Understanding Co-occurring Substance Use & Domestic Abuse
First published: 22/05/2017 | Last updated: August 4th, 2019
The UK Government defines domestic violence and abuse as “any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality”. This can encompass, but is not limited to, psychological, physical, sexual, financial and emotional abuse. Domestic abuse can occur through controlling behaviour i.e. acts designed to make a person dependent on the controller, and it can be coercive i.e. acts to harm, punish or frighten the victim. For those (predominately women) who are victims of domestic abuse, fear runs deep. Women are fearful of their partners, they are worried if they tell social services their children will be removed, they fear being homeless and worried how they will be portrayed by friends and family.
Now consider a woman who is a victim of domestic abuse but also uses substances (drugs, alcohol, medications) to a problematic level. Those feelings of fear and worry are intensified. Often described as a chicken and egg scenario, women who face problematic substance use issues and domestic abuse are faced with complexities in their support needs. If they go to a refuge, they may not be allowed stay because of their drug use. If they turn to a community addiction team, how will they get away from their abusive partner? That is if they can get to substance treatment at all. Some women feel they need substances to cope with the abuse, others are in a situation where the use of substances leads to abuse from a perpetrator. Some are in a relationship with partners that use and some perpetrators use these substances to control women. The co-occurrence of problematic substance use and domestic abuse in a woman’s life is not as simple as ‘just leave’ or ‘stop drinking’. Women need support that is safe, understanding and where possible, all in one.
Frontline services such as drug and alcohol, domestic abuse, GP, midwifery and social work, therefore play a vital role in identifying and supporting women with co-occurring substance use and domestic abuse issues. The similarities in their client group means they can ask about co-occurring issues and refer women to the right support. However, it’s key that practitioners in these services ask the right questions, using the right tone, and know what to do with the information disclosed to them.
What can clinicians do?
Domestic abuse services that can support women experiencing problematic drug and alcohol use are unfortunately scarce in the UK. There is also an uncertainty among many drug and alcohol workers as to how to effectively respond to a disclosure of domestic abuse. Against Violence and Abuse (AVA) offers research, guidance and training to practitioners about multiple disadvantage (substance use, domestic abuse, sexual violence, prostitution and mental health). Their Stella Toolkit highlights the importance of multi-agency working and issues ‘minimum standards’ for supporting women with co-occurring issues. Among these standards they stipulate: “clients should not be denied services due to issues with domestic violence or substance misuse” (p.24) and “clients need to be consulted about the interventions they find supportive and effective” (p.24). A client-centered response is imperative to supporting women with little to no agency. Domestic abuse strips a woman of choice and independence, and it is important that services offer her the choice in the services she sees as being the most important for her. A drug worker may identify a detox as the most important step whereas the woman may identify safe housing as the most pressing matter. A social worker may believe ‘leaving’ is key to a woman’s recovery while the woman may feel she’s not ready to leave and wants to get sober first.
Research (including my ongoing PhD project) shows that women with co-occurring problematic substance use and domestic abuse want to be listened to, to be believed and not to be judged no matter what they share. They want to know their options but not be pressured, to know their children will not be taken away from them, but not to be treated as less important if they don’t have children
In achieving this, services can work more collaboratively to respond to women’s needs. Frontline services can:
- Conduct a scoping exercise to map local services in their area
- Make contact with local services including domestic abuse and substance misuse
- Share information, leaflets and training materials
- Hold multi-agency training days
- Hold open days and invite local services to attend
- Set up an emergency referral system between local services
- Learn about the impact domestic abuse can have on women (particularly the non-physical aspects) – for more information on the impact domestic abuse has on a woman visit Women’s Aid, Refuge or The Freedom Project.
- Routinely enquire about domestic abuse and substance use
- Never presume a woman is not ‘the type of person’ to be abused
For additional information on implementing substance use and domestic abuse support and understanding in practice, look at Sarah Galvani’s suggestions for basic level and enhanced level responses in Grasping the nettle: alcohol and domestic violence, from 2010
Sarah Fox, SSA PhD Studentship Holder Manchester Metropolitan University
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.