Identifying IPV Perpetration in Addiction Recovery Programs: If, When, and How

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1 Identifying IPV Perpetration in Addiction Recovery Programs: If, When, and How Always screen for IPV victimization. Screen for perpetration only when the agency has set up policy/practice guidelines, and has a clear plan for handling a positive screen to which all staff are trained. A safer alternative to perpetrator screening is offering IPV education for all agency clients. ARIV proposes that every individual entering a recovery program who is in a current intimate relationship should be screened for IPV victimization. Also an individual who is not in a current relationship, but has a formerly intimate relationship where there is partner contact (e.g. they work together, live near one another, have common friends, share children, etc.) should also be screened for IPV victimization. But what about IPV perpetration? Should treatment and recovery program staff routinely screen for IPV perpetration? If they do, when? Should it be at or very near entry into the program, or should it be part of a larger assessment once the individual is better engaged and established in a program? Should the screen or assessment be part of a written or computer questionnaire that is routinely completed before meeting with a counselor or peer specialist, or is it better administered as a face-to-face set of conversational questions or incorporated into ongoing, emergent assessment that is best handled when a therapeutic relationship is established? Or might it be better to eschew perpetrator screening altogether and assume that everyone needs IPV perpetrator education and prevention? There is virtually no disagreement that screening men and women for IPV victimization is advisable. There is a lot of upside to early victim screening and little downside. The practice literature is nearly unanimous that addiction recovery will be enhanced by trauma-informed practice. When it addresses the issue at all, the practice literature is far less united on screening for perpetration. There are some studies (e.g. Goldkamp, et al., 1996; O Ferrell, et al., 2004; Roffman, et al., 2008; Easton, et al., 2007) that offer promising results for interventions with perpetration and co-occurring IPV perpetration, but none of these studies explicitly examine the question of whether, when, and how to screen for IPV in addiction settings. We are not, however, entirely without data with which to guide us on this matter. In a recent study, Markoff (2011) explored screening perpetrators, among other issues, in four focus groups with 109 addiction practitioners, most of whom practiced at the supervisory level. The Great Lakes Addictions Technology Transfer Center (GLATTC), also in 2011 and as part of the ARIV project, conducted an online discussion of experts specifically addressing whether to screen for IPV perpetration in addiction treatment. Several years earlier, in the formative study for the ARIV project, GLATTC surveyed 294 addiction professionals in the upper Midwest in

2 order to quantify practices toward systematic screening, agency engagement with communitybased IPV providers, and individual counselor screening behavior. Finally, Futures Without Violence, formerly the Family Violence Prevention Fund, issued guidelines for IPV screening in healthcare settings, including substance abuse (FVPF, 2004). Taken together, these papers provide some guidance on screening perpetrators which informs the ARIV model recommendations. These recommendations follow. We Always Ask About Domestic Violence Here. Screening for IPV perpetration, if it is done, should make clear that it is routine, and that the questions are asked of everyone entering the program. This declaration should not be left to individual practitioners. We advise agencies to provide signage to that effect that is clearly visible in the private space where screening is conducted. Such signage could indicate that We Always Ask About Domestic Violence Here or DV Hurts Everyone, So We Talk About DV Here.Although not empirically tested, we believe such signage will likely reduce the chances that perpetrators will assume IPV perpetration is being raised as an issue due to a victim s disclosure of violence. The Rule of Thirds. The effects of perpetration screening will have positive effects in some cases (e.g. positively engaging someone who needs to get it off his chest), negative effects in some cases (e.g. triggering feelings of exposure, suspiciousness, or other residual trauma, increasing risk to a victim), and no effect in many cases. Consequently, agencies that screen for perpetration ought to have policies and practices in place for all three possible outcomes. Moreover, the outcome may be unknown at the time of screening, so policies should not be limited to screening. These policies should be written down and all staff should know them. Train. Train. Train. Location may be the key to success in real estate, but training is critical to success and safety in screening IPV perpetrators. Counselors who screen for IPV perpetration need special training on IPV, the characteristics of batterers, and IPV risk appraisal. This training is far beyond the level of the ARIV course. Counselors who have not been formally trained in IPV may be naïve about batterers as well as about the dynamics of screening. They may believe, for example, that screening always leads to positive outcomes, or that it always threatens outcomes; neither is true. For example, some participants in the Markoff study who did not think screening perpetrators increased risk justified their position by believing that any risk to the victim was already in play and independent of screening. They also believed that any perpetrator risk could be effectively managed by greater clinical skill. The belief that IPV behavior is entirely determined by an individual s personal characteristics and is independent of situations outside the clinical setting is widespread among counselors of all stripes. Change. Change. Change. Screening for IPV victimization usually requires systematic change in order to sustain a safe screening procedure; expecting individual counselors to screen and intervene without systemic support insures failure. The simple fact that the counselor will be collecting data on illegal behavior is reason enough to develop formal screening and intervening procedures. Regardless of whether this information is discoverable in criminal and civil

3 proceedings, clients will believe it is, and victims may be at at risk based on that belief. Federal, state, and professional confidentiality regulations are well known to counselors, but little known to batterers. Beyond screening, agency policies need to be developed to guide the processing of screening data, as well as referrals. In the ARIV formative evaluation, as well as in other studies, the numbers are very clear: most agencies do not have policies and procedures on IPV victim screening, and certainly not perpetrator screening. While screening questions may be listed on an intake form, it is left to the individual screener how to ask the question and what to do with the information. As critics of perpetrator screening point out, collecting data without a clear plan of action is problematic. Have a plan. A key question asked by critics of IPV screening is this: what will screeners do with the information they get? In cases of victimization, the ARIV model calls for assertive inhouse or outside referral and follow-up with services following an educational intervention, development of a safety plan, and additional assessment. If a man or woman screens positive for IPV perpetration, what brief intervention will follow, and to whom will an assertive referral and follow-up be made? Regardless of how one interprets the research on the effectiveness of batterer intervention programs, it is preferred that referrals to those programs be made under the conditions of some involvement in the criminal justice system. That condition of accountability will not be present in most positive perpetrator screens. Furthermore, there is little evidence that batterer programs are effective when complicated by co-occurring substance use disorder. As a matter of fact, the research is clear that co-occurring substance abuse even something as simple as drunkenness is the best predictor of future battering (Gondolf, 2002). Therefore, the idea that addiction programs can screen for perpetration and refer those people screening positive out to batterer programs in the community is not realistic for many reason. If the perpetrator is a woman, if the perpetrator is gay or lesbian, or if the perpetrator has other co-occurring situations (poverty, cultural minority, etc.) the referral problem is greatly magnified. Finally, how realistic is it to expect people in recovery to voluntarily add another service to an already full program? All of these logistical concerns have led a number of experts to trade individual perpetrator screening for mandatory IPV education for all clients, perhaps using a bystander perspective: this might not apply to you, but it applies to someone you know and we all have to know how to deal with people who abuse other people. Other options exist for integrating IPV perpetration into a recovery program in-house, particularly when working actively with local IPV providers. IPV Perpetration is Gendered Behavior. Despite periodic media depictions of women who batter and the equivalence of IPV by gender, when motivation for aggression and impact of violence is considered, perpetration by men and women often looks different, although the untrained screener may not pick up on it. As Canadian film maker Brian Vallee had remarked, When it comes to domestic violence and gender, only three questions really count: Who s in the shelter? Who s in the hospital? Who s in the grave? Women more often (but not always) use aggression to escape violence, as self defense, or as a pre-emptive strike against threat. Men more often (but not always) use aggression to threaten, gain the upper hand, bring someone under control, or

4 punish for violation of norms. Reporting violence to screeners may also differ. Women are more likely than men bring up the issue of being a perpetrator. This may be due to stigma, socialization, or a host of other reasons. Since they are often more open, the naïve counselor may come to see them as more violent, but what the counselor is seeing is a reporting effect. Most women who batter are also the victims of IPV, but the same does not hold for men who batter. Timing. If a counselor or agency decides to screen for perpetration, the timing should be considered carefully. Although the term screening may connote that it should be done early, perhaps even at the first meeting, this is not the case. While asking about victimization is unlikely to be off-putting, the same is not so for asking about perpetration, especially for men. Many people are concerned that talking about IPV perpetration will adversely affect engagement of the man into the program. This is less likely to happen if the screening for perpetration happens later in the program. Like most everything, a calculus of risk is involved here; is the probability that a client will honestly admit to being an IPV perpetrator great enough to offset the potential damage to their engagement in the program? REFERENCES Bennett, L.W. & Prabhughate, P. Accounting For Intimate Partner Violence in Substance Abuse Recovery: Staff and Agency Readiness For Screening and Referral. Unpublished manuscript. Chicago, IL: University of Illinois. Easton, C. J., Mandel, D. L., Hunkele, K. A., Nich, C., Rounsaville, B. J., & Carroll, K. M. (2007). A Cognitive Behavioral Therapy for Alcohol-dependent Domestic Violence Offenders: An Integrated Substance Abuse-Domestic Violence Treatment Approach (SADV). The American Journal on Addictions, 16(1), Futures Without Violence (2004). National consensus guidelines on identifying and responding to domestic violence victimization in health care. Available at Goldkamp, J. S., Weiland, D., Collins, M., & White, M. (1996). The role of drug and alcohol abuse in domestic violence and its treatment: Dade county s domestic violence court experience: Final report. Philadelphia, PA: Crime and Justice Research Institute. Gondolf, E. W. (2002). Batterer intervention systems. Thousand Oaks, CA: Sage. Markoff, L. (2011, November). Substance Abuse Treatment- Batterer Intervention Integration Project. Cambridge, MA: Institute for Health and Recovery. O Ferrell, T.J., Murphy, C.M., Stephan, S.H., Fals-Stewart, W., & Murphy, M. (2004). Partner violence before and after couples based alcoholism treatment for male alcoholic patients. Journal of Consulting and Clinical Psychology, 72,

5 Roffman, R. A., Edleson, J. E., Neighbors, C., Mbilinyi, L., & Walker, D. (2008). The Men s Domestic Abuse Checkup: A protocol for reaching the non-adjudicated and untreated man who batters and who abuses substances. Violence Against Women, 14, The following individuals also contributed to this discussion, although the ideas described here are not necessarily representative of their opinions: David Adams, Patti Bland, Lori Crowder, Phyllis Frank, David Garvin, Barry Goldstein, Robert Haynor, Lisa Larance, Arthur Lurigio, Beth Glover Reed, Charles Stoops, Alan Rosenbaum, Sarah Ullman, Oliver Williams, and Pam Wiseman.