Domestic Violence and Substance Abuse Treatment

Every 15 seconds a woman is subjected to domestic violence in the United States. Domestic violence can be defined as a pattern of abusive behavior that is used to gain or maintain power and control in an intimate relationship, such as marriage, dating, family, friendship or living together. Anyone can be a victim or perpetrator of domestic violence.

Keeping this in mind, we will be focusing on male batterers and female survivors of domestic violence since this is the “typical” scenario and will be seen most often in treatment facilities. We will discuss substance abuse in both the batterer and the survivor.

When most people think of the relationship between substance abuse and domestic violence they picture an alcoholic husband beating his wife, and while this is one case, it is most certainly not the only. This case suggests a direct correlation between substance abuse and the occurrence of domestic violence. However, most studies show that while they are linked the relationship is not that straightforward.

The problem with directly linking the two issues together is similar to problems in dealing with co-occurring disorders (dual diagnosis) in that the question that is most often debated is which one came first, the drinking or the violence. Even though according to the U.S. Department of Justice study reports that 61% of domestic violence offenders also have substance abuse problems, we must remember that the violence may not necessarily be a consequence of the substance abuse and that the substance abuse could be a result of the violence. However, as with co-occurring disorders, it is imperative that we address both issues and not focus too much which came first.

Substance abuse in the batterer is what most people will think about when substance abuse and domestic violence are mentioned together so we will discuss this first. The characteristics of a batterer are very similar to the characteristics and risk factors you would find in substance abusers. These characteristics include: witnessing parental violence, parental substance abuse, corporal punishment, depression, socioeconomic hardships and an intense need for power and control.

Despite the difficulty of finding an exact cause and effect relationship between substance abuse and domestic violence, experts have organized batterers into three categories in order to improve their treatment. The first category is “Typical Batterers”. Typical batterers are characterized by keeping the violence they inflict in the home, which will be less severe when compared to other batterers, and are usually not substance abusers. They will also most likely have no history of legal troubles, mental illness and will usually be remorseful for the violence. The second category is “Antisocial Batterers”.

The characteristics of the antisocial batterer include being extremely abusive, having some mental health issues, may be a substance abuser and will most likely have difficulty completing domestic violence program without being provided additional services. The third category is “Sociopathic Batterers”. The characteristics of a sociopathic batterer include being the most extremely violent, heavy substance abuse, tremendous difficulties in treatment programs, little or no empathy for others, no remorse for the violence inflicted and the most likely of the three categories to have had legal issues.

Treatment for a batterer with a substance abuse problem can be much more difficult than the already difficult treatment for a person with just a drug or alcohol addiction problem. The most common model for batterer intervention is the Duluth Model. The Duluth Model is a behavioral change model that seeks to alter the batterer’s behavior by confronting his denial, his need for power and control and helping him realize his alternatives to the violent behavior. This model is a community-wide model that involves many people including law enforcement which ensures that the batterer will be arrested while the survivor is protected.

Like I said above, when most people think of substance abuse and domestic violence they only think of the addiction in the batterer. However, survivors of domestic violence are also likely to present in treatment programs with drug or alcohol problems. In fact, in 2002, the Department of Justice reported that 36% of survivors in domestic violence programs also had substance abuse problems.

Again, there is no direct cause and effect relationship between a survivor’s addiction and the domestic violence although it is commonly thought that the violence increases the likelihood that a survivor will abuse alcohol or drugs. While this may not be the case for all survivors with drug or alcohol problems, both the domestic violence and the addiction have an extreme impact on the survivor’s recovery from both and the treatment provider needs to be aware of this.

When a client presents for substance abuse treatment and reports a history of domestic violence, especially a recent history, there are several steps that a treatment provider should follow. First, the provider should make sure that the client is in a safe environment and that they understand that while they are at the facility they are safe. Second, the provider should never doubt the survivor’s story, even if there are discrepancies. If a client feels they cannot trust the counselor or provider they will leave treatment and put themselves back in dangerous situations. Finally, during the assessment the provider should identify the client’s options and the perceived benefits and consequences with each option and then have the client work on a safety plan. This will involve the client and make them feel involved in their treatment and encourage them to stay and feel as though they can accomplish their goals. One of the most important things to remember when working with survivors is that their safety, both physical and emotional, is the most important obstacle in the initial stages of treatment to be addressed. If it is not addressed immediately the likelihood of the client staying in treatment is very low.

Domestic violence and substance abuse are separately two of the most devastating issues in American society today, but combined they are significantly worse and more attention needs to be paid to the relationship and treatment of the two. It is vital to properly screen and assess clients as soon as they present for substance abuse treatment so the next steps of the treatment provider will be the correct ones. There are many resources available on domestic violence and addiction including SAMHSA TIP 25, the National Coalition Against Domestic Violence, the Tennessee Association of Alcohol, Drug & other Addiction Services, and Women’s Rural Advocacy Programs.