drinking and alcohol‐related problems occur along a continuum. At one end are the heaviest drinkers or individuals at highest risk of problems. This group is comprised of a relatively small number o f individuals, each at very high risk. A much larger number of persons are found to be nearer the lower‐risk light and moderate drinking end of the spectrum. Consequently, the latter may create a larger aggregate burden to society, depending both on the size of the group and level of group risk. When the contribution of the larger low/ moderate risk group outweighs the relative contribution of the smaller high‐risk group, the situation is referred to as the "prevention paradox."[[84]] As Skog states[86](p. 751):

In survey data it has been found repeatedly that only a fairly modest part of alcohol‐related problems can be attributed to heavy drinkers. Light and moderate consumers are responsible for the much larger fraction of the problems, as the large number of such drinkers make up for their smaller risk. On the basis of this "prevention paradox," the claim has been made that the population strategy of prevention is much more likely to produce tangible results than the risk‐group strategy.

Support for this strategy was found for reducing drunk driving,[87] and several population survey studies suggest that the prevention paradox may be valid for violent behavior.[[88]] Since a substantial proportion of sexual assaults among acquaintances (ie, "date rape"), domestic violence incidents, and public disorder offenses are attributable to light and moderate drinkers, a population‐based strategy that reduces the overall level of drinking and intoxication may be the most effective way to lower rates of these types of alcohol‐related crime. Such an approach also may affect those at highest risk because they, too, experience the benefits of prevention efforts that shift the risk curve to the left. Because much of the alcohol‐related crime is the result of heavy drinking episodes of non‐dependent drinkers, effective prevention efforts must work to reduce the risk of intoxication across the entire population of drinkers.[84] Population prevention efforts hold great promise because they target the social structures, norms, and other aspects of the environment, thereby addressing the conditions that give rise to risky drinking practices. Nevertheless, selective intervention strategies that focus more narrowly on specific high‐risk situations, groups and individuals, and interventions targeted at particular alcohol‐related problems and the aggressive tendencies of convicted offenders also are needed. Since convicted offenders and dependent drinkers are at a disproportionately high risk of future alcohol‐related violence, altering the drinking and criminal behavior patterns of even a fraction of these high risk groups is likely to have substantial benefits.

This section reviews some universal, selective, and targeted intervention strategies to reduce alcohol‐related violence and other crimes. Although universal strategies tend to be directed at the changing cultural norms and drinking contexts, they also may be directed at individual drinkers and even at altering the effects of drinking. Strategies focusing on high‐risk groups more often are directed at the individual or social‐context.

Since alcohol‐related offenses are problems for both the criminal justice and public health system, greater communication and co‐operation among practitioners and researchers in each system is likely to enhance the effectiveness of most interventions. Criminal justice and public health experts often are isolated from each other. They need to collaborate more closely in developing and implementing strategies to reduce the harm caused by the alcohol‐ crime nexus and to more effectively link existing data systems.

Many studies document the links between both the social and physical availability of alcohol and alcohol‐related problems, including crime.[[84]] Since this research provides strong evidence that increased alcohol availability increases rates of problems, a key to preventing alcohol‐related crime involves implementing environmental policies that limit the social and physical availability of alcohol. Such policies may be public, institutional, or both. Public policies that regulate alcohol availability are found at federal, state, and local levels of government; institutional policies regulate alcohol availability and drinking patterns through their effects in such institutional settings as alcohol outlets and worksites. Public policies may include regulations on how, where, and when alcohol is sold; where and when alcohol is consumed; the price of alcohol; the social environment related to drinking; enforcement mechanisms; and regulations on access to alcohol by minors. Although many of these policy approaches have been implemented and evaluated, those evaluations rarely have examined their impact on alcohol‐related crime in particular. Where alcohol‐related crime has been studied will be indicated, as will other interventions that appear promising and require further study.

Reducing Alcohol's Physical Availability. One policy intervention, raising the minimum legal drinking age to 21 in the United States, has been found to reduce drinking and driving among both underage and young adult drivers[90], and it probably reduced youth homicide rates as well.[91] Research cited in the previous section[[67]] confirms that alcohol outlet density at the neighborhood level is related to both violent assaults and drunk driving in the local community. Although all states and communities regulate alcohol sale and service, some communities have recently adopted a variety of zoning and planning initiatives to restrict new liquor licenses and challenge relicensing decisions, and the effectiveness of these efforts has rarely been evaluated.[92] The limited evidence to date, nevertheless, suggests that lowering outlet density in neighborhoods with "hot spots" of crime will reduce alcohol‐related offenses, including DWI, in the surrounding area.

Several states have mandated policies targeting operational practices of alcohol retailers through Responsible Beverage Service (RBS) programs and server liability legislation.[84] In other states and communities, such programs have been implemented voluntarily. These programs put into effect in local settings to alter the immediate drinking context include training staff to identify and refuse sales to obviously intoxicated patrons, implementing policies such as limiting the number of drinks served to a customer per hour, and providing increased food service. Although there is some evidence that RBS reduces the risk of patron intoxication[93] and traffic crashes,[94] it has been less effective in cutting off service to intoxicated and underage patrons.[84] One Australian intervention program was designed specifically to provide violence prevention training for pub licensees and staff. The training program resulted in an improvement in serving practices and policies that resulted in a lower rate of aggressive incidents inside these venues.[63]'[64] Similarly, a recent pilot test of the Safer Bars Training program implemented in Ontario, Canada, increased knowledge and changed attitudes among bar staff about the prevention and reduction of violence in bars.[95] Thus, training bar staff to prevent and manage aggressive behaviors in licensed establishments, as well as the active involvement of management in these goals, not only may reduce intoxication rates but may also directly address alcohol‐related violence. Such interventions may be most effective if they are accompanied by law enforcement monitoring of "hot spot" licensed establishments.

Strategies to reduce alcohol availability have been hampered by weak enforcement. For example, commercial suppliers routinely violate laws against providing alcohol to minors and intoxicated patrons. Two studies observed decreases in intoxicated patrons after law enforcement agencies conducted highly publicized programs to enforce laws against sales to obviously intoxicated patrons.[[96]] Thus a promising avenue for reducing alcohol‐related violence would be a combination of RBS training and enhanced law enforcement monitoring of the laws prohibiting service to intoxicated bar patrons, since these individuals are at greatly increased risk.

Despite the 21‐year minimum legal drinking age laws, minors have little difficulty gaining access to alcohol,[98] although they are less likely to drink in bars and licensed establishments.[84] Since adolescents and young adults are responsible for a disproportionate amount of alcohol‐related violence, universal strategies designed to reduce alcohol availability to youth also are likely to have an impact on their law‐related problems. Policies designed to reduce youth access include keg registration, enhancement of drivers' licenses, and penalties for having a false ID. These have been found to reduce DWI,[84] and their effects on alcohol‐related violence, though unknown, are potentially large.

Increasing the Price of Alcohol. A convincing body of research shows that increasing alcohol prices by raising alcohol excise taxes reduces alcohol consumption as well as alcohol problems, including violence[99] and motor vehicle fatalities.[100] State and federal excise taxes on alcoholic beverages have been largely static over the last five decades. The effect of inflation during the same period has resulted in a relative drop in the price of alcoholic beverages. One analysis examined the effects on crime rates of a hypothetical 10 percent increase in state excise taxes. It used data on state excise taxes for the 48 contiguous states from 1979 to 1988 and rates of violent crimes from the FBI's Uniform Crime reports. It estimated that an increase of 10 percent in state beer tax would reduce rape by 1.3 percent, assaults by 0.3 percent and robberies by 0.9 percent by reducing per capita consumption.[73] Both increases in excise taxes to reduce alcohol‐related crime and studies of the impact of such changes on various types of crime are desirable.

Altering the Social Environment. Both alcohol advertising and public health messages to counter advertising's effect are important aspects of a universal strategy. For example, a combination of effective laws, highly publicized enforcement, and public information and education were effective in reducing alcohol‐related traffic fatalities in the United States from 25,165 in 1982 to an estimated 15,794 in 1999.[101] Alcohol advertising and promotion send powerful messages regarding alcohol use, implying that it brings social and sexual success, relief from stress, and adult status. According to a recent Federal Trade Commission (FTC) report, the beer, wine, and distilled spirits industries spend at least $4 billion annually on promotional activities.[102] The research regarding the impact of alcohol marketing on alcohol‐related consumption and problems is equivocal and limited by methodological problems.[103] Nevertheless several studies [[104]] have found that alcohol advertising does have a measurable impact on consumption and problems. Even without research demonstrating a direct link to consumption, there is evidence of the influence of alcohol advertising on the norms and values of the society,[106] which suggests the need to carefully monitor advertisements and study their effects.

To limit the effects of alcohol advertising and promotion and the norms and attitudes that they foster, public health activists have sought to use the media and other information sources to provide accurate information and challenge mis‐perceptions. They have implemented initiatives involving media advocacy[107] and other media‐based counter advertising approaches. For example, to address the observation that youths overestimate the amount of alcohol consumed by their peers,[108] an initiative to reduce college alcohol‐related problems using social norms marketing has been implemented. Preliminary findings from a media campaign to correct students' perceptions of how much their peers drink shows decreases in rates of high‐risk drinking.[109] Although social norms marketing still has not been rigorously evaluated, this approach may also reduce the high rates of date rape and vandalism in the student population that frequently are associated with binge drinking.

Multiple strategies were combined in a coordinated Community Prevention Trial (CPT) study designed to reduce alcohol‐related trauma through the synergistic effects of simultaneously implementing a number of intervention strategies in three[107] experimental communities.[107] The CPT's intervention components included community mobilization, media advocacy, increased drinking/driving enforcement, initiation of RBS, and police monitoring and enforcement of responsible service and underage drinking laws.[107] In one of the three experimental communities and its matched control community, surveys were conducted in emergency rooms and hospital records were examined on a monthly basis to determine assault rates. Relative to the control community, assaults seen in the hospital in the experimental community declined 43 percent and hospitalized assault cases fell by 2 percent, suggesting an overall reduction in violence that is consistent with reduction in heavy drinking. There also was a 10 percent decrease in nighttime injury crashes and a 6 percent reduction in DWI crashes.[110] The demonstrated greater effectiveness of the combination of intervention strategies in reducing assaults suggests the desirability of replicating the study in communities in different regions and/or with different racial/ethnic and economic mixes.

Preventive interventions also may target populations that are at high risk for alcohol‐related violence but have not been identified in a criminal justice setting. Interventions also may focus on changing high‐risk locations and settings in which such individuals are found. Ideally, a selective prevention strategy should identify risky settings, groups, and individuals before violence occurs or at the first instance of violent behavior and tailor interventions to the developmental stage of the designated person's or setting's particular problems. High‐risk groups for subsequent alcohol‐related violence for whom interventions might be designed include young children with criminal and/or substance‐abusing parents, hyperactive pre‐school children, victims of violence who are seen in emergency rooms, newly married couples in which one partner is a heavy drinker, first‐time domestic violence offenders, members of college fraternities, and persons in alcoholism treatment.

For example, interventions might focus on victims of violence who appear in emergency rooms. These may be beneficial because injured persons are at elevated risk for further victimization and because suffering an injury may provide a "teachable moment," given the recency of the event and the patient's emotional state. Findings from a number of interventions in medical settings with adult problem drinkers[111] and older adolescents [112] suggest the utility of both routine alcohol assessments and the implementation of brief interventions in that setting with this high‐risk population. In one study, a brief motivational interview for reducing the harm associated with drinking was implemented among alcohol‐positive adolescents who were ER patients. The intervention was found to be effective in reducing both subsequent alcohol‐related injuries and drinking and driving[113] and thus also may reduce assaultive behavior.

Men in treatment for alcoholism constitute another high‐risk group because they have been found to have high rates of domestic violence. One program that involved behavioral marital therapy along with the alcoholism treatment found that participants' domestic violence rates were reduced from the year before to the year after treatment.[113] O'Farrell and Murphy[114] replicated this finding but observed that only alcoholics who were in remission reduced partner violence; those who relapsed after treatment did not.

Feminists and service providers often resist incorporating alcohol treatment into programs for domestic batterers to avoid providing them with an excuse for such violence. However, it may be time to reconsider this position. Although successful alcohol treatment does not necessarily lead to reduced partner violence, failure to address abusers' alcohol problems is likely to undermine positive effects of batterers' treatment that may occur. Thus, it is desirable for the criminal justice response to domestic violence to include alcohol assessment and mandatory treatment as an additional condition of a sentence, not as an alternative to a sanction. In addition, linkages between domestic violence and alcohol treatment programs, which now are infrequent, need to be expanded through efforts to address the philosophical, structural, and practical impediments to such linkage, and the effects of such changes should be evaluated.[115]

A wide variety of alcohol treatments currently are available, including cognitive behavioral therapy, motivational enhancement therapy, 12‐step programs, and pharmacotherapy. These treatment approaches also may be used in combination, depending on the individual's treatment needs. The first step is determining the offender's treatment needs. Surveys of probation and correctional populations indicate that those are enormous.[116] For example, about 40 percent of adult male and 29 percent of female jail inmates were drinking at the time of their offense; about a third of convicted inmates in local jails described themselves as having been daily drinkers at the time of their offense.[9] Among state prisoners, nearly 30 percent were daily drinkers during the period preceding their incarceration, and about a quarter of both men and women it standard diagnostic profile of alcohol dependence.[9] Given the magnitude of the alcohol problem for the CJS, arrestees routinely should be screened for alcohol and other drug problems. For those that appear to have abuse or dependence problems, fuller assessment of substance abuse involvement and inclusion of appropriate treatment should be included as part of, not as a substitute for, the sentence imposed by the court.

Although most interventions with offenders will focus on changing the effects of alcohol (through pharmacotherapy) and offenders' expectancies and behaviors (through behavioral treatments), other interventions may be undertaken at the community or policy level. These include policies that increase government funding for CJS treatment programs and personnel. This would permit more careful monitoring of offenders in the community, greater oversight by the courts of the quality of programs in which alcohol‐abusing offenders sentenced to probation participate, more attention to offenders' compliance with court‐ordered sanctions, and imposition of further sanctions for failure to comply with program requirements.

Other policies include the recent development of innovative specialized courts. Based on positive preliminary findings in drug courts[117] and the Dade County Domestic Violence Court experiment,[118] it would be desirable to expand such innovative programs to DWI offenders, alcohol‐involved spouse abusers, and even to first offenders convicted of a violent offense in which no weapon is involved. Non‐incarcerative sentences for these offenders would be based on the drug court and Dade County models that combine treatment with close supervision.

There is ample evidence that treatment of substance‐abusing offenders is both effective and cost effective.[[117], [119]] Yet only 62 percent of probationers and 39 percent of state prison inmates who were drinking at the time of their offense received any treatment after being put on probation or entering prison, respectively.[9] Most of the offenders participated in self‐help groups or peer counseling; a far smaller proportion received treatment or professional counseling.[9] Funding to expand substance abuse treatment programs in the correctional system requires both policy changes and program implementation. Nevertheless, these programs, accompanied by post‐release planning, increased monitoring, and more after‐care services for those who need them, also are likely to decrease subsequent alcohol‐ related crime.

The costs of alcohol‐related crime in lives and dollars are enormous. The burden falls on both the abuser and his/her household, the victims, and the public through criminal justice system expenses. Despite falling crime rates, the number of persons under correctional supervision with alcohol problems has grown in the past decade. This suggests the need to combine population‐wide approaches to further reduce overall rates of intoxication, more targeted intervention approaches to change the drinking behavior and/or the drinking environment of high‐risk groups, and increased availability of alcoholism treatment for dependent offenders in order to reduce alcohol‐related crime. Rigorous evaluations of the implementation and effectiveness of these efforts also are needed.

A comprehensive agenda of research on all aspects of alcohol‐related crime is beyond the scope of this article. Nevertheless, additional survey, experimental, and observation studies can serve as the basis for further interventions if they elaborate on how the various risk and protective factors mediate and moderate alcohol‐related violence for certain groups and the specific contexts in which they occur. Among the issues to be explored in surveys is an explanation of the recent decrease in alcohol‐related crime. An analysis of recent NCVS data covering 1993 through 1998 found that although there was an overall decrease of 23 percent in violent crimes, alcohol‐related violent offenses decreased by 31 percent, whereas crimes not involving a drinking offender fell by only 20 percent.[9] It is unclear to what extent these decreases are due to community policing programs, the changing demographics of the American population, decreases in drinking among high‐risk groups, or other factors. To address questions related to the changing role of alcohol in crime, however, requires the expansion of the survey instruments currently being used in several national data collection efforts (eg, NCVS and prisoner surveys) and/or much larger samples in new surveys focused on alcohol use and abuse.

Observational studies of violence might be conducted in bars and informal drinking settings, such as parks and fraternity houses. These could help pinpoint the situational factors that contribute to alcohol‐related violence and the mechanisms through which escalation of incidents occurs. Given the limits of studying alcohol‐related violence in a natural setting, additional experimental research on alcohol‐related aggression in controlled settings also might explore how the effects of alcohol on aggressive behavior are mediated by cognitive and affective factors. In depth interviews with victims and perpetrators might probe their experiences with violent and threatening situations to better understand the incident escalation process. Incidents that involve or do not involve alcohol might be compared with respect to the interaction processes and outcomes and how these are mediated by individual personality factors and victim‐ assailant relationships. Additionally, the effect of alcohol intoxication on criminal justice decision‐making merits further examination.

There are many ongoing intervention studies designed to reduce alcohol availability, consumption, and problem drinking. Too often, however, the outcome measures being used are limited to determining the quantity and frequency of drinking and/or patterns of alcohol consumption. It would be desirable if more investigators expanded their measures to include the effects of their interventions on a range of alcohol‐related problems, including crime and injuries.

The role of alcohol in criminal behavior is not yet fully understood. Nevertheless, there are a number of promising population strategies and individual‐oriented treatment approaches identified in this article. Expanded efforts to systematically implement and rigorously evaluate these approaches is likely to reduce alcohol‐related crime and the burden of alcohol on the criminal justice system, the victims of crime, and the society at large.