Substance Abuse & Domestic Violence: A Silent Yet Devastating Health Problem

1. Substance Abuse & Domestic Violence: A Silent Yet Devastating Health Problem Laura I. Garcia, MAAPS, CADC, PES & Yvette Medina, MS, LPC, CADC

2. Domestic Violence Myths

3. Myth #1: Domestic Violence Is Only Physical. Fact: • Abusive actions against another person can be verbal, emotional, sexual, and physical. There are four basic types of domestic violence: • Physical: Shoving, slapping, punching, pushing, hitting, kicking and restraining. • Sexual: When one partner forces unwanted, unwelcome, uninvited sexual acts upon another. • Psychological: Verbal and emotional abuse, threats, intimidation, stalking, swearing, insulting, isolation from family and friends, forced financial dependence. • Attacks against property and pets: Breaking household objects, hitting walls, abusing or killing beloved pets.

4. Myth #2: Domestic Violence Is Not Common. Fact: • While precise statistics are difficult to determine, all signs indicate that domestic violence is more common than most people believe or want to believe. • Due to lack of space, shelters for battered women are able to admit only 10 to 40 percent of women who request admission. • Although divorced women make up less than 8 percent of the US population, they account for 75 percent of all battered women and report being assaulted 14 times more often than women still living with a partner.

5. Myth #3: Domestic Violence Only Affects Women. Fact: • It can be directed at women, men, children, the elderly. It takes place among all social classes and all ethnic groups; however, women are the most targeted victims of domestic violence. • It is estimated that up to 10 million children witness an act of domestic violence annually. • Boys who witnessed domestic violence are more than twice as likely to abuse their wives or girlfriends than sons of nonviolent parents. • While men are victims of domestic abuse, 92 percent of those subjected to violence are women.

6. Myth #4: Domestic Violence Only Occurs Among Lower Class or Minority or Rural Communities. Fact: • Domestic violence crosses all race and class lines. Similar rates of abuse are reported in cities, suburbs and rural areas, according to the Bureau of Justice. • Abusers can be found living in mansions, as well as mobile homes. 

7. Myth #5: Battered Women Can Just Leave. Fact: • A combination of factors make it very difficult for the abused to leave. These include family and social pressure, shame, financial barriers, children, and religious beliefs. • Up to 50 percent of women with children fleeing domestic violence become homeless because they leave the abuser. Also, many who are abused face psychological ambivalence about leaving.

8. Myth #6: Abuse Takes Place Because of Alcohol or Drugs. Fact: • Substance abuse does not cause domestic violence. However, drugs and alcohol do lower inhibitions while increasing the level of violence, often to more dangerous levels. • The US Department of Health and Human Services estimates that one-quarter to one-half of abusers have substance abuse issues.

9. Myth #7: Victims Can Just Fight Back or Leave Fact: • Dealing with domestic violence is never as simple as fighting back or walking out the door. • Most men are stronger than women, the threat of physical abuse and even death is real. • Children and elderly people cannot fight back or leave

10. Myth #8: The Victim Provoked the Violence. Fact: • The abuser is completely responsible for the abuse. No one can say or do anything which warrants being beaten and battered. Abusers often try to deflect their responsibility by blaming the victim via comments, such as: • “You made me angry.” • “You made me jealous.” • “This would never have happened if you hadn’t done that.” • “I didn’t mean to do that, but you were out of control.”

11. Myth #9: Domestic Abuse Is a Private Matter and It’s None of My Business. Fact: • We all have a responsibility to care for one another.

12. Myth #10: Partners Need Couples Counseling. Fact: • It is the abuser alone who needs counseling in order to change behavior. • Couples counseling, couples pastoral and other form of marriage counseling places the victim at higher risk.

13. Myth #11: Abusers Are Evil People. Fact: • Abusers are people who may be strong and stable in some areas of their lives, but weak, unreasonable in other ways. This does not excuse their behavior because abuse is always wrong. • Abusers need to be held accountable for their actions and encouraged to seek help promptly by meeting with a psychologist, psychiatrist, therapist or spiritual leader trained in partner abuse intervention strategies. • With an informed community, with the help of family and friends, the cycle of abuse can be broken.

14. Frequency • In 2014, almost 65,800 intimate violence incidents were reported to Illinois law enforcement. • Between July 2013 and June 2014, there were 84 domestic violence-related deaths in Illinois, including 15 children. National Coalition Against Domestic Violence

15. 2017 • 41,243 adult survivors of domestic violence • 8,000 children witnessed domestic violence • Survivors & their children received 521,748 hours of services, 326,878 night of emergency shelter National Coalition Against Domestic Violence

16. 2017 Domestic Violence Homicide Report • There were 44 domestic violence related incidents which resulted in 61 deaths. • Homicides: Of the 47 homicides, there were two primary forms of homicide used - firearms at over 40% and stabbing at 36.17%. • Suicides: Of the 14 deaths classified as a suicide, all followed the commission of a homicide. The use of a firearm was the most common means of death. The other methods the perpetrators used to end their own lives was stabbing, strangulation, and drowning. https://www.ilcadv.org/resources/HomicideRpt2017.pdf

17. Definition • Domestic violence is the willful intimidation, physical assault, battery, sexual assault, and/or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. It includes physical violence, sexual violence, psychological violence, and emotional abuse. National Coalition Against Domestic Violence

18. “Domestic” • Under Illinois law family or household members are defined as: • family members related by blood or marriage; • people who are married or used to be married; • people who share or used to share a home, apartment, or other dwelling; • people who have or say they have a child in common; • people who have or say they have a blood relationship through a child; • people who are dating or used to date, including same sex couples; and • people with disabilities and their personal assistants.

19. It is essential to screen for current or past domestic violence issues!Why?

20. The Substance Abuse and Domestic Violence Relationship • Substance abuse does not "cause" domestic violence. • Substance abuse can affect both victims and perpetrators. • Failure to address domestic violence may interfere with treatment effectiveness. https://store.samhsa.gov/shin/content//SMA15-3583/SMA15-3583.pdf

21. The Substance Abuse and Domestic Violence Relationship, Cont. • Women living with an addictive disorder may find her abusive partner becomes angry when she seeks help, and his violence could push her to drop out of treatment. • Some batterers are worse domestic violence offenders when they are sober so partners of such batterers may try to subvert treatment efforts. https://store.samhsa.gov/shin/content//SMA15-3583/SMA15-3583.pdf

22. 2010 SAMHSA DATA for IL • An estimates 600 funded substance abuse treatment providers. • An estimates 41, 000 clients served. • 323 providers reported offering trauma-informed counseling. • 200 offered Domestic Violence as Ancillary services. https://www.samhsa.gov/data/sites/default/files/2010%20-%20NSSATS%20State%20Profiles/2010%20-%20NSSATS%20State%20Profiles/IL10.pdf

24. Not Always Physical • Emotional and psychological abuse can often be just as extreme as physical violence. • Lack of physical violence does not mean the abuser is any less dangerous to the victim, nor does it mean the victim is any less trapped by the abuse. National Coalition Against Domestic Violence

25. Blame • Unfair blame is frequently put upon the victim of abuse because of assumptions that victims choose to stay in abusive relationships. • Often she has maintained the abuse hidden from the family and friends. • Cultural factors often place the responsibility of marital success on woman.

27. Living with Domestic Violence

28. Toxic Stress • Stress is call to action • On one side of a continuum it helps us meet challenges to get up to learn • On the other side of the continuum: If we don’t have a chance to recover, it shuts down executive function, can’t store memories, erode frontal cortex over time. • Analogy of working out muscles • Recovery builds resilience Neuroscience and the Brain: Implications for Counseling and Therapy

29. Short-Term Effects of Domestic Violence on Children • Children’s immediate reactions to domestic violence may include: • Generalized anxiety • Sleeplessness • Nightmares • Difficulty concentrating • High activity levels • Increased aggression • Increased anxiety about being separated from a parent • Intense worry about their safety or the safety of a parent

30. Long-Term Effects of Domestic Violence on Children  • Chronic exposure to domestic violence, may include: •  Physical health problems • Behavior problems in adolescence (e.g., juvenile delinquency, alcohol, substance abuse) • Emotional difficulties in adulthood (e.g., depression, anxiety disorders, PTSD)

31. Key questions if D.V. is suspected • How does your partner help you control your alcohol or other drug use? • What happens after the argument? • How safe do you feel with your partner? • How does your partner show you respect? • Have your efforts to get clean and sober been sabotaged by your partner? • If you left this relationship how would your life be different? • Are you afraid of your partner?

32. When Addressing DV with Clients • Use caution and tact. Don't initially refer to the partner's behavior as domestic violence. Instead use language such as inappropriate behavior, unhealthy behavior, behavior that is unsafe. • A victim might not feel safe disclosing information to you. They may disclose more about themselves when they gain confidence and begin to trust you. • Be careful about criticizing the partner, they may become defensive or shut down if the partner is criticized. • Avoid labeling survival strategies or other behaviors as co-dependent, distorted, etc. • It is important to coordinate services as much as possible with the domestic violence advocate.

33. When Addressing DV with Clients, Cont. • Be aware that her relationship may be a trigger for continued use, but it may also be unsafe for her to leave. • Couple or family sessions can be very dangerous for victims of domestic violence. DO NOT provide information to the partner. • Some 12 Step group concepts can pose problems for women. These include submission to a higher power referred to exclusively in male terms, emphasis on "character defects," limited emphasis on strengths, and discouragement from talking about the abuse that has happened to them.

34. Treatment & Recovery Planning • Personal Safety Planning is a Priority • Self-Soothing/Self Care: Persistent Arousal makes them Chronically Anxious • Association: Helping them integrate traumatic experiences into the narrative of life (that was then, this is now), (Van der Kolk 2015). • “Develop new experiences that contradict overwhelming feelings of helplessness and replace them with a sense of ownership of physical reactions and sensation,” (Levine, 2015). • Social Connectedness (support groups, 12-step program)

35. Specific interventions • With tact and empathy avoid reinforcing negative connections in the brain, do not spend too much time discussing the damaging experiences. • Rehearsal/Practice/Activity is important: knowing is not enough. • Be creative: Yoga, massages, meditation, dance, art, sports, etc. However, be mindful and do not trigger trauma symptoms. (Ivey & Zalaquett, 2011)

36. Social Bonds • Brain structure and chemistry can be changed with meaningful social connections (mirror neurons). Model the behavior you wish them to practice. • Rubin & Terman (2012) speculate that social activity buffers stress’ impact on brain, (more serotonin & dopamine release, ect.) • Engagement with another person helps to develop nerve cells. Neuroscience and the Brain: Implications for Counseling and Therapy

37. Staff

38. Staff Who Are Experiencing DV • may often be late or call in sick. • may be withdrawn or unable to anticipate in staff activities. • may have very “involved” intimate partners. • may be hyper-vigilant, anxious, sad, stressed, etc. • may become agitated with change.

39. How to Help Staff • Document • Maintain staff confidentiality, however set-up a crisis response plan (communication tree is essential) • Any observable marks or bruises (date, time, location). • Any harassing behavior (date and time of calls, visits to workplace, etc.) • Be supportive and avoid judgmental behavior

40. 24/7 Hotline • 1-800-799-72331-800-787-3224 (TTY for Deaf/hard of hearing)Learn more about services for Deaf and hard of hearing individuals.