Working at the Intersection: Substance Abuse and Trauma in the Context of Violence Against Women. Patricia J. Bland.

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1 Presented at the Moving Forward in Challenging Times Conference July 6-8, 2011 SafePlace Austin, TX Working at the Intersection: Substance Abuse and Trauma (Bland, Patricia; April 2012) Working at the Intersection: Substance Abuse and Trauma in the Context of Violence Against Women Patricia J. Bland National Center on Domestic Violence, Trauma & Mental Health Alaska Network on Domestic Violence and Sexual Assault Recommendations Domestic violence shelters, domestic violence/sexual assault victim service providers, chemical dependency, and other behavioral health programs should collaborate to provide cross training and advanced interdisciplinary training to providers and services working with individuals impacted by multiple abuse issues (e.g. domestic violence, sexual assault (DV/SA), chemical dependency, trauma and mental health, etc.). Substance use issues can serve as a coping method as well as a mechanism of control. Both using substances and recovery from substance use disorders can be barriers to safety and autonomy, just as domestic violence, sexual assault, and sexual abuse can be barriers to sobriety in terms of both treatment access and relapse. See Risks to Safety, Sobriety, and Wellness sheet, attached. Co-occurring abuse issues are prevalent; serve as barriers to safety, sobriety, and wellness; and can increase lethality risk. Information about trauma-informed community resources pertaining to DV/SA, substance abuse, mental health, and disability issues should routinely be provided to all program participants and treatment recipients, no matter what service door is entered. Domestic violence/sexual assault victim advocates, chemical dependency, and other behavioral health treatment providers need to be aware of increased safety risks for survivors of DV/SA when victims are working toward sobriety and wellness. Offenders may find their partners easier to control when they are under the influence or experiencing psychiatric symptoms, and recovery may reduce abusers control of their partners, thus increasing the level of force or violence offenders may choose to use to reestablish control. Offenders may sabotage recovery for the people they victimize. Conjoint counseling for individuals with partners or family members who are offenders should be contra-indicated (basically couples counseling is not recommended in the presence of domestic violence). Problems stemming from substance use can serve as a barrier to an individual s access to safety, services, and autonomy. To determine how to best provide advocacy and

2 support, it can be helpful to learn whether a person is experiencing (or has experienced) substance use coercion and/or is using (or has used) substances to cope. Both substance use and misuse (abuse) are different issues, both of which can be coerced or freely chosen. Sometimes it can be confusing for a survivor to recognize coercion. Other times a survivor may take on negative beliefs and blame herself for harm that has occurred if she chose to use. These issues are best addressed if we understand the context in which use has occurred. A simple conversation can allow an advocate to provide nonjudgmental information and options as well as to reassure a survivor that whether or not she was drinking or using, no one has the right to hurt her, and that any harm she has experienced at the hands of another is not her fault. Similarly, safety challenges linked to the experience of addiction (a substance use disorder or chemical dependency) can also begin to be addressed through discussion, information, and referrals. The experience of addiction is not a choice. However, survivors provided with nonjudgmental information and support may choose to take steps to reduce harm or enter recovery, whether through self-help groups, treatment, or other supportive options when it is safe for them to do so. It can be reassuring and helpful for advocates to routinely acknowledge how common the experience of addiction is, how treatable it is, and how many options are available. It also helps to reassure a survivor experiencing addiction that, just as she is not responsible for the harm another human being has done to her, she is not responsible for the bio-psychosocial factors that led to her experience of the disease of addiction. If she seeks support around either issue, we can provide advocacy and referrals: She is not alone. Funding is needed for DV/SA programs to ensure that support groups and other advocacy and support options are readily available for program participants experiencing behavioral health disabilities, including substance use disorders. Ideally, this would include access to substance abuse professionals for DV/SA program participants seeking information and referral, pretreatment services, and relapse prevention options. Treatment programs should also be funded to ensure clients have access to advocates for group education, safety planning, and other DV/SA services for individuals in treatment at risk for harm from abusers. Safety options also should be prioritized for survivors of DV/SA in Methadone programs. This is necessary to reduce risk for Methadone treatment recipients who may be stalked by abusive partners aware they have to pick up a dose at a set time every day. Re: Batterers: Chemical dependency (CD) programs should screen and check criminal histories for domestic violence and refer abusers to state-certified batterer s accountability programs (BAP) when domestic violence is identified. CD programs and BAPs need to collaborate to ensure program participants receiving services from both agencies do not manipulate either system. (Be careful, though, since victims of 2

3 domestic violence/sexual assault may be arrested in error and this could lead to some unintended results.) Other pertinent recommendations to support trauma-informed treatment include: 1. Gender specific treatment options 2. Culturally-relevant treatment 3. Ready access to detoxification in a safe setting for women 4. Treatment on demand 5. Treatment programs where children can reside with parent 6. Policies that do NOT criminalize pregnant women with addiction issues 7. Trauma-informed, empowering treatment options that do not label survivors as co-dependent or professional victims 8. Safe housing options for women in recovery (for both single women and parenting women and their children) 9. Harm reduction models, since the above recommendations may take some time 3

4 Safety and Sobriety: Risk Factors in Traditional Treatment and Advocacy Programs There are many risks facing individuals who seek both safety and sobriety from traditional helping sources. The following is a list of five risks to safety in traditional treatment and five risks to sobriety in traditional advocacy programs. Review these lists and brainstorm how to address these risks to safety and sobriety. Then share your experience, strength and hope by identifying other risk factors you have encountered. How have you dealt with these risks? Who are your allies? Risks to Safety in Traditional Treatment 1. Safety may not be linked to sobriety. 2. The batterer may be included as part of conjoint, couples, or family counseling. 3. The batterer may sabotage treatment efforts (e.g., prevent partner from attending group, get partner to leave against medical advice, mislead counseling team, etc.). 4. Poor understanding of domestic violence by others may lead to re-victimization. An individual may be mislabeled as not having hit bottom yet, codependent, professional victim, resistant to treatment or abusive. It may be difficult for others to understand that immediate danger from a partner may be more life threatening than alcohol and other drugs at times. 5. Recovery and improved health and cognitive functioning can make it harder for an abuser to control a partner. The abuser may increase physical or other forms of violence to re-establish control. (For example, an individual receiving a daily dose at a methadone program could be stalked and threatened by their abuser.) Risks to Sobriety in Traditional Advocacy Programs 1. Sobriety may not be linked with safety. 2. The batterer s use of alcohol and other drugs to control a partner or sabotage recovery efforts may not be acknowledged as a risk factor in a safety plan. 3. Poor understanding of physiology and pharmacology and focus on options and choices may lead to re-victimization. It may be difficult for others to understand the impact of blackouts, brownouts, withdrawal, craving, etc., on program participants and their capacity to remember and utilize safety plans. Risks stemming from substances may be more life threatening than an abusive partner at times. 4

5 4. Others may not perceive the recovering person s need for structure as empowering. Easy access to night-time medications, alcohol-containing mouthwashes or cold preparations with pseudoephedrine may present a possible relapse issue. 6. Strict policies against use may make program participants feel unsafe to disclose recovery status for fear of being over-scrutinized. This can make it hard to ask for help for oneself or to disclose when another program participant is using substances. Permissions/Copyrights 2000, 2005 by Patricia J. Bland Getting Safe and Sober: Real Tools You Can Use Alaska Network on Domestic Violence and Sexual Assault 5