Common Perspectives
 

The importance of addressing domestic violence in substance abuse treatment for women becomes evident when one sees the research. Women who abuse substances are more likely to experience domestic violence in relationships (Miller, Downs, & Gondoli, 1989). Women who experience domestic violence are more likely to misuse prescription drugs as well as alcohol (Stark & Flitcraft, 1988). One study found that of women in a drug treatment center, 90 percent had been physically assaulted and 95 percent had been raped (Stevens & Arbiter, 1995).
 

Substance-abusing women and women who have experienced domestic violence report similar experiences. Both may demonstrate:
 

•  Isolation, shame, and guilt.
•  Behaviors that others describe as bizarre or dysfunctional.
•  Traumatization.
•  Initial denial of the problem.
• Loss of support systems and fear of losing children as a result of admitting their problem.
•  Low ego strengths.
•  Magical thinking (a client's belief that the problem will simply go away as if by magic).
•  Impairment of their ability to make logical decisions.
•  Involvement in the criminal justice system, either as a victim or offender.
•  Often seeking services only when in crisis.
•  Several returns to the substance, or to a relationship where battering continues, before making a lasting change.

 

All women in substance abuse treatment should be screened for domestic violence. When interviewing a client:
 

• Use caution and tact. Don't initially refer to the partner's behavior as domestic violence. Instead use language such as inappropriate behavior, unhealthy behavior, behavior that is unsafe, and possibly abuse.
• A woman might not feel safe disclosing information to you. She may disclose more about herself when she gains confidence and begins to trust you.
• Proceed sequentially from the least sensitive to the most sensitive topics. Use the early (least sensitive) part of the interview for relationship-building and the establishment of trust.
• Be careful about criticizing the partner. Battered women may care for their partners and may become defensive or shut down if the partner is criticized.
• Avoid labelling survival strategies or other behaviors as co-dependent.
• Get factual information. Often a woman will give vague answers to questions. Ask her to clarify her responses. For example, ask her to talk more about her experiences in relationships.

 

There are formal domestic violence screening tools in the Appendix of this document. Key questions which might lead to a formal screening include:
 

• What happens when you argue with your partner?
• How safe do you feel with your partner?
• How safe do you feel when you leave here?
• Can you tell me about a situation with your partner when yelling and screaming occurred?
• Can you tell me about a situation with your partner when things were destroyed?
• Can you tell me about a situation when your partner pushed, slapped, or hit you?
• How does your partner show respect to you?
• How does your partner attempt to control your alcohol or other drug use?
• Have your efforts to get clean and sober been sabotaged by your partner?

 

If the screening indicates a probability of violence, refer the woman either to a shelter or to a provider who deals with domestic violence issues. (A list of domestic violence service providers is included in the Appendix.)

It is important to coordinate services as much as possible with the domestic violence advocate. Coordinate discharge planning, especially when discharging from a residential program. This coordination allows the woman to identify several options, such as staying at a shelter or staying with family or friends if it is unsafe to go home. Explain confidentiality regulations to domestic violence advocates when coordinating services, as well as the meaning of American Society of Addiction Medicine (ASAM) criteria. When serving a mutual client, it is also helpful for domestic violence and substance abuse service providers to present a united effort when advocating with other systems (e.g., Department of Children and Family Services).

Intervention

As substance abuse professionals know, women often have treatment issues that are different from men's. When domestic violence is added, this difference is magnified.

Safety issues can seriously affect the woman's ability to maintain sobriety. Make safety as well as sobriety a top priority. Treatment should focus on both issues. Develop relapse prevention plans that include safety planning and ways to cope if her partner gets violent.

When a woman is harmed, she may be more likely to use substances to cope. She may use alcohol or drugs to medicate physical and/or emotional pain. She may even be coerced into use by her partner -- the abuser will often do whatever it takes to keep the woman under his control, including forcing use of substances and threatening her if she does not continue to use. Often her partner is using as well, and if she leaves to find a more sober support network, there is increased risk to her safety.

Recognize that even though her relationship may be a trigger for continued use, it may also be unsafe for her to leave. Victims of domestic violence aren't so much choosing to stay in violent relationships as they are choosing when it is safe for them (and their children) to leave. For many victims, this may be never.

Discuss these issues in terms of the dilemmas they create. When addressing issues of noncompliance, counselors should take into account the batterer's ability to sabotage substance abuse treatment through threats or fear.

Couple or family counseling can be very dangerous for victims of domestic violence. DO NOT provide information to the partner. If the perpetrator finds out about disclosure of the violence or of substance use, the woman may be punished.

Domestic violence is not caused by substance abuse and is not merely a symptom of substance abuse. Domestic violence is an issue of power and control, however often people identify anger as a symptom. Battered women often blame themselves for the beatings they have suffered. Victims often believe they are being abused because of their substance use and some substance abuse counselors believe this as well. Therefore, it is important to stress that abuse is not the victim's fault. Counselors may need to address domestic violence and substance abuse with different interventions.

Confrontational techniques are often not effective with victims of domestic abuse. They can be interpreted by the woman as an extension of how the abuser treats her. Also, avoid language that implies there is something wrong with the victim or that she caused her own abuse. Some examples of words to avoid with these women are codependency, enabling, and powerlessness. It is important to avoid codependency and enabling because these concepts do not hold the batterer fully accountable for his behavior. In the domestic violence community, codependency is a term for a woman's adherence to the socially sanctioned roles of women, and is always inappropriate when applied to domestic violence victims.

Some 12 Step groups' concepts can pose problems for women. These include submission to a higher power referred to exclusively in male terms, emphasis on "character defects," limited emphasis on strengths, and discouragement from talking about the abuse that has happened to them.

Whenever possible, domestic violence victims should be referred to gender-specific treatment and support groups. Mixed groups may involve descriptions of male aggression directed toward female partners.

Victims respond best to gender-specific empowerment and self-discovery. They often desire and benefit from all-female support groups. They often feel there are not many options. Language focusing on empowerment may help her develop the tools to stay safe and sober. Emphasize strengths and healthy decision-making.