What happens when alcohol and drugs enter intimate relationships? For many women, the consequences extend far beyond substance use itself, increasing the risk of emotional, physical, and sexual violence.
My recent study, From Bottles to Bruises: Partner Substance Use, Relationship Dynamics, and the Risk of Intimate Partner Violence in South Africa, published in the Int. J. Environ. Res. Public Health 2026, Vol.23(2),160; https://doi.org/10.3390/ijerph23020160 explores this critical but often overlooked connection using nationally representative data from the South African Demographic and Health Survey.
The findings paint a troubling picture. More than 40% of women reported that their partners used alcohol and/or drugs. Among these women, over one-third had experienced intimate partner violence (IPV). Even after accounting for other factors, women whose partners used substances were significantly more likely to experience abuse. The risk of emotional violence was more than doubled, while the likelihood of physical and sexual violence was nearly three times higher.
However, substance use is only part of the story.
The study found that controlling behaviours—such as monitoring a partner’s movements, restricting social interactions, or exerting excessive control over daily activities—were among the strongest predictors of violence. Women exposed to these behaviours faced dramatically higher odds of experiencing IPV, highlighting how abuse often begins long before physical harm occurs.
These findings challenge us to rethink how we address gender-based violence. While substance abuse interventions remain important, effective prevention requires a broader approach that also tackles harmful gender norms, unequal power relations, and coercive control within relationships.
For policymakers, healthcare providers, and community organisations, the message is clear: efforts to reduce intimate partner violence must integrate substance-use prevention with strategies that promote healthy, respectful, and equitable relationships.
Violence against women is not inevitable. By understanding the factors that drive abuse and addressing them together, we can move closer to a future where women are safe, empowered, and free from violence.
Watch the video below for a visual overview of the study findings and their implications for public health, policy, and women’s safety.