Integrative Services Project - The Research
PARTNER ABUSE PREVALENCE. Percentage of women reporting at least one incident of partner physical abuse or partner psychological abuse in the six months prior to treatment or services:
In substance abuse treatment agencies, 67.2% of women reported experiences of physical abuse, and 93.2% experiences of psychological abuse based on the Abusive Behavior Inventory. At least 90% of women in Substance Abuse treatment had a physically violent partner sometime in their life.
SUBSTANCE ABUSE PREVALENCE. In domestic violence programs, 26.2% of women had a lifetime diagnosis of alcohol dependence based on The Comprehensive International Diagnostic Interview (CIDI) from the International Classification of Diseases Version 10 (ICD-10).
39% of women in domestic violence programs reported problems with their alcohol or drug use based on the Index of Alcohol Involvement or Index of drug Involvement. Combining all measures, about 65% of women in domestic violence programs had problems with alcohol or drug use at some point in their lifetime.
It's important to note that this percentage is probably lower than the actual # of women experiencing substance abuse problems as the interview itself was scheduled days in advance, and women with use problems may leave shelter earlier than others due complications with their use (withdrawal symptoms, not able to use while staying in shelter, etc).
Many battered women also report alcohol use in combination with use of prescription drugs.
USE DURING VIOLENT INCIDENT. During the first violent partner relationship, 68% of the abusive partners were using alcohol or drugs or both at the time of a violent incident, 31% of the victims were using at the time.
In current partner relationships, 67% of the abusive partners were using at the time of a violent incident, 43% of the victims were using at the time.
ANXIETY. 38.4% of women in substance abuse treatment were classified as having moderate to severe anxiety on the Beck Anxiety Inventory, 49.1% in domestic violence programs had moderate to severe anxiety.
Among women in both substance abuse treatment and shelters/safe homes, higher levels of partner physical abuse and psychological abuse were associated with higher levels of anxiety.
DEPRESSION. 45.7% of women in substance abuse treatment were classified as having moderate to severe depression (measured by Beck Depression Inventory), 48.4% of women in domestic violence programs had moderate to severe depression.
Among women in both substance abuse treatment and shelters/safe homes, higher levels of partner physical abuse and psychological abuse were associated with higher levels of depression.
RESEARCH TOOLS USED: Diagnostic tools used in interview: Abusive Behavior Inventory; The Comprehensive International Diagnostic Interview (CIDI) from the International Classification of Diseases Version 10 (ICD-10); Lifetime Diagnosis of Alcohol Dependence Index of Alcohol Involvement; Index of Drug Involvement; Beck Depression Inventory; Beck Anxiety Inventory. Open ended questions used: Typical verbal conflict that became violent; Specific violent incident that was the most harmful; First time any partner ever did anything physically harmful.
Preliminary Findings from the AREA Grant Research, 2005-2007.
The specific aims of the AREA Grant research was to examine the extent to which: 1) substance abuse treatment programs have incorporated women's domestic violence experiences into treatment planning for women, and 2) domestic violence programs and shelters have incorporated women's substance abuse issues into service planning for women.
Data were collected from 25 staff in three domestic violence programs and 29 staff in three substance abuse treatment agencies in Iowa. Data were collected from 31 clients in the same three domestic violence programs and 39 clients in the same three substance abuse treatment agencies as the staff interviews. Most (69%) women in the domestic violence program sample had substance abuse experience, a percentage almost identical to the 65% we found in the original research among the domestic violence program sample that either had a lifetime diagnosis of alcohol dependence (26%) or were categorized as having substance abuse problems but did not meet the criteria for alcohol dependence (39%). A majority (86%) of the substance abuse treatment sample had domestic violence experiences, a percentage very close to the 90% of women we found in the original research among the substance abuse treatment sample to have had domestic violence experiences.
A more detailed data analysis is still being developed. The following information is based on the initial interpretative content analysis of the transcripts of the tapes.
There have been many changes in the substance abuse treatment agencies. Both staff and clients at substance abuse treatment agencies have perceived these changes as being positive. New domestic violence services have included: gender specific programming for women, both group and individual programming, improved screening and assessment of domestic violence, co-facilitated groups, addressing safety in the physical layout of the building, and in general more awareness of domestic violence. Despite this programming, however, both staff and clients identified additional areas in which domestic violence experiences could be addressed in substance abuse treatment.
There has been considerably more program incorporation of domestic violence education and services in substance abuse treatment agencies than of substance abuse education and services in domestic violence agencies. The funding structure for substance abuse treatment makes it difficult for counselors to provide outreach services to domestic violence programs. In addition, domestic violence advocates generally did not have the time, skill, or background to address women's substance abuse or use issues and felt uncomfortable doing so. These issues combined with policy changes to allow women who use to remain in the domestic violence shelter created a new set of issues to be addressed for domestic violence programs.
Domestic violence program clients expressed concerns over the lack of addressing the use of alcohol and other drugs, as well as the intoxication of clients, in the shelter. Allowing clients who are using or intoxicated to be in the shelter is a policy change. This change has the advantage of increasing the safety for substance abusing battered women. However, disadvantages were that some clients expressed concern over safety and relapse triggers. These disadvantages need to be addressed by incorporating substance abuse programming into the domestic violence shelter.
Although there have been positive changes that have enhanced substance abuse treatment for women, additional changes are needed, including: more gender specific programming in all levels of care, more systematic screening of domestic violence by more staff, gender specific residential treatment, and more domestic violence advocates available for individual sessions with clients. Staff also reported the need for having more consistent information on domestic violence in all treatment levels, incorporating domestic violence services more in the outpatient programs, and doing a better job of integrating domestic violence and substance abuse.
Two additional ways to address the asymmetrical collaboration between substance abuse treatment agencies and domestic violence programs are to provide more grant opportunities in the substance abuse field of service to fund and provide for outreach services to domestic violence programs and shelters, and to provide more funding for specialist staff who are well-trained and knowledgeable in both substance abuse and mental health issues to be on-site at the domestic violence program and shelter.
Additional substance abuse treatment services at the domestic violence program or shelter need, at a minimum, to be more systematic and consistent screening for substance abuse and a co-facilitated support group. Domestic violence clients saw a need for support groups on site at the shelter for women with both domestic violence and substance abuse problems. In particular, staff need to address the intoxication of women who are currently using and staying in the domestic violence shelter, preferably by individual counseling with substance abuse treatment staff. Domestic violence clients saw a need for support groups on site at the shelter for women with both domestic violence and substance abuse problems. Domestic violence clients also reported the need for a holistic approach with multiple professionals simultaneously helping substance abusing battered women address the many issues they face.
Couple's counseling is still being done as a part of substance abuse treatment, and even being a required part of treatment. The concern here is the use of couple's counseling with victims of domestic violence. Fear of additional violence constrains women from discussing topics that partners may not want them to discuss. In any case, couple's counseling places women at risk of additional violence from partners. For these reasons, the United States Department of Justice Office on Violence Against Women recommends not using couple's counseling in cases of domestic violence and prohibits the use of grant funds for this purpose.
The Integrative Services Project was supported under award numbers 2001-DD-BX-0086 and 2004-WR-AX-0034 from the Office on Violence Against Women, Office of Justice Programs, United States Department of Justice.
This research was supported under award number 96-WT-NX-0005 from the National Institute of Justice, Office of Justice Programs, United States Department of Justice.
The AREA Grant research was supported under award number 1 R15 AA014327--01A1 from the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, United States Department of Health and Human Services.