Substance Abuse Treatment
and Domestic Violence
Chapter 1 -- Effects of Domestic Violence on Substance
Abuse Treatment
Domestic violence is the use of intentional emotional, psychological, sexual,
or physical force by one family member or intimate partner to control another.
Violent acts include verbal, emotional, and physical intimidation; destruction
of the victim's possessions; maiming or killing pets; threats; forced sex; and
slapping, punching, kicking, choking, burning, stabbing, shooting, and killing
victims. Spouses, parents, stepparents, children, siblings, elderly relatives,
and intimate partners may all be targets of domestic violence (Peace at Home,
1995). (See Figure 1-1.)
This Treatment Improvement Protocol (TIP) focuses on heterosexual men who
abuse their domestic partners and on women who are abused by men, because these
individuals constitute a significant portion of the population seeking substance
abuse treatment. Though domestic violence encompasses the range of behaviors
above, the TIP focuses more on physical, or a combination of physical, sexual,
and emotional, violence. Therefore men who abuse their partners are referred to
throughout as batterers; women who are abused are called
survivors. Child abuse and neglect, elder abuse, women's abuse of men,
and domestic violence within same-sex relationships are important issues that
are not addressed in depth in this document, largely because each requires
separate comprehensive review. Other patterns of domestic violence outside the
scope of this TIP are abused women who in turn abuse their children or react
violently to their partners' continued attacks and adult or teenage children who
abuse their parents.
The primary purpose of this document is to provide the substance abuse
treatment field with an overview of domestic violence so that providers can
understand the particular needs and behaviors of batterers and survivors as
defined above and tailor treatment plans accordingly. This requires an
understanding not only of clients' issues but also of when it is necessary to
seek help from domestic violence experts. The TIP also may prove useful to
domestic violence support workers whose clients suffer from substance-related
problems.
As the TIP makes clear, each field can benefit enormously from the expertise
of the other, and cooperation and sharing of knowledge will pave the way for the
more coordinated system of care discussed in Chapter 6. Future publications will
examine aspects of the problem that concern such special populations as
adolescent gang members, the elderly, gay men and lesbians, and women who
batter. The first of these is an upcoming TIP that addresses substance abuse by
victims of child abuse and neglect.
Defining the Problem
In the United States, a woman is beaten every 15 seconds (Dutton, 1992;
Gelles and Straus, 1988). At least 30 percent of female trauma patients
(excluding traffic accident victims) have been victims of domestic violence
(McLeer and Anwar, 1989), and medical costs associated with injuries done to
women by their partners total more than $44 million annually (McLeer and Anwar,
1987). Much like patterns of substance abuse, violence between intimate partners
tends to escalate in frequency and severity over time (Bennett, 1995). "Severe
physical assaults of women occur in 8 percent to 13 percent of all marriages; in
two-thirds of these relationships, the assaults reoccur (Dutton, 1988)"
(Bennett, 1995, p. 760). In 1992, an estimated 1,414 females were killed by
"intimates," a finding that underscores the importance of identifying and
intervening in domestic violence situations as early as possible (Bureau of
Justice Statistics, 1995).
An estimated three million children witness acts of violence against their
mothers every year, and many come to believe that violent behavior is an
acceptable way to express anger, frustration, or a will to control. Some
researchers believe, in fact, that "violence in the family of origin [is]
consistently correlated with abuse or victimization as an adult" (Bennett, 1995,
p. 765; Hamberger and Hastings, 1986a; Kroll et al., 1985). Other researchers,
however, dispute this claim. The rate at which violence is transmitted across
generations in the general population has been estimated at 30 percent (Kaufman
and Zigler, 1993) and at 40 percent (Egeland et al., 1988). Although these
figures represent probabilities, not absolutes, and are open to considerable
interpretation, they suggest to some that 3 or 4 of every 10 children who
observe or experience violence in their families are at increased risk for
becoming involved in a violent relationship in adulthood.
Identifying the Connections
Researchers have found that one fourth to one half of men who commit acts of
domestic violence also have substance abuse problems (Gondolf, 1995; Leonard and
Jacob, 1987; Kantor and Straus, 1987; Coleman and Straus, 1983; Hamilton and
Collins, 1981; Pernanen, 1976). A recent survey of public child welfare agencies
conducted by the National Committee to Prevent Child Abuse found that as many as
80 percent of child abuse cases are associated with the use of alcohol and other
drugs (McCurdy and Daro, 1994), and the link between child abuse and other forms
of domestic violence is well established. Research also indicates that women who
abuse alcohol and other drugs are more likely to become victims of domestic
violence (Miller et al., 1989) and that victims of domestic violence are more
likely to receive prescriptions for and become dependent on tranquilizers,
sedatives, stimulants, and painkillers and are more likely to abuse alcohol
(Stark and Flitcraft, 1988a). Other evidence of the connection between substance
abuse and family violence includes the following data:
- About 40 percent of children from violent homes believe that their fathers
had a drinking problem and that they were more abusive when drinking (Roy,
1988).
- Childhood physical abuse is associated with later substance abuse by youth
(Dembo et al., 1987).
- Fifty percent of batterers are believed to have had "addiction" problems
(Faller, 1988).
- Substance abuse by one parent increases the likelihood that the
substance-abusing parent will be unable to protect children if the other
parent is violent (Reed, 1991).
- A study conducted by the Department of Justice of murder in families found
that more than half of defendants accused of murdering their spouses -- as
well as almost half of the victims -- had been drinking alcohol at the time of
the incident (Bureau of Justice Statistics, 1994).
- Teachers have reported a need for protective services three times more
often for children who are being raised by someone with an addiction than for
other children (Hayes and Emshoff, 1993).
- Alcoholic women are more likely to report a history of childhood physical
and emotional abuse than are nonalcoholic women (Covington and Kohen, 1984;
Miller et al., 1993; Rohsenow et al., 1988; Hein and Scheier, 1996).
- Women in recovery are likely to have a history of violent trauma and are
at high risk of being diagnosed with posttraumatic stress disorder (Fullilove
et al., 1993).
Source: The National Clearinghouse for Alcohol and Drug Information
DHHS Publication No. (SMA) 97-3163
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