# Presentation: 067391

## 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

## 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

## 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

## 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

## 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

## Women’s Lifetime Victimization and Their Drug Use			(National Victim Center, 1992)

- Miller, B.A., APA, May 1-6, 2004

## Female & Male Drug Problems by Male Partner Violence     Cunradi, et al., 2000		

- Miller, B.A., APA, May 1-6, 2004

## Emergency Departments:  PV and AOD 		N=143	El-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

## Inpatient detoxification treatment			 N=101 	 Hien and Scheier, 1996

- Miller, B.A., APA, May 1-6, 2004

## Prevalence of Severe Partner Violence AOD Outpatients              N=315

- Miller, B.A., APA, May 1-6, 2004

## 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

## 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

## 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

## Mental health symptoms associated with physical abuse 	N=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

## 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

## 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

## 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

## 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

## 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

## 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

## 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

## 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