Fluoxetine treatment of alcoholic perpetrators of domestic violence: a 12-week, double-blind, randomized, placebo-controlled intervention study

Abstract

Objective: Behaviorally based therapies for the treatment of perpetrators who initiate intimate partner violence (IPV) have generally shown minimal therapeutic efficacy. To explore a new treatment approach for IPV, we examined the effects of a selective serotonin reuptake inhibitor on the irritability subscale score of the Modified Overt Aggression Scale. This score served as a surrogate marker for the anger and physical aggression that characterize perpetrators of IPV.

Method: A 12-week, double-blind, randomized, placebo-controlled intervention study employing fluoxetine, alcohol treatment, and cognitive-behavioral therapy was performed. Sixty (46 men) non-court-mandated, DSM-IV-diagnosed alcoholic perpetrators of IPV with a history of at least 2 episodes of IPV in the year prior to participation in the study were evaluated. The primary outcome measure was the score on the irritability subscale of the Modified Overt Aggression Scale. Secondary measures included anxiety, depression, and ratings by the perpetrator's spouse/significant other. The study was conducted from January 2002 through December 2007.

Results: A repeated-measures analysis of variance using the irritability subscale scores obtained from perpetrators who completed the 12-week study (n = 24) showed a significant drug effect (F(1,21) = 12.09, P = .002). Last observation carried forward (F(1,32) = 4.24, P = .048) as well as intent-to-treat analysis (F(1,54) = 5.0, P = .034) also showed a significant drug effect. Spouses'/significant others' physical and nonphysical Partner Abuse Scale ratings showed a significant reduction of abuse over time (F(1,11) = 10.2, P = .009 and F(1,11) = 24.2, P = .0005, respectively).

Conclusion: This is the first controlled study to show that a pharmacologic intervention employing a selective serotonin reuptake inhibitor, in conjunction with alcohol treatment and cognitive-behavioral therapy, can reduce measures of anger and physical aggression in alcoholic perpetrators of IPV.

Trial registration: ClinicalTrials.gov NCT00011765.

Figure 1. Study Profile

Figure 2. Effect on the IS Score of the MOAS for Perpetrators Who Completed 12 Weeks of Treatment^a

^aBaseline scores were used as the covariate. There was no significant repeated-measures effect (F_2,42 = 0.85, P = .43) or interaction effect (F_2,42 = 0.02, P = .98). There was a significant drug effect (F_1,21 = 12.09, P = .002). Abbreviations: IS = irritability subscale, MOAS = Modified Overt Aggression Scale.