A Therapeutic Approach to DV and AOD

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A Therapeutic Approach to DV and AOD

• Hon. Eugene M. Hyman
• Hon. Peggy Fulton Hora (Ret.)
• Superior Court of California
• Family Violence and Specialist Courts
• 22 - 23 May 2008
• Canberra, ACT

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Childs View of Domestic Violence
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Domestic Violence

• Violence is learned behavior on which the
  judiciary can have a profound impact
• Judges can hold batterers accountable
• Magistrates actions can help stop the violence
  and protect the victim
• Judge is the ultimate legal authority

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Domestic Violence

• Defined Establishing and maintaining power and
  control over the victim through a pattern of
  controlling and intimidating behavior
• 92 incidents are male on female
• 1-2 female on male
• 4-8 same sex partners

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Abuse

• Can use physical, economic, sexual and/or
  psychological forms of abuse
• It is a BELIEF SYSTEM that states one partner has
  the right to have power and control over the
  other
• 15 people in relationships acts on this belief

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ER room visits

• 13 women treated in hospital emergency rooms in
  the U.S. report emotional or physical abuse in
  their lifetimes
•  

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DV is NOT caused by

• ABUSER TRAITS
• Insecurity
• Poor impulse control
• Problems with anger
• Prior history of abuse
• Substance abuse

• VICTIM TRAITS
• Low self-esteem
• Co-dependency
• Passivity
• Prior history of abuse
• Substance abuse

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Correlation does not equal causation

• 27 of male abusers witnessed their fathers
  abusing their mothers 73 DID NOT
• 60 of abusers do not use drugs
• 75 abuse when sober
• Its not about anger management. Most abusers
  do not abuse their co-workers, bosses, friends
  only their intimate partners

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BATTERERS BELIEFS

• She deserves violence when his needs/
  expectations not met
• Women are inferior to men
• Violence is legitimate means to assert power
• He needs her
• He will not be punished

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TRUE/FALSE Questions
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TRUE

• The top 5 of drinkers in the U.S. consume half
  of all alcoholic beverages sold.

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Whos drinking all that alcohol?

• 42 dont drink
• 12 seldom drink
• 8 drink 2/3 of all alcoholic beverages sold
• 5 consume 50
• In California, 50 of all addiction problems are
  as a result of alcohol

l
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TRUE

• Domestic violence is the single largest cause of
  homelessness for women and children in the U.S.

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TRUE

• Stalking is often a precursor to lethality in a
  domestic violence case

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Murder at night alcohol

• Murder in American families most often looks like
  this
• Victim is the wife
• Killed at night in her home by her husband who is
  older than 30 and has a criminal record. He acts
  alone
• In half of cases, a gun is used, 25 use a knife
• ½ of killers and 1/3 of victims were drinking

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Assessing Lethality

• Threats of homicide/suicide
• Fantasies of homicide/suicide
• Weapons
• Ownership of battered partner
• Centrality of the partner

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Lethality, cont.

• Separation violence
• Depression
• Access to the victim or her family
• Repeated outreach to law enforcement
• Escalation of batterer risk
• Hostage-taking

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FALSE

• Alcohol is present in about 1/3 of domestic
  violence cases

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Domestic ViolenceAOD Use by Batterers/Survivors
Brookoff, Daniel, M.D., Ph.D., Drugs, Alcohol
and Domestic Violence in Memphis, National
Institute of Justice Research Review (Oct. 1997)
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• The cost of violence committed under the
  influence of alcohol is 88 billion a year in the
  United States.
• Source Bekelman, Alan M. and Marcia I. Cohen,
  Violence Data Exchange Teams Information for
  Communities, Prevention Pipeline (Jan./Feb. 1999)

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FALSE

• Alcoholic women are no more likely than
  teetotalers to be victims of domestic violence

• Alcoholic women are significantly more likely to
  have experienced a range of moderate and severe
  physical violence from their spouses

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Alcoholic women

• 45 experienced childhood sexual violence
• vs.
• 14 of the general womens population
• 87 physically or sexually abused as children
• vs.
• 59 of nonalcoholic women

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TRUE

• Rates of domestic violence are about 15 times
  higher in households where husbands were
  described as often drunk as opposed to never
  drunk.

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Alcohol and Violence

• Alcohol was a key factor in the U.S.
• 86 homicides
• 37 assaults
• 60 sexual offenses
• 13 child abuse

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FALSE

• Most allegations of domestic violence are false

• It is more likely the victim will minimize or
  deny the violence rather than accuse her partner
  falsely

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TRUE

• Some drugs, such as PCP and steroids, may
  markedly increase violence potential

• Drugs may also be a catalyst for aggressive-prone
  individuals who exhibit violent behavior as a
  result of taking them.

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Alcohol Other Drugs

• Increases the likelihood of more severe battering
  incident than alcohol abuse by itself
• At high risk of chronic violent behavior

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AOD doesnt cause violencebut does lubricate
it

• Alcohol is the only substance which universally
  can be shown to increase aggression
• Alcohol is consistently a significant predictor
  of marital violence
• But impairs judgment and reduces inhibitions
• Must address both issues to be effective

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U. S. Army Study

• DV is a significant and preventable cause of
  injury to women
• Subjects who drink heavily are more likely to
  abuse their spouses both when they are and are
  NOT drinking
• Heavy drinking is also associated with episodes
  of spouse abuse even when drinking habits are
  measures years prior to the DV
• Early identification and treatment of heavy
  drinkers reduce consequences of drinking
  including DV

Bell, et al., Drinking and spouse abuse among
U.S. army soldiers, Alcoholism Clinical
Experimental Research 28(12) 1890-1897 (Dec. 2004)
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FALSE

• Domestic violence seldom occurs during pregnancy

• Studies show a rang of 21-63 prevalence of abuse
  during pregnancy. It is often the time of first
  abuse. The number one cause of death of pregnant
  women is homicide.

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You Cant Fade Me by Ice Cube

• All I saw was Ice Cube in court
•  Paying a gang of child support
•  Then I thought deep about giving up the money
•  What I need to do is kick the bitch in the
  tummy

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Sick Tired by Eric Clapton

• "I'm gonna get me a shotgun, baby, and stash it
  behind the bedroom door. I may have to blow your
  brains out, baby. Then you won't bother me no
  more."

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AOD Abusers Have Histories of DV

• If the issue of family violence is not addressed
  in recovery, it is often one of the triggers that
  sets off relapse
• The batterer must learn or relearn alternatives
  to violence
• Must stop blaming the victim
• Must engage in AOD treatment concurrently

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AOD and DV

• Addressing both substance abuse and violence
  enhances the likelihood of success
• AOD assessment should accompany all DV probation
  conditions

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Batterers Program Assessment

• Social, economic, family background
• Education
• Vocational achievements
• Criminal history
• Medical history
• Substance abuse history
• Consultation with probation

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Goal of Batterers Program

• Stop domestic violence
• Curriculum of batterers program must include
• Holding defendant accountable for violence
• Participation in same-gender groups
• Definitions of physical, emotional, sexual,
  economic, and verbal abuse
• Victim resources

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Program curriculum, cont.

• Must attend free of chemical influence
• Explore gender roles, socialization, nature of
  violence, dynamics of power and control, effects
  of abuse on children
• NO couples or family counseling
• Written contract with defendant
• Defendants waiver of confidentiality

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Does Batterer Intervention Work?

• One study found no significant differences
  between those who attended treatment and those
  who did not
• Whether an offender was employed or owned a house
  was predictive of re-offending
• Another study found minor improvement in some
  subjects

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Does it work?, cont.

• Those who did not attend were more likely to be
  re-arrested
• Attending the program had no effect on the
  incidence of physical violence or attitudes about
  it
• 24 in both experimental and control groups were
  re-arrested at least once in the first year of
  probation

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Does it work?, cont.

• There is some suggestion that longer treatment
  26 vs. 8 weeks is better (as is true for AOD
  tx)
• Intensive monitoring seemed to work better and
  judicial monitoring may be a useful approach

Do Batterer Intervention Programs Work? Two
Studies, NIJ Research for Practice, NCJ200331
(Sept. 03)
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TRUE

• Battered women are at increased risk of
  attempting suicide, abusing alcohol and other
  drugs, depression and abusing their children.

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Consequences of addictive use of alcohol and
other drugs by survivors

• May impair the decision-making process, limiting
  the possible alternatives to leaving a violent
  home. The average woman leaves seven times
  before she leaves for good.

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CPS Issues for Using Parents

• In California, 80 of child abuse/neglect cases
  are caused or exacerbated by substance abuse
• Children in alcohol-abusing families are almost 4
  times more likely to be victims of maltreatment

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DV Child Abuse

• A large (9,500 participants) U.S. study revealed
  that people who reported their mothers had been
  treated violently also reported exposure to
• Substance abuse (59)
• Mental illness (38)
• Sexual abuse (41)
• Psychological abuse (34)
• Physical abuse (31)

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DV child abuse, cont.

• DV and child maltreatment go hand-in-hand 30-60
  of the time
• The frequency of child abuse doubles in families
  experiencing intimate partner violence
• The rate of child abuse escalates with the
  severity and frequency of the abuse against the
  mother

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Unrelated Adults gt Child Abuse

• Living with an unrelated man increases the risk
  that a child will die violently
• These children are gt 50xs more likely to die
  than those who live with biological parents
• Children of single parents, foster parents or
  stepparents were of no greater risk
• 84 of killers were unrelated to the child 94
  were men

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Alcohol Abuse Clients

• 50 or more of men in treatment for alcohol abuse
  or dependency have also perpetrated intimate
  partner violence
• The prevalence of IPV among male substance
  abusers is probably high enough to warrant a
  presumption of the problem in this population

Walker, Robt. TK Logan, Treating Substance
Abuse Clients with Co-Occurring Intimate Partner
Violence, IV3 Offender Substance Abuse Report
(May/June 2004)
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Effects on Children Observing Family Violence

• INFANTS
• Weight/feeding problems
• Sleeping difficulties
• Excessive crying

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PRESCHOOLERS

• Development of Post-Traumatic Stress
• Intrusive memory of the violent act
• Re-enactment of the event in play
• Dysphoria, anxiety, fear
• Psychosomatic symptoms

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ELEMENTARY SCHOOL CHILDREN

• PTSD
• School failure
• Using friends to redramatize the event
• Psychosomatic symptoms
• Aggression towards peers/siblings

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HIGH SCHOOL CHILDREN

• PTSD
• Loss of impulse control
• Suicidal thoughts
• Use of drug to control dysphoria or anxiety
• Psychosomatic symptoms (headaches, stomach aches,
  ulcers, etc.)

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Post Traumatic Stress Disorder

• 30-57 women in AOD treatment meet criteria for
  PTSD
• 22 of women admitted to jail meet criteria
• 45-85 of battered women meet criteria
• Co-morbidity for PTSD and substance use disorders
  is 2-3xs higher for females

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Batterer Behaviors

• Harassing calls, visits
• Intimidating notes, stares
• Says victim is cause
• of his violence
• Requests continuances

• Stalking in/out court
• Using backers to intimidate
• Says remorseful, devoted
• Assaulting victim on way to court

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Victim Behaviors

• Reluctant to testify
• Distorted judgment
• Repressed memories
• Believes abusers promises

• Assumes blame for abuse
• Withholds information
• Masks injuries
• Hides shame
• Denies substance abuse

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Characteristics of Batterers

• Feels inadequate
• Dependent on victim
• Impulsive
• Low self-esteem
• Self-confident facade

• Substance abuse
• Need to control
• Dr. Jekyll Mr. Hyde
• Denies problems

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Court intervention in DV

• GOAL of court intervention should be better
  protection for the victim, should result in fewer
  victims, restoration of the batterer, less trauma
  for children, fewer probation violations

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YOU CAN HELP BY

• Remaining non-judgmental
• Recognizing the effects of DV (i.e., isolation,
  PTSD, gastrointestinal problems, depression,
  sleep and appetite disorders, physical injuries)
• Not assuming DV in lesbian, gay, bisexual or
  transgender relationships is mutual violence or
  fighting between equal combatants

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YOU CAN HELP, cont.

• Do not further harm the victim by
• Asking, Why dont you just leave?
• A resolve to leave is the most lethal time
• Say instead, Im concerned for your safety
• Calling it a relationship issue, a private
  matter, or otherwise trivializing the issue
• Help by assisting the victim through the court
  process and not second-guessing her choices