Domestic Violence Exchange.

Domestic Violence Exchange. April: examining the relationship between alcohol and other drug use and domestic violence

By Lori Berkey, Contributing Writer
04/08/2005

Region - With April being Alcohol Awareness Month, area service providers have shared insights into the relationship between alcohol and other drug use and domestic violence. Signs to recognize when alcohol and other drug use is a problem are offered, as well as where to go for help for alcohol and other substance problems and domestic violence situations - whether the issues are coexisting or not.

The relationship between alcohol and other drug use and domestic violence According to Susan Hillis, assistant vice president of Clinical Services at AdCare Hospital of Worcester Inc., alcohol and drug use does not make somebody become a batterer, but for people who have issues with battering, she said, substance use decreases their inhibitions so that they may be more likely to batter in those kinds of situations. Substance use also impairs people's judgment, their ability to read cues and their understanding of what's going on, she said, so "things that might ordinarily be a normal kind of thing" could be easily misinterpreted by someone who's under the influence, triggering an episode.
Hillis said that in her review of research studies, she has noticed that substance use and domestic violence are often reported to go "hand in hand," as those who have been victims of domestic violence in the past may be at risk for becoming batterers themselves and may be at risk for developing a substance use disorder. A past history of trauma, she said, is a common risk factor for both conditions. Citing a statistic from the National Institute on Alcohol Abuse and Alcoholism, she said between 35 and 50 percent of interpersonal violence has some sort of alcohol or substance use involved.
The severity of violence, when substance use is involved, Hillis said, is more drastic. And while substance use doesn't make people batter, she said, the fact that it impairs people's ability to monitor themselves and alters their perception makes it a dangerous combination when mixed with battering tendencies. Citing research from the "Journal of Consulting and Clinical Psychology" that studied men who were batterers who entered substance abuse treatment and men who entered battering treatment who had a history of alcoholism, she said it was discovered that when alcohol was involved there was an eight to 11 times greater effect of the violence, and the episode of severe violence was increased by 19 times.
"That's pretty startling statistics," she said.
Despite the statistics, Hillis said, besides seeing cases where people become more violent when substances are involved, she's seen other cases where people become less violent under the influence. Substance use can be part of the whole power and control violence package, Hillis said, raising complicated issues in treatment.
Chris Biron, clinical director at Shrewsbury Youth and Family Services, said she has seen situations where alcohol has been "unhealthfully useful."
"I've heard kids I've worked with say, 'When my mom was using, things were cool. When she's not using, she's a real …,'" Biron said.
Substance use can be entangled in domestic violence situations in many ways.
"Someone may be in a violent situation," Hillis said, "and may be forced to use with their partner because this is part of the power and control, or may be forced as part of the making up stage as 'this is how we're going to resolve all of this.'"
When evaluating what's needed for treatment, Hillis said it's important to look at how alcohol or substance use plays into domestic violence. There are questions she uses to determine this.
"When you get angry or when you get upset or your partner does something you don't like," she asks, "are you using alcohol as a way to self-medicate that and that gives you an excuse for violence? Or is it a way you self-medicate so you're not violent?"
The answer may lead to another question.
"So when you're upset and you've used substances in the past to kind of put a cap on it, what are you going to do now to address those issues?" she asks.
Those are issues for treatment, and yet the very act of addressing them tests other relationship dynamics.
"Some victims may find it easier to manage their partner if he's under the influence," Hillis said. "So she may subconsciously try to sabotage treatment because he may be easier if she just gives him a couple more drinks. He might calm down or pass out when in fact when he's sober he might be more threatening."
A wide range of issues, besides substance use needs to be addressed, she said, in regard to domestic violence situations.

Treatment, intervention issues and options
Hillis said that batterers often will get referred to anger management treatment by therapists when what is needed is batterer treatment. Anger management can be helpful, she said, but when battering is involved, batterer-specific treatment that addresses their issues of power and control is essential. When substance use is complicating matters further, alcohol or drug treatment also needs to be part of the treatment, she said. Someone needs to get substance abuse treatment to learn ways to not use, and also get batterer treatment to learn ways not to engage in that behavior as well, she added.
"There's a difference between a guy who punches a wall and gets upset versus a guy who punches their partner," Hillis said. "It's very different. And battering behavior is usually a heck of a lot more than physical violence. It's the power and control, the subtle emotional issues that they wield. So oftentimes batterers will stop being violent, but then the emotional abuse continues."
And then once people are in treatment, the whole power and control thing is huge, she added.
"Once a woman gets into treatment," Hillis said, "the batterer may be very threatened by that because now this woman is being taught all kinds of skills to take care of herself and stand up for herself, and that's very threatening. So he - looking at a male-female relationship - is looking for ways to sabotage her treatment because he doesn't want her to hear all of these kinds of things. And he may try to pull her out. Same thing with woman to woman violence or male to male."
Hillis suggested signs people can consider to determine if substance use is problematic. Tip-offs that use is a problem, she said, are when people feel they need to hide their use, when they are losing control of how much or how often they are using, and if it's starting to effect productivity at work because of not feeling well as a result in the morning.
Other signs, she said, include people planning their activities around substance use and when their social life resolves around substance use. AdCare Hospital, she said, offers inpatient and outpatient treatment for alcohol and other substance problems.
In regard to alcohol awareness month, Biron said she hopes people will recognize the prevalence of the problem within the community.
"I think too," she said, "it's important for people to know that people can be successful, functioning very well in several areas of their life and have an alcohol problem. I think that's actually an issue for Shrewsbury people to be aware of because I think it's under the surface a little bit as an issue in our community."
Hillis said she feels it's important for people involved in situations with substance use problems and domestic violence to access resources where professionals are knowledgeable about both aspects. She said through her work at AdCare she routinely collaborates by referring people to the Day Break program in Worcester for domestic violence counseling, advocacy, support, shelter and safety planning.
Making an initial call for help to an organization like AdCare or Day Break, or Shrewsbury Youth and Family Services is an important first step, Biron said.
"I think it's important for the people in Shrewsbury to know," she added, "that there's a team of people working, that if they call somewhere it's really a link to a greater world of help - and that we know who these people [resources] are and we have this connection with Day Break."
Whether or not substance use is a factor in domestic violence situations, Hillis said, she urges anyone who's thinking about getting out of a violent situation to first seek assistance in securing a safety plan.
"I try to remind people in domestic violence situations," Hillis said, "that sometimes when they leave, that's when things are the most dangerous. So I would not want someone to make an impulsive decision to walk out of the house until they've spoken with someone and come up with a safety plan. Daybreak is great in helping people come up with safety plans."

Hotlines:
Daybreak: (safety planning, counseling, advocacy, shelter for women and children) (508) 755-9030
PAVE: (for men who abuse) (508) 854-3320
Rape Crisis: 1-(800) 870-5905 (English) or 1-(800) 223-5001 (Spanish)
National Domestic Violence Hotline: 1-(800) 799-SAFE or (for TDD service) 1-(800) 787-3224

Alcohol and other substance use problems:
AdCare Hospital of Worcester: Inpatient and Outpatient treatment (508) 799-9000
Al-Anon and Al-Ateen (for family members): (508) 366-0556 or www.ma-al-anon-alateen.org

Information help lines:
Westborough Abuse and Violence Education and Support (WAVES): (508) 770-8555
Against Domestic Violence In Shrewsbury Education Project (ADVISE): (508) 842-0056
Gay Men's Domestic Violence Project: (800) 832-1909, www.gmdvp.org
The Network (for lesbian, bisexual women, transgendered): (617) 695-0877, crisis: (617) 423-SAFE

Other:
Shrewsbury Youth and Family Services (counseling, information and referral): (508) 845-6932
Voices Against Violence (crisis intervention, counseling, medical and legal advocacy for victims of domestic violence and sexual assault in Marlborough and Framingham): 1-(800) 593-1125
This column is made possible through a partnership with Shrewsbury Youth and Family Services (SYFS) and ADVISE (Against Domestic Violence In Shrewsbury Education Project). Special acknowledgements go to Chris Biron, MA, LMHC, clinical director at SYFS and Janet Trippi, cochair of ADVISE for sharing their expertise and for their assistance in coordinating input from other community resources.

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