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Abuse
Alcohol abuse isn't the only kind of abuse going on in the Love Medicine—there's plenty of psychological and physical abuse as well. This happens within families, with characters often carrying on long-standing psychological warfare, and others being outright violent and abusive to their partners.
As with alcoholism, it seems like these forms of abuse are stem from the characters' deep-seated unhappiness with their lives overall. Whatever the cause, the overwhelming number of examples of crummy behavior between the characters is pretty upsetting and creates a mood of overall violence and depression.
The narrators' kind of bland, impassive stance toward the abuses portrayed really drives home the bleakness of the characters' circumstances—this kind of stuff is so "normal" that the narrators can't even be bothered to get worked up about it.
Erdrich suggests that the cycles of violence continue seamlessly from generation to generation, with no progress or change, which suggests the overall crumminess of the characters' circumstances.
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