Drug-dependent women with partner violence: Treatment Issues

1. Drug-dependent women with partner violence: Treatment Issues Brenda A. Miller Senior Scientist Prevention Research Center/PIRE Berkeley, CA. Miller, B.A., APA, May 1-6, 2004

2. Conceptualizing Violence & Victimization • Physical assaults • Sexual assaults • Psychological terror and abuse • Attacks on self-esteem & self worth Miller, B.A., APA, May 1-6, 2004

3. Severe partner violence/psychological abuse Straus & Gelles, 1990 • Kicked, bitten, or hit with fist • Hit with object • Beat up • Burned or scalded • Choked, strangled, or smothered • Threatened with knife or gun • Used knife or gun • Threatened life with automobile • Threatened life in some other manner Miller, B.A., APA, May 1-6, 2004

4. Psychological control & aggression Pence & Paymar, 1993 Power/control wheel: • Intimidation (glaring or staring) • Emotional abuse (not sexually desirable) • Isolation (controlling access to friends/family) • Minimizing, denying or blaming (blame woman) • Using children (if leave, children stay) • Exert male “privilege” (man’s night out) • Economic abuse (control money) • Use coercion/threats (harm children/pets) Miller, B.A., APA, May 1-6, 2004

5. Prevalence of PV among women drug users • General population studies • Community samples of drug users • Medical patients • In- or outpatients for AOD treatment Miller, B.A., APA, May 1-6, 2004

6. Women’s Lifetime Victimization and Their Drug Use(National Victim Center, 1992) Miller, B.A., APA, May 1-6, 2004

7. Female & Male Drug Problems by Male Partner ViolenceCunradi, et al., 2000 Miller, B.A., APA, May 1-6, 2004

8. Emergency Departments: PV and AODN=143El-Bassell, et al., 2003 • Women physically abused by partner violence in past year (18%) • Significantly higher indicators of drug problems among abused women (DAST) • Significantly higher indicators of alcohol problems among abused women (AUDIT) • Alcohol and drug interactions Miller, B.A., APA, May 1-6, 2004

9. Inpatient detoxification treatmentN=101Hien and Scheier, 1996 Miller, B.A., APA, May 1-6, 2004

10. Prevalence of Severe Partner Violence AOD OutpatientsN=315 Miller, B.A., APA, May 1-6, 2004

11. Theoretical Explanations for Victimization – AOD Connections Victimization preceding AOD: • Victimization produces changes in self-perceptions and self-esteem • Self-Medication following victimization e.g., for PTSD symptoms • Changes in peer-group associations following victimization Miller, B.A., APA, May 1-6, 2004

12. Theoretical Explanations for AOD-Victimization Connections • Heavy AOD use reduces ability to provide self-protection/psychopharmacologic drug effects • Heavy AOD use reduces cognitive capabilities including recognizing risks • Involvement in AOD lifestyle places individual in settings where criminal activity takes place Miller, B.A., APA, May 1-6, 2004

13. Comorbid psychological & health disorders associated with partner violence • Many points in the system where individuals appear with psychological/physical health problems • Opportunities for screening • Funnels into appropriate treatment • Handicapped by fragmented system Miller, B.A., APA, May 1-6, 2004

14. Mental health symptoms associated with physical abuseN=182 (Gil-Revas et al., 1997) Rank order of symptoms significantly correlated to physical abuse for women • PTSD (r=.31) • Contemplated suicide (r=.24) • Anxiety (r=.18) • Depressive symptoms (r=.15) • Attempted suicide (ever, r=.16, last year r=.10) Miller, B.A., APA, May 1-6, 2004

15. Links between partner violence and health status • Lower perceived health status • Lower health care quality • Chronic headaches • Chronic pain, chronic pelvic pain • Gastrointestinal disorders • Somatic problems • Poorer health outcomes • Risk for STDs including HIV Miller, B.A., APA, May 1-6, 2004

16. Drug Treatment outcomes for women with partner violence histories • Neither physical nor sexual abuse were related to return to drug use during or after treatment (6 month follow-ups) (Gil-Revas, 1997) • Specific psychological disturbances associated with treatment participation are not the same ones associated with histories of violence (Gil Revas, 1997) • Another study by Hien & Scheier also suggests that outcomes are not predicted by histories of violence Miller, B.A., APA, May 1-6, 2004

17. Sensitivity in treating women with partner violence histories • Groups with men and women may not be safest environment • Asking means it is ok to tell • Respecting women’s right to participate in making decisions about her life • Assuring that a safety plan is in place Miller, B.A., APA, May 1-6, 2004

18. Barriers to Identifying Family Violence in AOD Settings • Beliefs about importance of family violence to AOD problems • Concerns about expertise in delivering family violence counseling • Treatment protocol concerns Miller, B.A., APA, May 1-6, 2004

19. Barriers to Identifying AOD Problems in Family Violence Settings • Safety is the predominant concern • If perpetrator has the problem--concern that he (and she) will view the AOD as the “cause” of the violence • If victim has the problem--concern that she (or he) will view the violence as justified Miller, B.A., APA, May 1-6, 2004

20. Barriers in Both AOD & Family Violence Settings • Lack of training & education • Lack of resources • Specialization of services • Crisis mentality Miller, B.A., APA, May 1-6, 2004

21. Important System Strategies • Addressing violence protection as part of AOD treatment services for women • Linking AOD treatment services to agencies that provide services for family violence • Addressing a safer community approach to violence and to drugs Miller, B.A., APA, May 1-6, 2004

22. Conclusion Community and System responses needed to reduce violence that women experience in their lives—the responsibility does not reside solely in treating women who are victims but addressing the larger community/environmental context Miller, B.A., APA, May 1-6, 2004