Fiending For A Fix: The Truth About Domestic Violence And Substance Abuse

1. Fiending For A Fix: The Truth About Domestic Violence And Substance Abuse Presented by: Stacey Myers, LCSW Rachel Lapointe, MSW

2. Overview of Presentation • Dynamics of Domestic Violence • Substance Abuse and Domestic Violence • Treatment Interventions

3. What is Domestic Violence? • 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 (Peace at Home, 1995) • It is an epidemic affecting individuals in every community, regardless of age, economic status, race, religion, nationality or educational background. The consequences of domestic violence can cross generations and truly last a lifetime.

4. Domestic Violence Facts • One in every four women will experience domestic violence in her lifetime. • 85% of domestic violence victims are women. • An estimated 1.3 million women are victims of physical assault by an intimate partner each year.

5. Continued…. • Boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults. • 30-60% of perpetrators of intimate partner violence also abuse children in the household. • Almost one-third of female homicide victims that are reported in police records are killed by an intimate partner.

6. Types of abuse • Physical • Verbal • Emotional • Financial • Sexual • Spiritual

7. Physical • Hitting • Choking • Pushing • Biting • Kicking • Withholding medication or medical treatment

8. Verbal • Threats • Humiliating comments in front of others • Name calling

9. Emotional • Keeping victim awake all night • Threats of suicide • Jealousy • Isolation • Withholding affection as punishment

10. Financial • Irresponsible with money • Control of money • Keeping victim from working

11. Sexual • Forced sex • Unwanted touching • Sexual name calling • Unfaithfulness • Manipulation of birth control

12. Spiritual • Forcing victim to go to a different place of worship • Keeping victim from going to her desired place of worship • Use of scripture to justify abuse

13. Cycle of violence • Abuse occurs • Excuses • Honeymoon • Routine • Tension • Abuse occurs

14. Why She stays • Threats - Fear • Children • Isolation • Low self-esteem • Limited resources • Love • Religious beliefs

15. Characteristics of abusers“Red flags for abuse” • Jealousy • Controlling behavior • Blames others for his problems • Cruelty to animals or children • Jekyll and Hyde personality • Past battering **They are not “out of control”

16. How a victim may present • Low self-esteem • May have depression and/or anxiety disorders • Presence of destructive/compulsive behaviors • Take responsibility for abuser’s behavior • May report that she feels “crazy”

17. Domestic Violence and Substance Abuse – The Connections • Women who abuse alcohol and other drugs are more likely to become victims of domestic violence (Miller et al., 1989) • One third of women in prison are domestic violence survivors and 60% of incarcerated women are substance abusers or substance dependent (Fowler, 2009). • Battered women have an 8 times higher risk for attempting suicide than nonbattered women, 6 times higher risk of drug abuse and 15 times higher rate of alcohol abuse (Stark, E & Flitcraft, A., 1996) • Alcoholic women are more likely to report a history of childhood physical and emotional abuse than are nonalcoholic women (Covington and Kohen, 1984) • Childhood physical abuse is associated with later substance abuse by youth (Dembo, et al., 1987)

18. The Societal Context • “The societal expectations about drinking and drinking behavior in our society teach people that if they want to avoid being held responsible for their violence, they can either drink before they are violent or at least say they were drunk” Gelles, R. J., 1993 • Even when alcohol or drugs are not involved, women victims frequently are assumed to have provoked the abuse. • Intoxicated victims are more likely to be blamed than sober victims and aggression toward an inebriated victim is considered more acceptable than aggression toward a sober one (Aramburu and Leigh, 1991)

19. Substance Abuse as Coping Skill • Self-medication with legal or illegal drugs is both an expression of a desire to exert a measure of personal control and an attempt to numb the pain of experience. (Herman, J. 1992) • Minimize the severity of domestic violence • “If you can’t beat ‘em, join em” • Substance abuse upgraded to Substance Dependence • No access to mental health services or domestic violence programs

20. Substances as Methodof Control • Use by perpetrators of childhood sexual abuse • Initiate victim into drug use – sabotage recovery efforts • Victim becomes dependent on relationship for financial means to obtain substances • Threats to reveal substance abuse by victim • “Drugging” victim

21. Danger Level Increased • Less aware of and responsive to cues of forthcoming violence • Less able to escape • More likely to fight back and increase likelihood of serious injury • Lessens awareness of injuries suffered. • Less able to protect children

22. Screening for Abuse • Obvious signs of physical abuse • Inconsistent explanations for injuries • Complications in pregnancy • Stress-related illnesses • Documented or reported child abuse by partner of client • Client’s description of her partner’s treatment of her.

23. Screening, cont’d • Avoid “bad mouthing” client’s partner • Never conduct interview with client partner present • Reassure client confidentiality and safety • Family of origin questions – increases level of comfort • Questions about current relationship (isolating, forced drug use, threats, harming pets, threats to take children away)

24. Suggested Questions • Do you feel safe in your current relationship? • Do you or your partner argue often? • Do arguments ever end in pushing, shoving, slapping or name-calling? • Have you ever been concerned about the safety of your children? • Do you feel you can say no if you don’t want to have sex?

25. Motivational Interviewing Precontemplation Stage (not yet considering change) • Raise consciousness • Ask open-ended questions • Provide feedback and information Contemplation (Considers change, then rejects; ambivalence) • Self and environmental re-evaluation • Develop discrepancy • Affirm client concerns

26. Motivational Interviewing Preparation Stage (recognition of problem, makes actions statements, makes decision to change) • Develop goals • Present Options • Emphasize client responsibility for change Action Stage (Active participation in treatment plan) • Counter conditioning • Reinforcement management • Implement contract • Support Self efficacy

27. Motivational Interviewing Maintenance (awareness of past problems with change) • Stimulus control • Develop strategies to use when past patterns emerge • Relapse prevention plan • Affirm ability to maintain change (Kail, 2010)

28. Cognitive Behavioral Therapy • Stinkin’ Thinkin’ • “Shoulding” all over yourself • “Musterbating” • Positive self talk • Identify destructive behaviors (negative coping skills) • Develop positive coping strategies • Identify triggers that lead to substance abuse • Relapse prevention plan • Co-dependency

29. Barriers to Treatment • Lack of affordable services • Lack of access to services (sabotage by batterer) • Batterer entering treatment with client. • Lack of accommodations for women with children • Stigma and guilt may foster a denial of problems. • Differing modalities

30. Safety Planning • Assess level of danger • Identify domestic violence service providers • Safe numbers to call • Identify important documents needed • Hide car keys • Keyword for children to use • If inpatient, safe discharge plan

31. Gulf Coast Women’s Center for Nonviolence • Emergency shelter for women and children in danger from domestic violence situations. • Childcare • Counseling (individual and group) • Case management/life skills • Shelter • Meals • Therapeutic preschool • Legal assistance

32. References • Aramburu, B., and Leigh, B. (1991). For Better or worse: Attributions about drunken aggression toward male and female victims. Violence and Victims 6(1): 31-42. • Covington, S. S., and Kohen, J. (1984). Women, alcohol, and sexuality. Advances in Substance Abuse 4(1):41-56. • Dembo, R.; Dertke, M.; LaVoie, L.; Borders, S: Washburn, M.: and Schmeidler, J. (1987). Physical abuse, sexual victimization and illicit drug abuse: A structural analysis among high risk adolescents. Journal of Adolescence 10:13-33. • Fowler, D.N. (2009). Screening for co-occurring intimate partner abuse and substance abuse: Challenges across service delivery systems. Journal of Social Work Practice in the Addictions, 9, 318-339. • Gelles, F.J. (1993). Alcohol and other drugs are associated with violence-they are not its cause. Current Controversies on Family violence (Newbury Park, CA: Sage Publications, 184. • Herman, J. L., (1992). Trauma and Recovery (New York: Basic Books, , 42-45. • Miller, B.A.; Downs, W.R.: and Gondoli, D.M. (1989) Spousal violence among alcoholic women as compared to a random household sample of women. Journal of Studies on Alcoholism 50(6): 533-540. • Kail, B.L. (2010). Motivating women with substance abuse and intimate partner violence. Journal of Social Work Practice in the Addictions, 10, 25-43. • Stark, E., and Fllitcraft, A., (1996). Women at Risk: Domestic Violence and Women’s Health. (Thousand Oaks, CA: Safe Publications) 8-18, 162-163.