Citation
Gilchrist, G. (2012), "Addressing intimate partner violence among substance abusers", Advances in Dual Diagnosis, Vol. 5 No. 2. https://doi.org/10.1108/add.2012.54105baa.001
Publisher
:Emerald Group Publishing Limited
Copyright © 2012, Emerald Group Publishing Limited
Addressing intimate partner violence among substance abusers
Article Type: Editorial From: Advances in Dual Diagnosis, Volume 5, Issue 2
Research suggests that at least four in every ten females in substance abuse treatment are victims (El-Bassel et al., 2001; O’Farrell et al., 2003; Gilchrist et al., 2011) and at least four in every ten males in substance abuse treatment are perpetrators (Frye et al., 2007; El-Bassel et al., 2007) of intimate partner violence (IPV). Many females in treatment for substance abuse have male partners who are also substance abusers; therefore, their risk of experiencing IPV is high. Victims (Golding, 1999; Campbell, 2002) and perpetrators of IPV (Stith et al., 2004; Rhodes et al., 2009) are more likely to experience mental health problems.
In the UK, the annual cost of IPV is estimated at £36.7 billion, however, the real cost may be greater given the “under-reporting of violence” (Department of Health, 2010). Per-capita costs among substance abusers may be higher given the “revolving door” resulting from high treatment drop-out and higher involvement with criminal justice, child protection and mental health services.
Very little emphasis is given to addressing IPV among substance abusers in the recent approaches to tackle both issues. The Government’s Alcohol Strategy (HM Government, 2012) has highlighted the link between alcohol and violence. The UK drug strategy (National Treatment Agency, 2010) emphasises a recovery-based approach, especially for those with multiple and complex needs. However, experiencing IPV may limit this recovery. For example, poorer substance abuse outcomes have been reported for victims of IPV (Greenfield et al., 2002); victims report isolation from family and friends, poor mental and physical health (Golding, 1999; Campbell, 2002) and greater drug and sexual risk behaviours, potentially due to the controlling behaviour of the perpetrator; and IPV can impact on parenting. Improving Services for Women and Child Victims of Violence (Department of Health, 2010) identified that substance abuse was a key issue in relation to families with complex needs. However, none of these strategies have identified specific action for substance abusers who are victims, or who perpetrate IPV.
Recently funding to the domestic violence and sexual abuse sector from local authorities has been substantially cut (Towers and Walby, 2012), resulting in the need for mainstream substance abuse and mental health services to improve their response to IPV and enhance workforce competencies to manage IPV and its resulting sequelae more effectively.
Many mainstream substance abuse treatment services are not equipped to respond adequately to IPV victimisation or perpetration, reducing the impact of interventions for this group of patients. Klostermann (2006) has highlighted that “(substance abuse) providers are increasingly faced with the challenge of addressing IPV among their patients and their intimate partners. Yet, effective options for clinicians who confront this issue are extremely limited. Thus, providers need to develop strategies for addressing IPV that can be incorporated and integrated into their base intervention packages”. Few randomised controlled trials have been conducted among substance abusers who experience or perpetrate IPV. However, evidence from trials of non-substance abusers suggest that psychosocial and advocacy interventions are effective in reducing the incidence of physical partner violence among female victims (Ramsay et al., 2005, 2009). One psychosocial intervention tested among male perpetrators in substance abuse treatment has found promising results in relation to reducing IPV (Easton et al., 2007).
In addition, substance abuse (and indeed, mental health) treatment staff may lack the competencies and confidence to identify and respond to IPV victimisation and perpetration among their clients. To improve the treatment response, staff should receive training in how to assess and address IPV among their clients, and appropriate care pathways established.
The current edition of Advances in Dual Diagnosis offers a combination of original research papers and viewpoints from international experts in the field of IPV on possible approaches to addressing IPV, mental health and substance abuse.
In the first paper from this issue, Gilchrist, Blázquez and Torrens (pages 46-58) present secondary analysis of a cross-sectional study among female drug users in Barcelona, Spain. This study reported greater odds for experiencing IPV among female drug users with a history of depressive disorder and borderline personality disorder.
In the second paper, Holly and Horvath (pages 59-67) from the Stella Project Mental Health Initiative from Against Violence and Abuse in England review best practice in relation to responding to IPV, substance abuse and mental health. In addition, they present initial findings from the evaluation of the Stella Project Mental Health Initiative.
Hegarty (pages 68-73) provides a viewpoint in the third paper on how health practitioners can identify and respond to alcohol use/abuse and IPV, and describes the benefits and challenges of whole family approaches to address these issues.
The fourth paper by Stover and Spink (pages 74-85) presents findings from a qualitative study among fathers with co-occurring substance abuse and IPV in the USA. The findings are discussed in relation to their implications for interventions with fathers with co-occurring substance abuse and IPV issues.
In the final paper, Easton (pages 86-93) compares substance dependent men, with and without co-occurring mental health symptoms, who were arrested for IPV and attended an integrated substance abuse and IPV programme. Men with co-occurring mental health symptoms had more pre-treatment impairments, more drug use during treatment, a trend for more problems with aggressive behaviours throughout treatment and significantly more impairments in anger control subscales at post treatment compared to men without co-occurring mental health symptoms. Implications for treatment are discussed for male substance abusers who perpetrate IPV.
Gail Gilchrist
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