ABSTRACT

Objective:

to analyze the discourse of women on the interface between marital violence and alcohol use by the partner.

Method:

qualitative exploratory research, based on the methodological reference of oral history. We interviewed 19 women with a history of marital violence and involvement with drugs. The data were analyzed through discourse of the collective subject.

Results:

the participants’ discourse points to consumption of alcohol by partners as a potentiating element of violent episodes, also experienced by their parents, signaling to its transgenerational character; it also calls attention to the danger of marital violence resulting from men’s reactions to having their alcohol consumption questioned by their partners.

Final considerations:

the study identifies alcohol as a precipitating and/or potentiating factor of conjugal violence, as well as the intergenerational character of violence based on male domination and intolerance.

Descriptors:
Violence Against Women; Intimate Partner Violence; Drug Users; Nursing; Health Promotion

RESUMEN

Objetivo:

analizar el discurso de las mujeres sobre la interfaz entre la violencia conyugal y el uso de alcohol por el compañero.

Método:

investigación exploratoria, cualitativa, basada en el referencial metodológico de la historia oral. Se entrevistaron a 19 mujeres con antecedentes de violencia conyugal e implicación con drogas. Los datos fueron analizados a través del discurso del sujeto colectivo.

Resultados:

el discurso de las participantes apunta el consumo del alcohol por el compañero como elemento impulsor de los episodios violentos, evento también experimentado por los padres, señalando para su carácter transgeneracional; advierte también a la violencia conyugal derivada de la reacción del hombre al ser cuestionado por la compañera en cuanto al consumo del alcohol.

Consideraciones finales:

el estudio identifica el alcohol como factor precipitador y/o impulsor de la violencia conyugal, así como el carácter intergeneracional de la violencia basada en la concepción de dominación e intolerancia masculina.

Descriptores:
Violencia Contra la Mujer; Violencia de Pareja; Consumidores de Drogas; Enfermería; Promoción de la Salud

RESUMO

Objetivo:

analisar o discurso de mulheres sobre a interface entre violência conjugal e uso de álcool pelo companheiro.

Método:

pesquisa exploratória, qualitativa, fundamentada no referencial metodológico da história oral. Foram entrevistadas 19 mulheres com história de violência conjugal e envolvimento com drogas. Os dados foram analisados através do discurso do sujeito coletivo.

Resultados:

o discurso das participantes aponta o consumo do álcool pelo companheiro como elemento potencializador dos episódios violentos, evento também experienciado pelos pais, sinalizando para seu caráter transgeracional; alerta ainda para a violência conjugal decorrente da reação do homem ao ser questionado pela companheira quanto ao consumo do álcool.

Considerações finais:

o estudo identifica o álcool como fator precipitador e/ou potencializador da violência conjugal, bem como o caráter intergeracional da violência alicerçada na concepção de dominação e intolerância masculina.

Descritores:
Violência Contra a Mulher; Violência por Parceiro Íntimo; Usuários de Drogas; Enfermagem; Promoção da Saúde

INTRODUCTION

Violence against women represents a major challenge in the area of public health and safety, resulting in sickness and having repercussions on economic productivity. Confronting this issue requires professional preparation, so it can be identified early, especially when it is interfaced with consumption of alcohol and other drugs.

Several studies point out the damages to the physical and psychological health of women, generating costs for the health sector⁽¹1 Acosta DF, Gomes VLO, Fonseca AD, Gomes GC. Violência contra a mulher por parceiro íntimo:(in) visibilidade do problema. Texto Contexto Enferm[Internet]. 2015[cited 2017 May 27];24(1):121-7. Available from: http://www.scielo.br/pdf/tce/v24n1/pt_0104-0707-tce-24-01-00121.pdf
http://www.scielo.br/pdf/tce/v24n1/pt_01...

2 Dourado SM, Noronha CV. Visible and invisible marks: facial injuries suffered by women as the result of acts of domestic violence. Ciênc Saúde Colet[Internet]. 2015[cited 2017 Jun 22];20(9):2911-20. Available from: http://www.scielo.br/pdf/csc/v20n9/en_1413-8123-csc-20-09-2911.pdf
http://www.scielo.br/pdf/csc/v20n9/en_14...

3 Begum S, Donta B, Nair S, Prakasam CP. Socio-demographic factors associated with domestic violence in urban slums, Mumbai, Maharashtra, India. Indian J Med Res[Internet]. 2015[cited 2017 Jan 23];141(6):783-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525403/
https://www.ncbi.nlm.nih.gov/pmc/article...

4 Thureau S, Le Blanc-Louvry I, Thureau S, Gricourt C, Proust B. Conjugal violence: a comparison of violence against men by women and women by men. J Forensic Leg Med[Internet]. 2015[cited 2017 Jun 21];31:42-6. Available from: http://www.jflmjournal.org/article/S1752-928X(14)00230-3/fulltext
http://www.jflmjournal.org/article/S1752... ^-55 Islam MJ, Broidy L, Baird K, Mazerolle P. Intimate partner violence around the time of pregnancy and postpartum depression: the experience of women of Bangladesh. PLoS One[Internet]. 2017[cited 2017 Jun 29];12(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417480/
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾. This issue has been severely affecting families and society due to high numbers of morbidity and mortality. The Map of Violence (2014) identified the occurrence of 2.4 times more female homicides in Brazil than the international average, making it the world’s fifth-highest in the number of women killed by aggression. As for morbidity, in the same year, 147.691 women needed medical attention as a result of violence, a burden on public finances⁽⁶6 Waiselfisz JJ. Mapa da Violência 2016: homicídios por armas de fogo no Brasil. Flacso Brasil[Internet]. 2015[cited 2017 May 30]. 71p. Available from: http://www.mapadaviolencia.org.br/pdf2016/Mapa2016_armas_web.pdf
http://www.mapadaviolencia.org.br/pdf201... ⁾.

Considering the magnitude and implications of violence against women, certain mechanisms were built with the aim of preventing and confronting the phenomenon. Law No. 11.340⁽⁷7 Brasil. Lei n.º 11.340, de 7 de agosto de 2006. Cria mecanismos para coibir a violência doméstica e familiar contra a mulher. Diário Oficial da República Federativa do Brasil, de 8 de agosto de 2006. p.1.⁾ created devices to curb domestic and family violence, typifying expressions of violence into five forms: physical, which corresponds to any conduct that affects the integrity of the body; sexual, characterized by impositions that nullify the exercise of women’s sexual and reproductive rights; patrimonial, identified as subtraction or destruction of objects or economic resources as a strategy of domination; moral, associated with slander, defamation and insults; and, finally, psychological, related to actions aiming to degrade or control the actions of women.

Regardless of its form of expression, the experience of violence triggers physical and mental illness resulting from direct injuries, presented through bruising, lacerations and fractures caused by physical aggression, or even from somatization, characterized as mental and physical symptoms of emotional origin, such as insomnia, low self-esteem, panic disorder, gastric ulcers and hypertension⁽¹1 Acosta DF, Gomes VLO, Fonseca AD, Gomes GC. Violência contra a mulher por parceiro íntimo:(in) visibilidade do problema. Texto Contexto Enferm[Internet]. 2015[cited 2017 May 27];24(1):121-7. Available from: http://www.scielo.br/pdf/tce/v24n1/pt_0104-0707-tce-24-01-00121.pdf
http://www.scielo.br/pdf/tce/v24n1/pt_01... ⁾. Observation of damages to the physical integrity of victims is corroborated by a study made in France, which also refers to cuts and avulsions, warning that these injuries can lead to death⁽⁴4 Thureau S, Le Blanc-Louvry I, Thureau S, Gricourt C, Proust B. Conjugal violence: a comparison of violence against men by women and women by men. J Forensic Leg Med[Internet]. 2015[cited 2017 Jun 21];31:42-6. Available from: http://www.jflmjournal.org/article/S1752-928X(14)00230-3/fulltext
http://www.jflmjournal.org/article/S1752... ⁾.

While all these health hazards are already typified, practitioners find it difficult to recognize and address the situation. This is due to professionals’ insufficient training and also the social construction of gender, which makes it difficult for hospitalized women to admit the situation of domestic violence⁽⁸8 Cruz NM, Tavares VS, Gomes NP, Silva Filho CC, Magalhães JRF, Estrela FM. Meanings of the reports of violence against women: a descriptive study. O Braz J Nurs[Internet]. 2015[cited 2017 May 26];14(2):144-50. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4717
http://www.objnursing.uff.br/index.php/n... ⁾. A research developed in Israel also reveals that primary care-focused health professionals do not commonly recognize cases of domestic violence. Consequently, injuries go without being notified, and physical and psychological repercussions are not perceived: when it comes to health care professionals, these elements remain invisible⁽⁹9 Daoud N, Sergienko R, Shoham-Vardi I. Intimate partner violence prevalence, recurrence, types, and risk factors among Arab, and Jewish immigrant and nonimmigrant women of childbearing age in Israel. J Interpers Violence[Internet]. 2017[cited 2017 Jun 21]. Available from: http://journals.sagepub.com/doi/10.1177/0886260517705665
http://journals.sagepub.com/doi/10.1177/... ⁾. In Turkey, a research with nursing students addressed the non-recognition of cases of violence, suggesting integration of courses on the subject into the nursing curriculum to help detect signs of violence against women⁽¹⁰10 Tambag H, Turan Z. Ability of nursing students to recognize signs of violence against women. Int J Nurs Knowl[Internet]. 2015[cited 2017 Apr 23];26(3):107-12. Available from: http://onlinelibrary.wiley.com/doi/10.1111/2047-3095.12050/full
http://onlinelibrary.wiley.com/doi/10.11... ⁾.

The difficulty of addressing marital violence in the healthcare network is also a reflection of the multiplicity and complexity of elements associated with the phenomenon, such as low levels of education and involvement with alcohol and other drugs. The latter stands out in the literature as an important component of conjugal violence. However, studies rarely point out which aspects of drug involvement are related to the occurrence of domestic aggravation⁽¹¹11 Vieira LB, Cortes LF, Padoin SMM, Souza IEO, Paula CC, Terra MG. Abuso de álcool e drogas e violência contra as mulheres: denuncia de vividos. Rev Bras Enferm[Internet]. 2014[cited 2017 Apr 27];67(3):366-72. Available from: http://www.scielo.br/pdf/reben/v67n3/0034-7167-reben-67-03-0366.pdf
http://www.scielo.br/pdf/reben/v67n3/003...

12 Razera J, Cenci CMB, Falcke D. Violência doméstica e transgeracionalidade: um estudo de caso. Rev Psicol IMED[Internet]. 2014[cited 2017 May 9];6(1):47-51. Available from: https://dialnet.unirioja.es/descarga/articulo/5154960.pdf
https://dialnet.unirioja.es/descarga/art... ^-1313 Silva ACLG, Coelho EBS, Njaine K. Violência conjugal: as controvérsias no relato dos parceiros íntimos em inquéritos policiais. Ciênc Saúde Colet[Internet]. 2014[cited 2017 Apr 3];19(4):1255-62. Available from: http://www.scielo.br/pdf/csc/v19n4/1413-8123-csc-19-04-01255.pdf
http://www.scielo.br/pdf/csc/v19n4/1413-... ⁾. Authors from the US and India emphasize that there is no clear understanding of the relationship between alcohol and increased risk of violence, which attest to the importance of future studies examining this association⁽¹⁴14 Eckhardt CI, Parrott DJ, Sprunger JG. Mechanims of alcohol-facilitated intimate partner violence. Violence Against Women[Internet]. 2015[cited 2017 Jun 22];21(8):939-57. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795825/
https://www.ncbi.nlm.nih.gov/pmc/article... ^-1515 Ramadugu S, Jayaram PV, Srivastava K, Chatterjee K, Madhusudan T. Understanding intimate partner violence and its correlates. Ind Psychiatry J[Internet]. 2015[cited 2017 Jun 21];24(2):172-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866346/
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾. Faced with such a gap, we outline the following research question: what is the discourse of women on the interface between conjugal violence and their partners’ consumption of alcohol?

OBJECTIVE

To analyze the discourse of women on the interface between conjugal violence and the consumption of alcohol by the partner.

METHOD

Ethical aspects

The scope of this study was developed in the thesis Vivências, vulnerabilidades e enfrentamentos da violência conjugal: discurso de mulheres envolvidas com drogas, approved by the Research Ethics Committee of the State University of Bahia, and complies with the ethical and legal provisions contained in Resolution 466/12 of the National Health Council⁽¹⁶16 Brasil. Ministério da Saúde. Conselho Nacional de Saúde. Resolução n. 466, de 12 de dezembro de 2012. Diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União 13 junho de 2012; Seção 1.⁾. Data collection was initiated only after the signing of an Informed Consent Term by the women, who chose to perform the interview in their own homes or residences of people close to them. In these residences, a space was chosen that would guarantee privacy during the collection of data.

Type of study and methodological reference

This research had a qualitative approach, based on the semi-structured interview, a technique that allows the exploration of sensitive subjects, providing rich information and detailed perceptions and experiences, broadening the knowledge on investigated social objects⁽¹⁷17 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; 2014⁾.

Scenario of the study

The research was carried out in the coverage area of two family health units (USFs), located in the urban zone of a municipality in the interior of Bahia (Brazil). According to data from Ipea⁽¹⁸18 IPEA. Atlas de violência 2016. Brasília: Instituto de Pesquisa Econômica Aplicada; 2016.⁾ (2016), the municipality is one of the most violent in the country, a situation evidenced by the 1136.9% increase in the homicide rate during the assessed period, due to deterioration of security conditions and high social vulnerability.

Data source

The study was carried out with 19 women residing in the referred municipality. Inclusion criteria were the following: to reside in the area covered by one of the two family health units, to have a history of marital violence and involvement with drugs, and an age equal to or greater than 18 years. Exclusion criteria were: signs of emotional instability, expressed by the greater tendency for panic disorders, states of negativity and depression, and to be using drugs or suffering from substance withdrawal syndrome. Evaluation of emotional instability was carried out by the researcher, in some cases with the support of a psychologist from the local Psychosocial Care Center for Alcohol and Drugs and also from the Family Health Support Center. The number of collaborators was limited due to the difficulty of identifying women who experience the phenomena of conjugal violence and involvement with drugs.

Approach to the community was supported by community health agents, who made visits in the coverage area of the health units possible. Several home visits were considered necessary in order to promote a bond between researcher and interviewee, developing a trustworthiness for the sharing of experiences.

Data collection and organization

Data collection was performed between October 2016 and February 2017. Recovery of memories of women involved with alcohol and situations of conjugal violence occurred through an in-depth interview. Individual interviews were recorded, with their narrative organization being performed only after transcription, textualization, and transcreation. Transcription consists in the faithful conversion of the recorded content to written form. During the textualization stage, after incorporation of answers, the first-person narrative is organized chronologically, facilitating the comprehension of the person’s experience. The last phase corresponded to transcreation, meaning the elaboration of a complete textual registry, enriched with extratextual elements from the field diaries.

Data Analysis

Data were analyzed through comparison between interviews, in view of the opinions, perspectives and facts reported. This analysis was guided by discourse of the collective subject, a method for grouping individual expressions that have similar senses, so as to establish general semantic categories⁽¹⁹19 Lefevre F, Lefevre AMC. Discurso do sujeito coletivo: representações sociais e intervenções comunicativas. Texto Contexto Enferm[Internet]. 2014[cited 2017 Apr 27];23(2):502-7. Available from: http://www.scielo.br/pdf/tce/v23n2/pt_0104-0707-tce-23-02-00502.pdf
http://www.scielo.br/pdf/tce/v23n2/pt_01... ⁾. Thus, the content of the interviews was converted into a synthesis-statement, written in the first-person singular, as a kind of synthetical expression of the collective. Results were anchored in the produced knowledge on marital violence and drugs, and in the analytical category of gender.

RESULTS

The 19 collaborators, women in situations of conjugal violence and involved with drugs, were between 20 and 69 years old. They were mostly black, Catholic, married or in stable union and had one to three children, little schooling and monthly incomes of less than a minimum wage. In respect to drug involvement, most reported frequent abuse of alcoholic beverages and cigarettes, in addition to use of benzodiazepines. The women also reported frequent abuse of alcohol and cigarettes by their companions.

The interface between partners’ alcohol consumption and marital violence was revealed by collective discourses organized in the following categories: “Alcohol potentiates partner’s violent behavior,” “Partner reacts violently to being questioned about his alcohol consumption,” and “Intra-family violence permeated by partner’s use of alcohol is transgenerational.”

Idea-synthesis 1: Alcohol potentiates partner’s violent behavior

In this discourse, women point to effects of alcohol on the daily habits of their peers, including potentiating violent episodes, expressed in various ways.

Idea-synthesis 2: Partner reacts violently to being questioned about his alcohol consumption

The discourses also reveal that when asked about alcohol consumption the husbands react violently, which demonstrates the interface between conjugal violence and men being questioned about their drug use.

Idea-synthesis 3: Intra-family violence permeated by partner’s use of alcohol is transgenerational

In their discourse, women reveal that their own family follows the same patterns as their parents’ family: the partner uses alcohol and harasses his wife and children; and the woman naturalizes this condition. This transgenerationality of intrafamily abuse predisposes women to experience conjugal violence.

DISCUSSION

The discourse of women in situations of conjugal violence and involvement with drugs reveals the relationship between alcohol consumption by the partner and the triggering of conjugal violence. From this perspective, men that are socially perceived as non-aggressive begin to behave violently, and those with already violent behaviors manifest them in a potentialized way. This is corroborated by national and international studies showing how male partners’ use of alcohol plays an important role in domestic violence: drinking behavior is demonstrably not only a direct cause of disagreement between couples, but also a factor of violence⁽³3 Begum S, Donta B, Nair S, Prakasam CP. Socio-demographic factors associated with domestic violence in urban slums, Mumbai, Maharashtra, India. Indian J Med Res[Internet]. 2015[cited 2017 Jan 23];141(6):783-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525403/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,1414 Eckhardt CI, Parrott DJ, Sprunger JG. Mechanims of alcohol-facilitated intimate partner violence. Violence Against Women[Internet]. 2015[cited 2017 Jun 22];21(8):939-57. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795825/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,2020 Leite FMC, Amorim MHC, Wehrmeister FC, Gigante DP. Violence against women, Espírito Santo, Brazil. Rev Saúde Pública[Internet]. 2017[cited 2017 Jun 05];51:33. Available from: http://www.scielo.br/pdf/rsp/v51/0034-8910-rsp-S1518-87872017051006815.pdf
http://www.scielo.br/pdf/rsp/v51/0034-89... ^-2121 Vasconcelos MS, Holanda VR, Alburqueque TT. Profile of the aggressor and factors associated with violence against women. Cogitare Enferm[Internet]. 2016[cited 2017 May 20];21(1):1-10. Available from: http://docs.bvsalud.org/biblioref/2016/07/698/41960-171298-1-pb.pdf
http://docs.bvsalud.org/biblioref/2016/0... ⁾.

Although this study does not establish a cause and effect relationship between use of psychoactive substances and occurrence of violent acts, the former’s role as a violence enhancer can be explained by the effects of the substance on the body. Neurotransmitter stimulation triggered by the drug inhibits several neural regions and, consequently, generates structural and behavioral changes in the individual⁽²²22 Haes TM, Clé DV, Nunes TF, Roriz-Filho JS, Moriguti JC. Álcool e sistema nervoso central. Med [Internet]. 2010[cited 2017 Apr 13];43(2):153-63. Available from: http://www.revistas.usp.br/rmrp/article/view/173/174
http://www.revistas.usp.br/rmrp/article/... ⁾. These neurological disorders alter the integrative control of the functions of the organism and affect the neural processes that determine behavior, generating inability to make rational decisions, mood inconstancy, euphoria, and intolerance to certain situations⁽²³23 Santos MD, Araújo MF, Silva ES, Pinto MB, Santos NCCB, Menezes CCPS. Teenagers and youth perception about alcohol pathophysiology and influence this on consumption. Rev Enferm UFPE[Internet]. 2016[cited 2017 May 27];10(9):3241-50. Available from: http://www.revista.ufpe.br/revistaenfermagem/index.php/revista/article/view/9416/pdf_10953
http://www.revista.ufpe.br/revistaenferm... ⁾.

With loss of critical sense and control of actions, the inability to make rational decisions and intolerance in the face of certain situations become mainly responsible for inhibiting self-control. This inhibition deprives the person of the ability to discern morally accepted behaviors, contributing to the adoption of violent behaviors⁽²⁴24 Lopes APAT, Ganassin GS, Marcon SS, Decesaro MN. Abuso de bebida alcoólica e sua relação no contexto familiar. Estud Psicol[Internet]. 2015[cited 2017 Jun 22];20(1):22-30. Available from: http://www.scielo.br/pdf/epsic/v20n1/1413-294X-epsic-20-01-0022.pdf
http://www.scielo.br/pdf/epsic/v20n1/141... ⁾. This effect of alcohol on the behavior of the individual explains the relationship between aggressions experienced by women and abuse of alcohol and other drugs by their partners, as well as the fact that men demonstrate more peaceful behaviors when free from the effect of psychoactive substances⁽¹¹11 Vieira LB, Cortes LF, Padoin SMM, Souza IEO, Paula CC, Terra MG. Abuso de álcool e drogas e violência contra as mulheres: denuncia de vividos. Rev Bras Enferm[Internet]. 2014[cited 2017 Apr 27];67(3):366-72. Available from: http://www.scielo.br/pdf/reben/v67n3/0034-7167-reben-67-03-0366.pdf
http://www.scielo.br/pdf/reben/v67n3/003... ⁾. Corroborating this idea, a study conducted in India, with 272 couples, and in South Africa, with 1388 women, revealed that alcohol use by the partners represented an increased risk factor for aggression⁽¹⁵15 Ramadugu S, Jayaram PV, Srivastava K, Chatterjee K, Madhusudan T. Understanding intimate partner violence and its correlates. Ind Psychiatry J[Internet]. 2015[cited 2017 Jun 21];24(2):172-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866346/
https://www.ncbi.nlm.nih.gov/pmc/article... ^,2525 Pipitan EV, Kalichman SC, Eaton LA, Cain D, Sikkema KJ, Skinner D, et al. Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa. J Behav Med[Internet]. 2013[cited 2017 Jun 01];36(3):295-304. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646073/
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾. A similar reality was confirmed in a study of 422 pregnant women in Ethiopia, which investigated the prevalence of conjugal violence during pregnancy and its associated factors⁽²⁶26 Gebrezgi BH, Badi MB, Cherkose EA, Weldehaweria NB. Factors associated with intimate partner physical violence among women attending antenatal care in Shire Endaselassie Town, Tigray, Northern Ethiopia: a cross-sectional study, July 2015. Reprod Health[Internet]. 2017[cited 2017 Jun 23];14(1):76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483282/pdf/12978_2017_Article_337.pdf
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾.

By revealing the abuse to which women are exposed in a context of conjugal violence permeated by the consumption of alcohol by the companion, the discourses make it possible to identify all the forms of expressions typified in the Maria da Penha Law, which have also been pointed out in other studies developed nationally and internationally⁽²¹21 Vasconcelos MS, Holanda VR, Alburqueque TT. Profile of the aggressor and factors associated with violence against women. Cogitare Enferm[Internet]. 2016[cited 2017 May 20];21(1):1-10. Available from: http://docs.bvsalud.org/biblioref/2016/07/698/41960-171298-1-pb.pdf
http://docs.bvsalud.org/biblioref/2016/0... ^,2727 Peasant C, Sullivan TP, Weiss NH, Martinez I, Meyer JP. Beyond the syndemic: condom negotiation and use among women experiencing partner violence. AIDS Care[Internet]. 2017[cited 2017 Jul 30];29(4):516-23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291821/
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾. Regarding physical violence, for example, while discourses pointed to the experience of hair pulling, kicking and suffocation, a study conducted with Pernambuco women also revealed the relationship between alcohol consumption and aggressive behavior of the partner, referring to other forms of violence such as punching and stabbing, resulting in lacerations and bone fractures⁽²¹21 Vasconcelos MS, Holanda VR, Alburqueque TT. Profile of the aggressor and factors associated with violence against women. Cogitare Enferm[Internet]. 2016[cited 2017 May 20];21(1):1-10. Available from: http://docs.bvsalud.org/biblioref/2016/07/698/41960-171298-1-pb.pdf
http://docs.bvsalud.org/biblioref/2016/0... ⁾.

Regarding the patrimonial form of expression, it is worth emphasizing that in the discourses this is considered to occur when the companion, under the effect of alcohol, breaks household items and deprives the family of food by throwing it in the trash. In a study carried out in Minas Gerais with 27 women, alcohol consumption by partners was observed as part of the daily life of women affected by conjugal violence, related to the retention and subtraction of economic resources, especially those used to support the family⁽²⁸28 Pereira RCBR, Loreto MDS, Teixeira KMD, Sousa JMM. O fenômeno da violência patrimonial contra a mulher: Percepções das vítimas. Oikos[Internet]. 2013[cited 2017 May 26];24(1):207-36. Available from: http://www.seer.ufv.br/seer/oikos/index.php/httpwwwseerufvbrseeroikos/article/viewFile/89/156
http://www.seer.ufv.br/seer/oikos/index.... ⁾. This reality is also pointed out in other literature, even acknowledging the influence of dependence on the redirection of resources previously destined for the provision of the home, with these resources being used to purchase alcohol, compromising the family’s livelihood⁽¹¹11 Vieira LB, Cortes LF, Padoin SMM, Souza IEO, Paula CC, Terra MG. Abuso de álcool e drogas e violência contra as mulheres: denuncia de vividos. Rev Bras Enferm[Internet]. 2014[cited 2017 Apr 27];67(3):366-72. Available from: http://www.scielo.br/pdf/reben/v67n3/0034-7167-reben-67-03-0366.pdf
http://www.scielo.br/pdf/reben/v67n3/003... ^,1313 Silva ACLG, Coelho EBS, Njaine K. Violência conjugal: as controvérsias no relato dos parceiros íntimos em inquéritos policiais. Ciênc Saúde Colet[Internet]. 2014[cited 2017 Apr 3];19(4):1255-62. Available from: http://www.scielo.br/pdf/csc/v19n4/1413-8123-csc-19-04-01255.pdf
http://www.scielo.br/pdf/csc/v19n4/1413-... ⁾.

The discourses also allowed us to identify the manifestation of violence in psychological form, expressed through threats involving weapons and firearms, and in moral form, evidenced by the dishonorable curses that women were subjected to, in acts of slander and defamation. The presence of the psychological and moral forms of expression was also pointed out in a study carried out from records of a police station in the southern region of Brazil, in which occurrences of violence against women associated with alcohol use were significantly moral and psychological, expressed in threats, humiliation and cursing, triggering reports of fear, impotence, guilt, low self-esteem and submission⁽²⁹29 Griebler CN, Borges JL. Violência contra a mulher: perfil dos envolvidos em boletins de ocorrência da Lei Maria da Penha. Psicol[Internet]. 2013[cited 2017 May 26];44(2):215-25. Available from: http://revistaseletronicas.pucrs.br/ojs/index.php/revistapsico/article/view/11463/9640
http://revistaseletronicas.pucrs.br/ojs/... ⁾.

Sexual violence, also present in discourses, is corroborated by a study carried out in the interior of Rio Grande do Sul; its findings revealed that women were forced to maintain sexual practices through intimidation, threat, and coercion, even during the gestational period⁽¹¹11 Vieira LB, Cortes LF, Padoin SMM, Souza IEO, Paula CC, Terra MG. Abuso de álcool e drogas e violência contra as mulheres: denuncia de vividos. Rev Bras Enferm[Internet]. 2014[cited 2017 Apr 27];67(3):366-72. Available from: http://www.scielo.br/pdf/reben/v67n3/0034-7167-reben-67-03-0366.pdf
http://www.scielo.br/pdf/reben/v67n3/003... ⁾. This is confirmed in a study carried out in the USA which recognizes conjugal rape as a common occurrence⁽²⁷27 Peasant C, Sullivan TP, Weiss NH, Martinez I, Meyer JP. Beyond the syndemic: condom negotiation and use among women experiencing partner violence. AIDS Care[Internet]. 2017[cited 2017 Jul 30];29(4):516-23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291821/
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾. This occurrence is better understood from the current perspective on gender, which, by reinforcing inequality in the roles and conducts of men and women, corroborates sex in marriage as a man’s right and a woman’s obligation. This condition makes it difficult to recognize conjugal acts of violence and, consequently, contributes to the scarcity of reports of sexual violence.

Besides the understanding that the partner’s consumption of alcohol precipitates violence, expressed in different ways, another element that favored its occurrence was related to instances where the female questioned the partner’s use of alcohol. Men’s violent reactions when questioned are explained by a historical and socio-cultural process which naturalizes and reproduces submission and passivity as attributes inherent to the feminine gender. A Brazilian study of women victims of violence, when investigating the factors that triggered or intensified conflicts in the marital relationship, identified an idealization of man as the sole owner of knowledge, reason and power—one who should not, therefore be questioned—and of woman as a person who owes allegiance and obedience, having no right to self-expression, disagreement or decision in respect to partner⁽³⁰30 Paixão GPN, Gomes NP, Diniz NMF, Couto TM, Vianna LAC, Santos SMP. Situations which precipitate conflicts in the conjugal relationship: the women’s discourse. Texto Contexto Enferm[Internet]. 2014[cited 2017 Jun 28];23(4):1041-9. Available from: http://www.scielo.br/pdf/tce/v23n4/0104-0707-tce-23-04-01041.pdf
http://www.scielo.br/pdf/tce/v23n4/0104-... ⁾. Other studies, conducted in Cuba, Nigeria, and East Africa, also have data on male control and female subservience as factors in violence against women⁽³¹31 Angulo LL, Curbelo ML. Impacto del maltrato a la mujer en la conducta parasuicida en el municipio de Cienfuegos en el año 2009. Rev Hosp Psiquiátr Haban[Internet]. 2012[cited 2017 Jun 28];9(2). Available from: http://www.medigraphic.com/pdfs/revhospsihab/hph-2012/hph122f.pdf
http://www.medigraphic.com/pdfs/revhosps...

32 Mandal M, Hindin MJ. Men’s controlling behaviors and women’s experiences of physical violence in Malawi. Matern Child Health J[Internet]. 2013[cited 2017 Jun 28];17(7):1332-8. Available from: https://link.springer.com/article/10.1007%1137-1
https://link.springer.com/article/10.100... ^-3333 Tanimu TS, Yohanna S, Omeiza SY. The pattern and correlates of intimate partner violence among women in Kano, Nigeria. Afr J Prim Health Care Fam Med[Internet]. 2016[cited 2017 Jun 29];8(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153410/
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾.

The social reassertion of men’s expectations of women is the basis for the socially legitimized domination of the male. A context in which men’s supposed rights are imputed to the feminine gender reinforces a relationship of power wherein there is no tolerance to any kind of questioning by women, and not only in relation to alcohol consumption. In this environment, the naturalization of female domestication through violence is also replicated, associating and strengthening the idea of the power of a dominator who obtains a right to aggression. Thus, pre-established roles are performed by each gender. These roles are socially agreed and, naturally, reaffirmed in marital relations⁽³⁰30 Paixão GPN, Gomes NP, Diniz NMF, Couto TM, Vianna LAC, Santos SMP. Situations which precipitate conflicts in the conjugal relationship: the women’s discourse. Texto Contexto Enferm[Internet]. 2014[cited 2017 Jun 28];23(4):1041-9. Available from: http://www.scielo.br/pdf/tce/v23n4/0104-0707-tce-23-04-01041.pdf
http://www.scielo.br/pdf/tce/v23n4/0104-... ⁾.

Such conduct of domination, which justifies acts of violence as manifestations of masculinity and female subordination, is based on the construction of patriarchy, and cannot be ignored in the face of conjugal violence, even though it is naturalized even by the professionals of the healthcare system⁽³⁴34 Carvalho MC, Germano Z. Estudo de caso acerca da relação conjugal violenta. Encon Rev Psicol[Internet]. 2014[cited 2017 Jun 25];17(26):179-94. Available from: http://www.pgsskroton.com.br/seer/index.php/renc/article/view/2426/2326
http://www.pgsskroton.com.br/seer/index.... ^-3535 Porto RTS, Bispo JP, Lima EC. Violência doméstica e sexual no âmbito da Estratégia de Saúde da Família: atuação profissional e barreiras para o enfrentamento. Physis[Internet]. 2014[cited 2017 Jun 08];24(3):787-807. Available from: http://www.redalyc.org/pdf/4008/400834035007.pdf
http://www.redalyc.org/pdf/4008/40083403... ⁾. For example, an international study carried out with Angolan health professionals on their perceptions of violence against women in the marital relationship, identified the cultural construction of the social role of women in the family as a pillar of support for the naturalization of this type of violence, marked by the belief in male superiority and female frailty⁽³⁶36 Nascimento EFGA, Ribeiro AP, Souza ER. Perceptions and practices of Angolan health care professionals concerning intimate partner violence against women. Cad Saúde Pública[Internet]. 2014[cited 2017 Jun 25];30(6):1229-38. Available from: http://www.scielo.br/pdf/csp/v30n6/0102-311X-csp-30-6-1229.pdf
http://www.scielo.br/pdf/csp/v30n6/0102-... ⁾.

Another relevant piece of data identified in the oral history of the participants was the report of involvement with alcohol as a precipitator of domestic and intrafamily violence being a transgenerational experience. This finding is corroborated by other studies conducted in Brazil, which point out that children of couples in violent relationships are more likely to repeat the same experience in their future relationships⁽¹²12 Razera J, Cenci CMB, Falcke D. Violência doméstica e transgeracionalidade: um estudo de caso. Rev Psicol IMED[Internet]. 2014[cited 2017 May 9];6(1):47-51. Available from: https://dialnet.unirioja.es/descarga/articulo/5154960.pdf
https://dialnet.unirioja.es/descarga/art... ^,3737 Colossi PM, Falcke D. Gritos do silêncio: a violência psicológica no casal. Psicol[Internet]. 2013[cited 2017 May 15];44(3):310-8. Available from: http://revistaseletronicas.pucrs.br/ojs/index.php/revistapsico/article/view/11032/10404
http://revistaseletronicas.pucrs.br/ojs/... ^-3838 Paixão GPN, Gomes NP, Diniz NMF, Lira MOSC, Carvalho MRS, Silva RS. Women experiencing the intergenerationality of conjugal violence. Rev Latino-Am Enfermagem[Internet]. 2015[cited 2017 May 26];23(5):874-9. Available from: http://www.scielo.br/pdf/rlae/v23n5/0104-1169-rlae-23-05-00874.pdf
http://www.scielo.br/pdf/rlae/v23n5/0104... ⁾. A survey conducted in Sri Lanka with multiple generations of families also pointed to the transgenerationality of violence when children witness and/or experience violence in childhood and adolescence and reproduce it in marital life⁽³⁹39 Sriskandarajah V, Neuner F, Catani C. Predictors of violence against children in Tamil families in northern Sri Lanka. Soc Sci Med[Internet]. 2015[cited 2017 Jul 4];146:257-65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26521032
https://www.ncbi.nlm.nih.gov/pubmed/2652... ⁾.

Reaffirming this reality, research in Bangladesh showed that women who witnessed or experienced involvement with alcohol and violence in childhood were more likely to be involved in marital violence as adults⁽⁴⁰40 Islam TM, Tareque MI, Tiedt AD, Hoque N. The intergenerational transmission of intimate partner violence in Bangladesh. Glob Health Action[Internet]. 2014[cited 2017 Apr 1];7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033320/
https://www.ncbi.nlm.nih.gov/pmc/article... ⁾. A study conducted in Brazil to investigate transgenerational patterns of family violence associated with alcohol use also confirmed transgenerational reproduction, as well as the reiteration of patterns of consumption, types of violence and reactions of the victims⁽⁴¹41 Tondowski CS, Feijó MR, Silva EA, Gebara CFP, Sanchez ZM, Noto AR. Padrões intergeracionais de violência familiar associada ao abuso de bebidas alcoólicas: um estudo baseado em genogramas. Psicol Reflex Crit[Internet]. 2014[cited 2017 Jun 28];27(4):806-14. Available from: http http://www.scielo.br/pdf/prc/v27n4/0102-7972-prc-27-04-00806.pdf
http http://www.scielo.br/pdf/prc/v27n4/... ⁾. Thus, by witnessing violent relationships between parents since childhood, women can naturalize and reproduce the same model in their marital bonds. Naturalization of experiences of intrafamily violence associated with alcohol use, as a relational model, favors the construction and permanence of women in disrespectful marital relationships.

Contributions to nursing, health and public policy

Although this study was limited to the individual context of women from an urban area of the Northeast, understanding the expectations created by the social construction of gender allows results to be extrapolated to other realities, even outside Brazil. By unveiling the interface between the experience of conjugal violence and the consumption of alcohol by partners, the study offers elements that may support interventions enabling prevention and coping with these phenomena.

FINAL CONSIDERATIONS

The discourse of women in situations of conjugal violence and drug involvement indicates the consumption of alcohol by the companion as a precipitating and potentiating element of the violent episodes, something also experienced by the parents, pointing to its transgenerational character. It also calls attention to marital violence resulting from the man’s reaction, which does not admit having his alcohol consumption questioned by the female partner.

Considering that the discourse reveals women’s understanding that their partners’ use of alcohol makes them vulnerable to violence, educational actions are necessary in order to stimulate reflections about this issue and its relation to alcohol, as well as its transgenerational character, anchored in the social construction of gender. We hope that the various spaces for women’s care will promote women’s empowerment, providing a recognition of the experience of violence and strategies for a life free of violence.

In this context, nurses are essential references. They are able to carry out an educational process with actions not only in healthcare spaces but also in the education and social security scenarios, preventing and confronting the phenomenon. In the school context, these actions are essential, since they can discourage the early use of drugs in the child and youth public, as well as contribute to the social deconstruction of gender inequality, perhaps allowing the construction of more symmetrical relationships between men and women. It is also believed that early intervention will avoid the reproduction of the conjugal context witnessed in the relationship between parents, a way of minimizing the transgenerational character of violence in future marital relationships.

REFERENCES

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