Partner Violence/Substance Abuse Project Essay
Develop an informational video on intimate partner violence or substance abuse.
Create a 3-minute video clip that includes information on prevention, treatment, and available resources.
You must include a reference page with at least three citations using resources that are less than five years old. Partner Violence/Substance Abuse Project Essay
Consider the following information when pulling your research together:
Summarize the models of care that have evolved in caring for victims of intentional violence.
Describe the impact of substance abuse and addiction on individual people and their families, communities, and nations.
Intimate partner violence (IPV) continues to be a pervasive public health and human rights issue. According to a recent survey by the Centers for Disease Control (CDC), 31% of U.S. women1 will experience physical violence by an intimate partner during their lifetimes and 47% will experience psychological aggression (Breiding et al., 2014). Rates of IPV in same-gender relationships are similar to (or slightly higher than) those found in heterosexual relationships (Walters, Chen, & Breiding, 2013; for
more information, please see Allen et al., 2007). IPV is best understood as an ongoing pattern of power and control in romantic relationships that is enforced by the use of abusive tactics, such as intimidation,
threats, physical or sexual violence, isolation, economic abuse, stalking, psychological abuse, and coercion related to mental health and substance use (Bancroft, 2003; Johnson & Leone, 2005; Stark, 2007; Warshaw, Lyon, Bland, Phillips, & Hooper, 2014). The use of violent tactics to reinforce an ongoing dynamic of domination and intimidation can have profound effects—it is that pervasive, all-encompassing dynamic that survivors often say is the most devastating (Stark, 2007; Warshaw et al., 2014).
For many people, abuse by a partner is their first experience of victimization; for others, intimate partner violence occurs in the context of other lifetime trauma (Warshaw, Brasher, & Gil, 2009). Research suggests that survivors of IPV often experience multiple forms of interpersonal trauma throughout their lives, including abuse or neglect in childhood, sexual assault, intergenerational trauma, community violence, and/or witnessing family violence as a child (Becker et al., 2010; Chen et al., 2013; Edmund & Bland, 2011; Faulkner et al., 2014; Partner Violence/Substance Abuse Project Essay Jackson et al., 2015; Lang et al., 2004). One study found that women who experienced abuse in childhood were 6 times more likely to report adult physical or sexual violence, as compared to women who did not report
experiencing abuse in childhood (Kimerling et al., 2007). Furthermore, 1 Within heterosexual relationships, IPV is most often perpetrated by men against women (Black et al., 2011; Caldwell et al., 2012). When gender-specific language is used within this brief, it is reflective of the research being cited. This is not meant in any way to minimize or disregard the experiences of trans* survivors, male survivors, LGBTQI survivors, or survivors in same-gender relationships.
IPV is best understood as an ongoing pattern of power and control in romantic relationships.
An Applied Research Paper on the Relationship Between IPV and Substance Use experiencing forms of societal oppression, such as discrimination based on race or ethnicity, class, sexual orientation, gender identity, immigration status, disability, or age, is often traumatic in itself (Edmund & Bland, 2011) and can limit access to services and supports (Stockman et al., 2015). While many survivors do heal and recover from the effects of IPV, it can have long-term effects on the health and well-being of survivors. Experiencing multiple forms of abuse, trauma, or violence can increase this risk. Partner Violence/Substance Abuse Project Essay
Research has documented myriad adverse trauma-related physical and mental health effects resulting from IPV, including chronic pain, injury, depression, posttraumatic stress disorder (PTSD), and substance use (Black et al., 2011; Dutton, 2009; Dutton et al., 2006; Golding, 1999; Jones, Hughes, & Unterstaller, 2001; Phillips et al. 2014). For many survivors who use substances, it is a way to cope with
the traumatic effects of abuse (Bennett & O’Brien, 2007; Schumacher & Holt, 2012, Warshaw et al., 2014, Wingwood et al., 2000). Others are coerced into using by an abusive partner who then sabotages their efforts toward recovery and threatens to undermine them with authorities (e.g., the police, treatment providers, the courts) by disclosing their substance use. These tactics are used to further control their partner and have a chilling effect on survivors’ ability to access safety and support and to retain custody of their children (Warshaw et al., 2014). Emerging research demonstrates that substance use coercion is common within abusive relationships (Warshaw et al., 2014). While substance use coercion remains an emerging area of research in itself, it is an important contextual factor to consider when reviewing research on the relationship between IPV and substance use.
“Substance use” is defined in this brief as the use of alcohol and/or other drugs. It can be distinguished
from “substance abuse,” which is defined variously by researchers and treatment providers, and is based on the quantity consumed or frequency of use. “Substance use disorder” (SUD) is the terminology found in the DSM-V, which combines the previous concepts of substance abuse and substance dependence (American Psychiatric Association, 2013). It should be noted that the terms substance use, abuse, and dependence are used in this paper to reflect those used in the research studies that have been cited. Partner Violence/Substance Abuse Project Essay
For many survivors who use substances, it is a way to cope with the traumatic effects of abuse. Others are coerced into using by an abusive partner.
An Applied Research Paper on the Relationship Between IPV and Substance Use
CURRENT EVIDENCE: CO-EXISTING SUBSTANCE USE AND IPV
This section begins with data on the prevalence of co-existing IPV and substance use or substance
use disorders, and then explains what is currently known about the relationship between substance
use and experiencing IPV2. It also provides a summary of some of the complex issues being grappled with in this area of research, including the temporal relationship between IPV and substance use and the role of potentially confounding factors.
HOW COMMONLY DO IPV AND SUBSTANCE USE CO-EXIST?
The co-existence of substance use and IPV has been established via prevalence estimates from a
variety of sources, including national surveys, studies utilizing community samples, and studies of
specific groups of people (e.g. IPV survivors; people seeking medical treatment, substance use
disorder treatment, or community services). In studies of people who use or are dependent on
substances, researchers have consistently found high rates of lifetime IPV (Burke, Thiemen, Gielen,
et al. 2005; Cohen et al., 2003; El-Bassel, Gilbert, Wu, et al., 2005; Engstrom, El-Bassel, Gilbert,
2012; Stuart, et al. 2013). For example, in a study of men and women entering substance abuse
treatment, 47% of the women reported having experienced victimization by an intimate partner at
some point in their lives (Schneider & Burnette, 2009). Another study of women accessing
substance abuse treatment services found that approximately 67% reported experiencing physical
IPV in the past 6 months (Downs, 2001). In addition, a study of women who use injectable drugs
found that 31% reported experiencing physical and sexual IPV in the previous year (Wagner et al.,
2009), and a study of women who attended a methadone clinic found that 90% had experienced
IPV in their lifetime (Engstrom, El-Bassel, Gilbert, 2012). In all cases, both the past-year and
lifetime rates of IPV among people who use substances is considerably higher than those found in
recent national surveys (Black et al., 2011; Breiding et al., 2014). Partner Violence/Substance Abuse Project Essay
At the same time, many studies have found that women who have been abused by an intimate
partner are more likely to use or become dependent on substances, as compared to women who
have not experienced IPV (Anderson, 2002; Bonomi et al., 2006; Eby, 2004; Lipsky, Caetano, Field,
& Larkin, 2005; Smith, Homish, Leonard, & Cornelius, 2012). This has been established through
studies utilizing national or general community samples as well as samples of DV survivors in a
2 It is important to note that IPV has been defined and operationalized by the articles cited in a range of ways, some of which do not conceptualize coercive control as central to IPV. An analysis and critique of the measurement of IPV is included in the discussion section of this brief. An Applied Research Paper on the Relationship Between IPV and Substance Use variety of settings. For example, a community-based study of low-income women found higher rates of substance abuse among IPV survivors (26%), as compared to those who had not experienced IPV (5%) (Eby, 2004). A 2012 national cohort study of 11,782 women found that, as compared to those with no history of IPV, women with a recent history of experiencing IPV had nearly six times the risk of problematic alcohol use (LaFlair et al., 2012). Similarly, results of a large national survey indicate that IPV survivors are two times as likely as those who have never been victimized to participate in alcohol treatment (Lipsky & Caetano, 2008). Partner Violence/Substance Abuse Project Essay
Studies that focus solely on IPV survivors have yielded similar results. One study found higher rates
of both past-year alcohol (18.1%) and drug (6.4%) dependence in a community sample of IPV
survivors, as compared to the general population3 (6.6% and 2.6% respectively) (Nathanson, Shorey,
Tirone, & Rhatigan, 2012; SAMHSA, 2014). Furthermore, in a study of 174 DV shelter residents, 72%
of women screened reported frequent alcohol or drug use, use of multiple substances, or a current
alcohol or substance use-related problem (Poole et al., 2008). In 2007, Fowler conducted a study
with 102 DV shelter residents incorporating well-validated questionnaires and diagnostic
interviews focusing on substance use and abuse. Overall, 67.7% of women met the study’s criteria
for having a moderate to high risk for past-month substance abuse, and 55%-60% of women met
the study’s criteria for substance or alcohol dependence. Interestingly, even in this study of DV
shelter residents, women’s use of cocaine in the past month and women’s total number of years of
alcohol use were both significantly correlated with physical IPV.
In summary, the data as a whole indicate a high prevalence of co-existing IPV and substance use or
abuse. However, the exact prevalence rates of substance use or abuse among IPV survivors vary
from 18%-72%, and the prevalence rates of IPV among people using substances vary from 31%-
90%. This variance is related to a number of significant differences in methodologies among
studies, including the sample assessed (e.g., DV shelter residents, nationally representative surveys,
IPV survivors in the community, people who use substances, women accessing methadone clinics);
type of substance or substances studied (alcohol versus drugs or other substances); the way IPV is
operationalized in each study; and the way that substance use, abuse, or dependence is defined
and measured within each study.
3 Note: IPV survivors were not excluded from this general population survey and are therefore included in this estimate. An Applied Research Paper on the Relationship Between IPV and Substance Use Partner Violence/Substance Abuse Project Essay
WHAT DO WE KNOW ABOUT THE RELATIONSHIP BETWEEN IPV AND SPECIFIC SUBSTANCES?
Research has also been conducted on the relationship between IPV and the type of substance or
substances used by survivors. Experiencing IPV is associated with increased alcohol use (Golinelli
et al., 2008; Stuart et al., 2013; Temple et al., 2008; Wong et al., 2011), and abuse, heavy drinking,
or dependence (Boden et al., 2012; Bonomi et al., 2006; El-Bassel et al., 2003; La Flair et al., 2012;
Lipsky & Caetano, 2008; Reingle et al., 2012; Reingle-Gonzalez et al., 2014; Smith et al., 2012;
Stuart et al., 2013; Vos et al., 2006; White & Chen, 2002). While the above studies found a
significant statistical relationship between experiencing IPV and alcohol use, the strength of the relationship varied across studies. However, a recent systematic review and meta-analysis of 55 studies found an overall odds ratio (OR) of 1.80 for the association between adolescent and adult IPV and alcohol use (Devries et al., 2014). In other words, respondents were 1.8 times more likely to report alcohol use when they also reported being abused by an intimate partner.
A number of studies also found that victimization by an intimate partner is related to drug use (Bonomi et al., 2006; Burke et al., 2005; El-Bassel et al., 2005; Engstrom et al., 2012; Partner Violence/Substance Abuse Project Essay
Golinelli et al., 2008; Lipsky et al., 2005; Lipsky & Caetano, 2008; Testa et al., 2003; Vos et al.,
2006) and to drug abuse and dependence (El-Bassel et al., 2003; Lipsky & Caetano, 2008; Smith et
al., 2012). While most studies reviewed examined drug use in general, a few looked at the
relationship between experiencing IPV and the use of specific drugs. For example, a national
survey found that survivors were significantly more likely to experience problems related to
cannabis, cocaine, and opioid use, as compared to other substances (Smith, et al. 2012). In a
longitudinal study of women attending a methadone clinic, those who reported previous IPV were
approximately three times as likely to report subsequent frequent heroin use, as compared to
women who did not report experiencing earlier IPV (El-Bassel, Gilbert, Wu, et al. 2005). However,
overall the findings on the relationship between experiencing IPV and using drugs have been
mixed, with marked variation across studies (Burke et al., 2005; El-Bassel et al., 2005; Lipsky et al.,
2005; Smith et al., 2012; Stuart et al., 2013; Testa et al., 2003). No recent meta-analysis has tested
the relationships among IPV and drug use, abuse, or dependence. Partner Violence/Substance Abuse Project Essay
Much of the violence reported in the literature involves intimate partnerviolence (IPV) committed by men toward women, a pervasive problem in asignificant proportion of U.S.families. Roughly 1,800 instances of homicide and manslaughter between intimatepartners occurred in 1998, with more than 1,300 of these involving women asvictims (Rennison and Welchans,2000). The findings from the National Crime Victimization Survey indicate thatnearly 1 million women are victims of IPV each year (Rennisonand Welchans, 2000). Surveys of representativesamples of couples that include less severe instances of aggression (e.g.,single episodes of pushing or slapping one’s partner) suggested that 8.7 millioncouples experience an incident of physical violence from within the dyad eachyear (Straus and Gelles, 1990). Additionally, asurvey of U.S.couples indicated more than one in five experienced at least one episode ofviolence during the previous year (Schafer et al., 1998).
IPV and Substance Abuse
Intimate partner violence is a major public health concern. Substance usehas been found to co-occur in 40% to 60% of IPV incidents across variousstudies (Easton et al., 2000a, 2000b; Fals-Stewart etal., in press; Moore and Stuart, 2004). Several lines of evidence suggest thatsubstance use plays a facilitative role in IPV by precipitating or exacerbatingviolence (Fals-Stewart, 2003). Several studiessuggest the promise of interventions that target substance use in men who havehistories of IPV (Fals-Stewart, 2003; Fals-Stewart et al., in press; Moore and Stuart, 2004). Partner Violence/Substance Abuse Project Essay
It is known that many IPV episodes involve alcohol or drug consumption.Kaufman Kantor and Straus (1990) found over 20% ofmales were drinking prior to the most recent and severe act of violence. Fals-Stewart (2003) found that on days of heavy drug use,physical violence was 11 times more likely. Victims of IPV report that theoffender had been drinking or using illicit drugs (Miller, 1990; Roberts,1998). Miller (1990) reported that offenders of IPV typically use alcohol and have a dual problem with drugs. In addition, the strongrelationship between substance use and perpetration of IPV has been found inprimary health care settings (McCauley et al., 1995), family practice clinics(Oriel and Fleming, 1998), prenatal clinics (Muhajarineand D’Arcy, 1999) and rural health clinics (Van Hightower andGorton, 1998). The relationship between substance abuse and IPV has also beenobserved to be quite prevalent among individuals presenting at psychiatricsettings (Gondolf et al., 1991) and substance abusetreatment facilities (Easton et al., 2000b). Partner Violence/Substance Abuse Project Essay
A Proximal Effects Model
Three primary conceptual models have been posited to explain the observed relationshipbetween substance use and spousal violence: 1) spurious model; 2) indirecteffects model; and 3) proximal effects model (Fals-Stewart,2003; Leonard and Quigley, 1999).
The spurious model suggests that the relationship between substance use and IPVis the result of these variables being related to other factors that influenceboth drinking and violence. For example, individuals who are young may tend tobe violent and to use drugs; thus, drug use and violence may appear directlyrelated when, in fact, they are not. Although not entirely consistent, theresults of several studies suggest that alcohol and other drug use areassociated with IPV after controlling for factors thought to be associated withboth behaviors such as age, education, socioeconomic or occupational status,and ethnicity (e.g., Leonard and Jacob, 1988; Pan et al., 1994). However, therelationship between substance use and violence remains strong even aftercontrolling for levels of general hostility (e.g., Leonard and Senchak, 1993) and normative views of aggression (Kaufman Kantor and Straus, 1990). Partner Violence/Substance Abuse Project Essay
In the indirect effects model, substance use is viewed as being corrosive torelationship quality. Thus, long-term substance use creates an environment thatsets the stage for partner conflict and, ultimately, partner violence. Again,however, when marital satisfaction, relationship discord or other similarvariables are controlled for when examining the link between substance use andviolence, the relationship remains strong (e.g., McKenryet al., 1995).
According to this model (Fals-Stewart, 2003),individuals who consume psychoactive substances are more likely to engage inpartner violence because intoxication facilitates violence, which may bemediated through the psychopharmacologic effects of drugs on cognitiveprocessing (Chermack and Taylor, 1995) or theexpectancies associated with intoxication (Critchlow,1983). It follows from this theory that substance use should precede IPV andthe episode of violence should occur closely in time to the consumption of thedrug. Several longitudinal studies supported temporal ordering consistent withthis model. Fals-Stewart (2003) collected dailydiaries from partners with histories of IPV entering either an alcoholism ordomestic violence treatment program over a five-month period, which allowed fora detailed examination of the daily temporal relationship betweenmale-to-female aggression and drinking. The data suggested that alcohol andmale-to-female aggression were linked only on days when the drinking occurredbefore the IPV episode. The odds of severe male-to-female physical aggressionwere more than 11 times higher on days of men’s drinking than on days of nodrinking. Moreover, in both samples, over 60% of all IPV episodes occurredwithin two hours of drinking by the male partner. These findings were recentlyreplicated with another sample of men entering treatment for drug abuse (Fals-Stewart et al., 2003). Partner Violence/Substance Abuse Project Essay
Three conceptual models have been put forth to explain the relationshipbetween alcohol use and violence. Although each may have some merit and may, infact, explain part of the relationship between substance use and violence, thegreatest empirical support rests with the proximal effects model (Fals-Stewart, 2003). Hence, it is reasonable thatinterventions targeting substance use among men with histories of IPV andsubstance use may lead to reductions in partner violence.
Referral for Treatment
Currently, men convicted for IPV are referred to batterer/IPV programs(e.g., the Duluth Model). The program uses a psychoeducationstructure; actual behaviors are identified and challenged by facilitators, whomodel alternative behaviors and solutions to conflict. This approach oftentreats men with IPV in a classroom setting with 10 to 20 men in a group format.This method has the following limitations: 1) lack of structured/standardizedassessments to rule out co-occurring psychiatric or substance abuse disorders;2) lack of objective indicators to rule out current substance use (e.g., breathsamples, urine toxicology screening); 3) lack of collateral data from thevictim regarding ongoing abuse; and 4) lack of other therapeutic options formen who request additional or other treatments (e.g., individual therapy, psychiatricconsultation, parenting, couples therapy) (Babcock and LaTaillede,2000). Partner Violence/Substance Abuse Project Essay
In addition to these limitations, there is very little empirical supportregarding the effectiveness of the Duluth Model in reducing violence orsubstance use (Babcock and LaTaillede, 2000). Infact, meta-analytic reviews of outcomes for these approaches have consistentlyfound them to be of very limited effectiveness, with effect sizes near zero(Babcock and LaTaillede, 2000). Many battererprograms do not address substance use, are highly confrontational in nature andreach far fewer individuals than substance abuse treatment programs. Hence, itis likely that focusing on IPV with men who batter within the context of asubstance abuse treatment facility may reach a comparatively larger number ofindividuals with IPV.
Standard Treatment Effects
Several studies suggest that treatment-associated reductions in substanceuse are related to reductions in violence. O’Farrell et al. (2003) examinedpartner violence in the year before and the year after individually based,outpatient alcoholism treatment for male alcoholic patients, compared with ademographically matched nonalcoholic comparison group. The results illustratedthat in the year before treatment, 56% of the alcoholic patients had beenviolent toward their female partner, four times the rate of the comparisonsample (14%).
However, in the year after treatment, violence decreased significantly to25% of the alcoholic sample but remained higher than the comparison group. Partner Violence/Substance Abuse Project Essay
In a parallel study, Fals-Stewart et al. (2003)examined partner violence among a sample of married or cohabiting men enteringoutpatient treatment for drug abuse. During the year before treatment, theprevalence of IPV was roughly 60%, but dropped to 35% during the one-year, posttreatment follow-up period. In both studies, treatmentswere standard 12-step facilitation interventions that did not address partnerviolence (e.g., Schumacher et al., 2003). Nonetheless, participation in theprograms resulted in significant reductions in interpersonal violence,consistent with the proximal effects model. Additionally, this line of researchsuggests that tailoring or developing substance abuse treatments to addressdomestic violence-related problems (e.g., managing anger and negative moodstates) may reduce IPV, especially in the event of a substance abuse relapse.Since substance abuse treatment facilities provide a treatment venue for maleoffenders of IPV, addiction specialists and psychiatrists will play a crucial rolein the assessment of co-occurring substance abuse and IPV. In addition to usingthe DSM-IV for the Axis Isubstance-related diagnoses and the Addiction Severity Index (ASI) (McLellan et al., 1992) for diagnosing severity of substanceabuse/dependence, psychiatrists can also utilize the following diagnosticassessments to evaluate type, amount and frequency of intimate partner orfamily violence: 1) Timeline Follow-Back method (TLFB) (Fals-Stewartet al., 2000); 2) Revised Conflict Tactics Scale (CTS2) (Straus et al., 1996);and 3) State-Trait Anger Expression Inventory (STAXI) (Spielberger,1991). Partner Violence/Substance Abuse Project Essay
Behavioral couples therapy.Several studies suggest that interventions targeting reduction in substance useand skill deficits have particular promise in this population. In particular,and highly relevant to the proposed project, behavioral couples therapy, acognitive-behavioral approach that teaches couples techniques to reduceconflict and improve relationship functioning, has been demonstrated to beeffective in several select populations (Fals-Stewartet al., 2002; O’Farrell and Fals-Stewart, 2000).Although behavioral couples therapy is effective withthese populations, it has limited application to individuals convicted ofinterpersonal violence who are referred or mandated to substance abusetreatment.
For example, behavioral couples therapy requires participation of the femalepartner and, therefore, has the following problems: 1) in many cases, thefemale partner has left the relationship and has no ongoing contact; 2) thepartner may refuse to participate in the male’s treatment; 3) a male offendermay refuse to have his partner participate in his treatment because ofunwillingness to reveal the extent of his substance use; and 4) there may beimposed restraining or protective orders that limits contact between theoffender and the victim. Partner Violence/Substance Abuse Project Essay
Cognitive-behavioraltherapy. One individual approach to substance abuse treatment withstrong empirical support and the capacity to expand to address other problemsis cognitive-behavioral therapy (CBT) (Carroll, 1998; DeRubeisand Crits-Christoph, 1998; Irvin et al., 1999). Basedon social learning theories of substance use disorders, CBT focuses on theimplementation of effective coping skills for recognizing, avoiding and copingwith situations that increase the risk of drug use and related problems.Cognitive-behavioral therapy is one of comparatively few empirically supportedtherapies that has been demonstrated to be effective across a range ofsubstance use disorders including abusers of alcohol (Morgenstern and Longabaugh, 2000; Project MATCH Research Group, 1997),marijuana (Sinha et al., 2003) and cocaine (Carrollet al., 1998; Maude-Griffin et al., 1998; McKay et al., 1997; Monti et al., 1997). Cognitive-behavioral therapy is alsowell-accepted by the clinical community and can be implemented effectively byclinicians (Morgenstern et al., 2001). Moreover, CBT has also been demonstratedto be effective for a range of other behavioral and mental health disorders (DeRubeis and Crits-Christoph,1998) and can easily be adapted to address multiple problems such asco-occurring substance abuse and depression (Dobson, 1989). Partner Violence/Substance Abuse Project Essay
Substanceabuse-domestic violence treatment. In a recent preliminary study,CBT was tailored to treat men with co-occurring alcohol dependence and IPV(Easton et al., unpublished data). This treatment model is called an integratedsubstance abuse domestic violence treatment. This study assessed whether thisapproach was efficacious in decreasing alcohol use and IPV. Men (n=78; meanage=38) arrested for domestic violence within the past six months meeting DSM-IV criteria for alcohol dependencewere randomized to either 12 group sessions of integrated substance abusedomestic violence treatment, which focused both on alcohol use and IPV, or 12sessions of manual-guided group Twelve-Step Facilitation (Nowinskiet al., 1992). Twelve-Step Facilitation was chosen as the comparison conditionbecause this approach is comparative to standard treatment for this population,and would provide preliminary indication of the value of targeting alcohol usealone. Partner Violence/Substance Abuse Project Essay
Of the participants, 49% were white, 33% were African-American, and 10% wereHispanic; 70% were employed, and 63% reported living alone. The sample’s meannumber of arrests was 4.60 (standard deviation=4.2), with a mean of twoprevious domestic violence arrests. The groups were not significantly differentacross age, race, employment, education, other key demographic variables orbaseline addiction severity composite scores. However, there were significantdifferences across groups with respect to whether the participants were livingalone or with their female partners (76% in Twelve-Step Facilitation group wereliving alone versus 50% of the integrated treatment group; p<0.02). Partner Violence/Substance Abuse Project Essay
The integrated treatment group reported using alcohol significantly fewerdays in 12 weeks of treatment. For example, the group reported 76 total daysabstinent, while the Twelve-Step Facilitation group reported a mean of 68 totaldays (p<0.03). The integratedtreatment group reported significantly more physical violence episodes atbaseline (e.g., slapping, pushing, punching, kicking and hair pulling withinthe past 30 days) (37.9%) as compared to the Twelve-Step Facilitation group(6.9%) (p<0.005).Repeated measures ANOVA (analysis of variance) indicated a trend for a greaterreduction in the frequency of violent episodes across time for the integratedtreatment group compared to the Twelve-Step Facilitation group (p<0.094).
This is one of the first randomized, controlled studies utilizing a versionof CBT among men who have co-occurring substance use and IPV. Although thismodel shows promise, it is in its infancy stage of development and furtherinvestigation is needed with larger sample sizes and across a broader spectrumof substance abuse disorders. Partner Violence/Substance Abuse Project Essay
Although substance use and IPV remains a public health concern, there havebeen advances in our basic understanding of how to treat men with co-occurringsubstance abuse and IPV. For example, when substance use and IPV co-occur,research suggests that substance use plays a facilitative role in IPV byprecipitating or exacerbating violence. Hence, it is important to treat thesubstance abuse disorder. We also know that standard batterer interventionprograms are not effective at decreasing IPV or substance use, and, therefore,other referrals to substance abuse or mental health treatment are needed. Weknow that behavioral couples therapy is an effectiveapproach for decreasing substance use; IPV among couples in an intactrelationship, in which both members are motivated for treatment. Alternativeapproaches that are grounded in evidenced-based practice hold promise fordevelopment of effective treatments for men with co-occurring substance abuseand IPV (Table). Partner Violence/Substance Abuse Project Essay