Effective Practices for Managing Domestic Violence and Addiction Drug Treatment Conference

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Effective Practices for Managing Domestic
Violence and Addiction Drug Treatment
ConferenceEvidence-Based Practice Made
PracticalAugust 31th, 2010Presenter Bea
Coté, LCSW, LMFT
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DRUG TREATMENT COURT goals

• To increase the personal, familial, and societal
  accountability of adult and juvenile offenders
  and defendants and respondents in juvenile
  petitions for abuse, neglect, or both and
• To promote effective interaction and use of
  resources among criminal and juvenile justice
  personnel, child protective services personnel,
  and community agencies.

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DRUG TREATMENT COURT goals

• To reduce alcoholism and other drug dependencies
  among adult and juvenile offenders and defendants
  and among respondents in juvenile petitions for
  abuse, neglect, or both
• To reduce criminal and delinquent recidivism and
  the incidence of child abuse and neglect
• To reduce the alcohol-related and other
  drug-related court workload

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Why this is important to you

• Often, the folks you see in court are also DV
  clients
• Making the right referral
• Protecting victims
• Not protecting abusers- holding them accountable

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Some basics

• Nationwide, in 50 of all domestic violence
  murders, the killer had used alcohol before the
  murder.
• So far this year in North Carolina, there have
  been at least 45 murders related to domestic
  violence. Not enough evidence unclear
  relationship unsolved murder body not
  discovered murders last couple days

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• That means of course, theres a likelihood that
  22 of these people were murdered by someone who
  was drunk. (but probably not solely high on
  other substances)
• 12/43 were male victims. 4 of those were men
  killed by women.
• 4 were people attempting to defend victims. 1 was
  a same-sex partner.
• 5/43 were children.
• That leaves us with 28/43 were women
  girlfriends wives ex-girlfriends ex-wives.

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• Many of these folks have been involved with our
  systems our services, prior to the murders.
• Someone had an opportunity to recognize, address,
  refer, protect, hold accountable, treat,
  incarcerate, house, support and advocate.
• This does not mean that we are responsible for
  the murders. We are responsible for making DV
  unacceptable in North Carolina.

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Definitions

• DV communitys domestic violence definition a
  pattern of coercive, controlling or abusive
  behaviors toward an intimate partner/former
  partner. Note that only the violent behavior or
  threats violate laws.
• NC law- defines it as a physical act of abuse or
  threats toward family or household members or
  former household members
• Today, were talking about the first definition

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Gender bias?

• In a 1995-1996 study conducted in the 50 States
  and the District of Columbia, 7.6 of men were
  raped and/or physically assaulted by a current or
  former spouse, cohabiting partner, or dating
  partner/acquaintance at some time in their
  lifetime (ABA, 2000).
• (based on survey sample of 16,000 participants,
  equally male and female)
• Intimate partners committed 3 of the nonfatal
  violence against men (Tjaden Theonnes, 2003).
• One in 33 men have been the victim of an
  attempted or completed rape by an intimate
  partner (Theonnes Tjaden, 2000).

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Gender

• Our DV teams at the CMC network report that over
  the last quarter, 98 of DV-related injuries they
  saw were inflicted by male partners on women.
• Caution male victims are less likely to report
  less likely to seek services.

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The Missing Statistic
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What DV isnt

• A fight
• A lovers quarrel
• An argument
• A dispute
• An incident
• Isolated
• First time

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9-1-1 call Did you have a good time?
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When the victim is in Drug Court

• Up to 80 of battered women who seek safety at a
  shelter are drug/alcohol abusing or dependent.
  (She) may or may not have been that way when she
  met her abuser. Either way, her addiction makes
  her much more vulnerable.
• Her D/A issues are going to be a lot more obvious
  to you in court and you may be tempted to address
  that problem first.
• She may appear more out-of-control- may be a hot
  mess!
• She has to be safe before she can be sober.

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When the abuser is your client

• If you dont know, you may unwittingly be
  protecting him and re-victimizing her.
• He may use his addiction/alcoholism as an excuse.
• He may use her addiction as an excuse.
• He may clean up a whole lot better than she
  does may present better in court. He could just
  be a really good obfuscator.

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• She may buy that shes the problem and may try to
  convince the court of that. She may make him look
  good, thinking he has a better chance of
  convincing you that hes okay- because shes the
  problem. She may be completely dependent on him
  and therefore truly believe a number of things
  that hes not abusive that hes her rescuer
  hes a good parent, etc. She needs to believe
  those things.

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Why are victims with addictions at higher risk?

• Abusers who seek/build vulnerable women. Some do
  it for the challenge others are needy.
• What factors make her more vulnerable?
• DSS involvement

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• THE RELATIONSHIP
• BETWEEN SUBSTANCE ABUSE
• AND
• DOMESTIC VIOLENCE

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Similar Characteristics Between Substance Abuse
and Domestic Violence

• SUBSTANCE ABUSE
• Isolation of the family
• Causes a lot of pain
• Mental, Emotional, Physical, Verbal, Sexual,
  Financial
• effects
• Lowers self-esteem negatively affects sense of
  selfworth

• DOMESTIC VIOLENCE
• Isolation of the family
• Causes a lot of pain
• Mental, Emotional, Physical, Verbal, Sexual,
  Financial
• effects
• Lowers self-esteem negatively affects sense of
  selfworth

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Similar Characteristics Between Substance Abuse
and Domestic Violence contd

• Failed attempts to stop using
• Intergenerational cycle
• Genetic
• Deny, minimize problem
• Progressive
• Relapse
• Can be fatal

• Failed attempts to stop violence or leave
• Intergenerational cycle
• Learned behavior
• Deny, minimize problem
• Progressive
• Return to abusive relationship
• Can be fatal

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So, what does it look like, when alcohol
anddomestic violence come together?WARNING-
Look away if youre queasy
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• When a batterer says, the alcohol made me do it
  hes blaming one problem violence, on another
  alcohol abuse.

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• In characterizing substance abuse and domestic
  violence, practitioners have observed that the
  two problems are separate but similar, and they
  each interact and exacerbate each other. For,
  example, both problems are passed on from
  generation to generation both involve denial,
  with substance abusers

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• and batterers blaming victims for their behavior
  usually, neither problem decreases until a crisis
  occurs and secrecy is often the rule, with
  victims of abuse (wrongly) blaming themselves for
  their partners substance abuse or violent
  behavior (Engelmann, 1992, p.6).

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• Intoxication appears to increase the likelihood
  that a batterer may misinterpret or distort a
  partners remarks, demeanor, or actions by
  blunting whatever cognitive regulators the
  abuser possesses (Stosny, 1995, p. 36)

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Alcohol, drugs, and violence

• Alcohol is the substance most frequently
  implicated in homicide and in other violent
  events as well.
• Evidence of an individual level association
  between alcohol and violence is widespread.
• - The consumption of alcohol increases the
  aggressiveness of the response to cues.

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Alcohol, drugs, and violence

• Alcoholic women are more likely to report a
  history of childhood physical and emotional abuse
  than are non-alcoholic women.
• Women in recovery are likely to have a history of
  violent trauma and are at high risk of being
  diagnosed with PTSD.

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Relationship Between Alcohol Abuse and Woman
Abuse contd

• If alcohol worked exclusively as a disinhibiting
  agent, there would be no domestic violence when
  sober. Although there is less violence when
  sober, substance and alcohol abusers are more
  likely to engage in domestic violence than are
  non-abusers.

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The Victim

• 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.
• Substance -abusing women often report that their
  abusive partners become angry or threatened when
  they seek help.
• The mans violence or threats of violence may
  push the woman to drop out of treatment.

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The Perpetrator

• Some batterers are less violent and easier to
  handle when they are drunk or high.
• If a batterer is more violent when sober or
  abstinent, his partner may encourage drinking or
  taking drugs.
• Victims can blame themselves for their partners
  substance abuse I made them do it is an
  enabling ideology.
• Surviving isnt enabling.

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Substance abuse and domestic violence contd

• Alcohol and drugs do not cause family violence-
  they merely make abusers less likely to control
  their violent tendencies.
• Abusers who blame their violence on drinking or
  drugs are not taking responsibility for their
  violence.
• Abusers with substance abuse problems must
  address both issues. Treatment of one will not
  treat the other.
• Violent abusers who abuse substances are more
  likely to inflict serious injury and to commit
  sexual violence.

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Relationship between alcohol and violence contd

• (For) men incarcerated for a violent offense
  chronic alcohol patterns had little predictive
  value, but that acute episodes of drinking
  immediately before the offense were significant.
• Significantly higher MAST (Michigan alcoholism
  screening test) scores for the abusive men

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Possible Reasons

• That Alcohol/Substance
• Abuse Can Facilitate
• Woman Abuse

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as an excuse

• Time-out from responsibility and a means to
  disavow the resulting behavior.
• Batterers use substances first as a vehicle, then
  as an excuse, for being controlling and violent.

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as a cognitive disrupter

• Drugs or alcohol may reduce the users ability to
  perceive, integrate, and process information.
• This increases the risk of violence.
• Substance-induced cognitive distortion is one
  factor that increases the risk the user will
  interpret his partners behavior as arbitrary,
  aggressive, abandoning, or overwhelming.
• Substances may make batterers be more likely than
  non-batterers to misinterpret the actions of
  their partners.

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as a power motive

• Both substance abuse and woman abuse may share
  common origins in a need to achieve personal
  power and control.
• While small quantities of a substance tend to
  increase a social users sense of altruistic
  power, larger quantities for social users - or
  any amount for an abuser- increases the users
  sense of personal power and domination over
  others.
• This power-using relationship is more
  characteristic of men than women.

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as a situational variable

• Situational variables
• Violence can occur as part of the situations
  associated with obtaining and using substances.
  (Lifestyle of an addict)
• A battered woman may use substances as a means of
  attempting to manage the batters violence and a
  means of increasing her own safety.

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Barriers to treatment for our clients

• Threats of physical harm, withholding of
  financial support, or abuse directed toward
  children can lead survivors to resort to using
  substances (or relapsing) to buffer their
  distress.
• A victims becoming clean or sober can threaten
  the batterers sense of control, increasing the
  likelihood of an instance of domestic violence.
  (Upping the ante)

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Language can be a barrier...

• Domestic violence programs may speak of
  empowerment, moving forward, building a new life.
• Substance abuse treatment may speak of denial,
  enabling, codependency, and powerlessness.
• Some domestic violence workers are not well
  educated in the field of substance abuse and have
  inaccurate understanding of the nature of
  treatment. They may seem overly protective of
  their clients, to the point of being
  non-cooperative. Assure them that you have the
  same goals- foremost, safety for the victim.

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Different goals...

• For treatment programs, abstinence is the goal.
• For domestic violence programs, safety is the
  goal.
• It is not a matter of choosing one goal over the
  other- both are important. It is a matter of
  timing the interventions to yield the greatest
  benefit.

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Screening potential victims

• See DVAC Screening Guide
• Never talk to the couple together
• Dont reveal what the victim says without written
  his/her permission

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• Has your partner ever attempted to control,
  intimidate, or scare you? If
• client answers yes, ask the following questions
• Have you ever been stalked by a partner or
  ex-partner? (following you or keeping track of
  your activities, causing you to feel intimidated
  or concerned for your safety) How long did it go
  on?

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??
3. In what ways, if any, has a partner (or ex)
ever physically hurt you? (slapped, punched,
shoved, choked, threatened with weapons, or
otherwise hurt you) How long did it continue?
4. In what ways, if any, has a partner (or ex)
ever forced you to have sex or perform sexual
acts in such a way that caused you either
distress, harm, fear, or humiliation? How long
did it continue? 5. In what ways, if any, has a
partner (or ex) ever verbally abused you? (called
you names, humiliated you in public, screamed at
you, blamed you for everything, lied, made empty
promises, etc.) How long did it continue?
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• 6. In what ways, if any, has a partner (or ex)
  ever psychologically abused or terrorized
• you? (For example, kept you from seeing
  family/friends, threatened to hurt or kill you
• or loved ones, controlled your life, interrogated
  you, controlled money, destroyed your
• belongings, accused you of having affairs,
  smashed things, kept you up at night,
• punched walls, had affairs, or caused you to lose
  a job)

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7. In what ways, if any, has a partner prevented
you from seeking support? (insisting on taking
you to your appointments, speaking for you,
answering doctors, counselors, pastors for you,
keeping the car from you)
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Screening possible abusers
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• Dont be fooled. The abuser may be the most
  together, likeable, well-functioning of the
  two.
• Dont make assumptions based on past arrests.
  Victims are often arrested, charged and
  prosecuted as abusers. But, if there are multiple
  charges and multiple victims (RED FLAG), well, if
  it walks like a duck
• Multiple areas of criminal involvement- also
  another sign.
• The victim may present as the abuser.

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• The easiest way to tell who the abuser is
• WHO HAS THE POWER?
• That is- WHO CAN SAY NO? WHO CAN GET UP AND WALK
  OUT?
• Also Who makes the decisions? Who makes excuses
  for the other? Contrary to what batterers will
  say, victims are almost always reluctant to blame
  their partner.

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Making referrals for the victim

• Help the client establish a relationship with a
  domestic violence program. Do not hesitate to
  make referrals.
• If a client denies a history of domestic
  violence but the counselor believes that it is
  possible, additional discussion with the client
  might be necessary.
• If she delays or refuses Create a safety plan.
  These are available online or through your
  shelter.
• Give her area resources.
• Remember forcing a victim to do anything means
  treating her the same way her abuser does.
  (Though I do understand how frustrating this is)

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Psychosocial issues for the victim

• Shift focus and responsibility to the abuser for
  the abuse.
• She is responsible for her only her behavior.
• Maintain responsibility for the substance or
  alcohol abuse.
• Enhance problem-solving and decision-making
  skills.

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• TREATMENT ISSUES
• For the Abuser

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Entering treatment is a crisis for the abuser
that itself enhances the likelihood of violence.

• No-violence contract.
• Fostering accountability and personal
  responsibility.
• No excuses will be accepted!
• Facilitate communication between providers.

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Making referrals, continued

• Both problems, DV and substance abuse, should be
  addressed at the same time, once the client is in
  outpatient services. Ask your local service
  providers if this is possible. Best-case scenario
  would be if all service providers worked
  together.
• Time and expense of both programs may be an
  issue. Most BIPs do not have funding and cannot
  accept insurance as these programs are not
  allowed to function as clinical programs.
• Select a state-approved batterer intervention
  program, or abuser treatment program (google NC
  abuser treatment programs for list of programs
  at Council for Women). Report violations of state
  Rules to same agency.

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What else can I do?

• Belong and actively participate in local efforts
  to eradicate domestic violence. Many communities
  have CCRs-coordinated community response teams
  on which your input and expertise would be
  valued.
• Bring training events to your community.
  Participate in awareness efforts. Check with CCRs
  or your shelter for upcoming events.
• Form collaborative partnerships with providers
  and Child Protective Services.
• Find out what your community resources are. Have
  a list on hand.

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• Be able to answer what happens with a same-sex
  couple? What are the resources? What about a male
  victim- what are the counseling and shelter
  resources?
• Does my community shelter pets for victims? What
  if she wont go to inpatient treatment- could a
  reason be that she fears for her pets safety?
• Does the victim feel she may lose custody of her
  kids if she acknowledges DV?

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THANK YOU!