Best Practices: Addressing Substance Abuse

In Batterers' Programs

Overview

The incidence of substance abuse among men in batterers' programs is between 50 percent and 100 percent, depending on the proportion of the men who were referred by the criminal justice system (Bennett, 1995). Batterers referred through the courts are more likely to also be substance abusers than self-referred men. Men who are violent outside their families are more likely to have substance abuse problems than men who are violent only within their families. Alcohol or drug abuse does not cause the abusive behavior. However, for most batterers, alcohol and drug use may:

Increase the risk that he will misinterpret his partner's behavior.
Increase his belief that violent behavior is due to alcohol or drugs.
Make him think less clearly about the repercussions of his actions.
Reduce his ability to tell when a victim is injured.
Reduce the chance that he will benefit from punishment, education, or treatment.

Victim safety

The most essential consideration is the safety of domestic violence victims. The interventions must account for the safety of victims whether they are in domestic violence programs or in substance abuse treatment.

Batterer screening

Because so many batterers are also substance abusers, all batterers should be thoroughly screened for substance abuse problems. A screening for substance abuse is a preliminary step that determines the probability of an alcohol or drug problem. Batterers' intervention programs screen for substance abuse through:

Initial interviews. Program staff should ask established questions and be trained to interpret responses. Direct questioning about alcohol and drug use often makes substance abusers deny the importance or effect of alcohol or drugs in their lives. (Examples of screening questions and formal screening tools are in the Appendix.)

Observations of behavior and interactions during the batterers' program. Lateness, fatigue, aggression, or the smell of alcohol point toward the need for formal alcohol and other drug assessment. Look for signs of alcohol or drug use. ( See box.) Interactions with recovering alcoholics and addicts in the batterers' program are usually revealing, because recovering men can often identify substance abuse patterns in others. Exposure of batterers who are substance abusers to recovering alcoholics and addicts is one of the more compelling reasons for not excluding active substance abusers from batterers' programs.

Existing records. The contract signed between the batterer and the program should include access to criminal justice, mental health, and medical records.

Refer for assessment. If screening reveals the possibility of substance abuse, the batterer should be referred for formal assessment (unless the evaluator has appropriate training and certification). Formal assessment of substance abuse problems should be conducted by specialists qualified by the Illinois Alcohol and Other Drug Abuse Professional Certification Association. If a probation officer is not actively involved in monitoring the batterer's progress, the batterers' program should assume the role of case manager during substance abuse assessment. The batterers' program should not regard the referral for assessment as a referral to another agency that will then assume responsibility for the case, since this has led to batterers "slipping between the cracks."

Evaluate abstinent batterers. Abstinent and recovering alcoholics and addicts will usually score positive on the Short Michigan Alcoholism Screening Test (SMAST), CAGE-D, and other screening tools. (Examples of such screening tools are in the Appendix of this document.) Abstinent batterers with no observable supports for staying sober should be considered at high risk for relapse, and consequently, a safety risk.

Case manage active substance abusing batterers who acceptalcohol and other drug intervention. Men who are assessed as abusing, or dependent on, alcohol or other drugs require integrated or parallel substance abuse and domestic violence programming. In cases where addiction impairs the man's ability to utilize the batterers' program, the batterer/addict may complete an initial phase of addiction treatment such as medical detoxification and engagement with a support program. He then continues in counseling and/or a support program while in the batterers' program. The batterers' program should receive regular reports from the substance abuse program about the man's progress in substance abuse treatment. This will require a Qualified Service Organization Agreement (see Appendix) or a two-way consent. Similarly, the batterers' program should also release to the substance abuse program (with the signed consent of the batterer) regular reports of attendance, participation, and compliance in the batterers' program.

Intervene with active substance abusing batterers who refuse alcohol and other drug intervention. When a batterer is also a substance abuser but does not understand or accept the situation, he should still be admitted into a batterers' program. He can then be referred to substance abuse treatment.

Under the conditions of a court mandate, programs should communicate to probation officers or case managers that a man requires substance abuse treatment.

The current or former partners of voluntary or non-court-referred batterers should be notified of his refusal to enter substance abuse treatment, along with the risk that such a refusal represents.

Acceptance of an addiction treatment referral (including support group attendance) should be made a priority goal of the intervention program.

Integrate substance abuse and batterers' programs with caution.An integrated program provides domestic violence and substance abuse services under the same program, with differing degrees of integration. Integrated programs under substance abuse programs should actively utilize domestic violence programs as consultants and pay them for their services. They should also actively participate in the community's coordinated domestic violence council. Integrated programs under domestic violence agencies should actively utilize addiction program staff as consultants and pay them for their services. Sharing certain staff members across agencies may be an alternative to an integrated program. Programs that are not integrated (i.e., batterers' program and substance abuse program are in different settings) must utilize networking, case management, joint staffing, or some other means of ensuring continuity.

Safety and sobriety are interconnected. Lack of sobriety, either in victims or in batterers, increases the risk for further violence against victims. Lack of victim safety threatens the sobriety of both victim and batterer. However, abstinence and sobriety are not sufficient conditions for safety.