Integrating Substance Abuse and Domestic Violence Intervention

Transcription

1 Integrating Substance Abuse and Domestic Violence Intervention with Men who Batter Larry Bennett, PhD Graham Barnes

2 There IS a Link... Over 50% of men in BIPs have substance abuse issues 1 and are eight times as likely to batter on a day in which they have been drinking 2 Half of partnered men entering substance abuse treatment have battered in the past year 3 and are 11 times as likely to batter on a day in which they have been drinking 2 Between a quarter and half of the women receiving services for DV have substance abuse problems 4 Between 55 and 99 percent of women who have substance abuse issues have been victimized at some point in their life 5 and between 67 and 80 percent of women in substance abuse treatment are DV victims 6 2

3 There is a Link... But What is it? Most men are not drinking or drugging when they batter 1 Most (80%) heavy drinkers don t batter 1 The apparent correlation between substance abuse and DV fits only a sub group of people. 2 When male dominant attitudes are controlled, relationship between substance abuse and DV lessens, suggesting both substance abuse and attitudes toward gender are important in preventing DV 3 3

4 Current Models of the Intimate Partner Violence/Substance (Ab)use Relationship Cognitive disinhibition: The Proximal Model Comorbidity Drunkenness : Men s Need for Power Situational Culturally based excuses Expectancy 4

5 Many Roads to Rome Human aggression is over determined Alcohol/drugs use (intoxication) is a road Alcohol/drug abuse/dependency (SUD) is a road Male power/control motivation is a road Attachment/weak impulse control is a road etc. etc. None of these are usually the stand alone causes of violence 5

6 Summary: Men who Batter How alcohol and drug use and abuse increases the risk for DV is complex It s different for every person and sometimes different for each event Removing the substance (abstinence) is likely to reduce DV in only a minority of cases 6

7 Intervention Issues If a man (or woman) is arrested for DV, or seeks help as a victim of DV, whose job is it to detect substance abuse? Under what policy? In what way? If substance abuse by a batterer or victim is detected, what happens next, and who decides? What is the policy? If a man or woman is arrested for alcohol or drugs, or is in treatment for alcohol or drugs, whose job is it to detect DV? Under what policy? In what way? If DV is detected, what happens next, and who decides? 7

8 Most importantly: Assuming all the necessary services/sanctions/treatment are not provided by the same agency, how do multiple agencies work to support victim safety and substance abuse recovery? 8

9 Domestic Violence and Substance Abuse Treatment (TIP 25) Substance Abuse and Mental Health Services Administration 9

10 Manual of the Illinois Domestic Violence/ Substance Abuse Interdisciplinary Task Force (2 nd Edition, 185 pp.) 10

11 Iowa Integrated Services Project 11

12 Protocol for Screening and Management of Co-occurring Substance Abuse and Domestic Violence Georgia Commission on Family Violence Georgia Department on Corrections April 1,

13 Tool Kit Using Screening Tools Alcohol Use Disorders Identification Test (AUDIT) CAGE AID K 6 (WHO Mental Health Screen) A Deductive Screen For DV Perpetration Modified Conflict Tactics Scale Danger Assessment (English) Danger Assessment (Spanish) Women s Experience of Battering sample Memorandum of Understanding sample Consent to Release Information Confidentiality of Probation Records Contact with Victims of FVIP Participants Confidentiality in Substance Abuse Treatment Agencies Rules of Board of Corrections, Chapter

14 Larry s Assumptions Safety: The purpose of intervention with substance abusing batterers is to increase the safety of victims, to hold batterers accountable, and enhance recovery of all (not to save marriages or enhance personal growth) Substance abuse (by either the victim or the offender) makes victims unsafe Battering and victimization threaten substance abuse recovery 14

15 Assumptions Responsibility & choice. The perpetrator is fully responsible for the violence; He is not provoked, triggered, or stressed into violence; He does not become violent by drinking or drugging alone; Both violence and substance use are always a choice. Violence is a vehicle. DV is a vehicle chosen to establish control over a person, persons, or a situation: Coercion and denial of civil rights 15

16 Assumptions Co dependency. It is inaccurate to label battered women codependent, which is a victim blaming term describing the sociallysanctioned roles of women in a traditional society 66% of substance abuse counselors believe battered women are co dependent 1 16

17 Assumptions Our society and culture reinforce substance abuse, domestic violence, and intoxicated domestic violence. Consequently, neither substance abuse nor domestic violence may be viewed entirely at the personal level Abstinence and sobriety are neither necessary nor sufficient conditions for nonviolence 17

18 How Effective? (briefly) Effect of batterer intervention programs on DV Effect of victim service programs on DV Effect of criminal justice sanctions on DV Effect of substance abuse treatment on substance abuse 18

19 Mixed & Unintended Consequences Drug Court: Great for substance abuse, not (yet) for DV Unintended consequences: The adverse effects of the War on Drugs on poor and minority communities America s shame: 5% of the world s population and 25% of the world s jail population 19

20 Effect of BIPs: Mixed Two meta analyses of experimental and quasi experimental BIP outcome studies concluded that BIPs are often not effective 1 or if effective, the effects are relatively small 2 The bronze standard Multi site Study found that at 4 years after BIP, 90% of men had not battered in the past year 3 20

21 Predicting Re assault after Batterer Intervention Predicting re assault at intake History of severe partner abuse History of non DV arrest Severe mental disorder Predicting re assault during the program Women s feeling of safety Drunkenness Almost all re assaulters get away with it

22 Batterer Intervention Summary Continue Batterer Intervention + experiment Attending to the unintended consequences of batterer Intervention regulation Victim safety Overall continue to study Batterer Intervention systems 22

23 Effect of Substance Abuse Treatment: Mixed 20 Years of research shows treatment is effective (when delivered by qualified professionals, using empirically validated medications and therapies, applied for adequate durations and followed by monitoring and maintenance) 1 Trauma informed treatment effective for women 2 No one path to recovery is best 23

24 Similar (Small) Effect Sizes The effectiveness of medications on asthma, hypertension, or diabetes The effectiveness of aspirin in prevention of heart attacks The effectiveness of substance abuse treatment on recovery The effectiveness of batterer programs in prevention of future DV 24

25 Serial, Integrated, and Coordinated Interventions

26 Serial Interventions Assessment DV Program Substance Abuse Treatment 26

27 Problems with Serial Interventions for Offenders Offender rarely shows up at second service Offender is acculturated in the primary problem Only works with a high level of case management, highly trained staff at primary service, and assertive probation officers Current best practice: NO SERIAL INTERVENTIONS EXCEPT DETOX 27

28 Integrated Services SA DV Agency Integrated: Distinct Programs & Staff (eg: mental health agency with Both substance abuse and BIP) Substance Abuse DV Agency & Staff Integrated: Distinct Programs (eg: substance abuse agency with in house BIP) Substance Abuse & DV Theoretically Integrated: Program built on common foundation (e.g., Power Model, Dialectical Behavior Therapy, Trauma Theory) 28

29 Issues for Integrated Services Accountability and standards Reduction to the common denominator (Usually substance abuse) Finding paying and keeping properly trained staff 29

30 Coordinated Services Substance Abuse Treatment DV Agency Case Coordination Model 30

31 Issues with Coordinated Services for Offenders Confidentiality, sharing information (e.g. HIPAA) Cost, compared to integrated programs Time commitment for intensive treatments Cognitive impairment in early recovery may interfere 31

32 Integrated and Coordinated Community Based Programs for Men who Batter

33 Not Much Yet Integrated and coordinated services for batterers not as well developed as services for victims Substance abuse treatment agencies have taken the lead 33

34 Good Ideas (Maybe) But Risky Business for Batterers Self help Couples counseling Anger management Men s growth groups Psychotherapy Pastoral/faith based programs Confrontational approaches 34

35 Program Recommendations (Gondolf, 2003) Existing programs adequate with changes Rapid (pre trial?) intake to program Ongoing monitoring of substance use, emotional/psychiatric problems, reoffense Intensive (2 3x/week) intervention for prior/severe offenders for first month Victim support 35

36 System Recommendations Periodic court review (DV Court) Assertive case management & risk review Support & safety planning with female partners Coordinated Community Response Swift and certain response to re assault, dropout, and non compliance 36

37 Some Integration Attempts Dade County FL 1 Integrated Domestic Violence Model Duluth based Yale 2 Substance Abuse Treatment Unit s Substance Abuse Domestic Violence 10 session CBT model U. Maryland MET Clinical Trial 3 ADA/Dawn Farm (Michigan) 4 Accountability/Recovery model Behavioral Couples Therapy (Harvard) 5 No discussion of domestic violence at all 37

38 This webinar was supported by Grant No WT AX K073 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this webinar are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

39 More Information? Larry Bennett, PhD Graham Barnes