INTIMATE PARTNER VIOLENCEAND METHAMPHETAMINE USEAN OVERVIEW OF TREATMENT EXPERIENCE
ISAMHSA – A Standard Data Set • 217 enrollments in IOP Matrix • At intake, 16% reported trouble controlling violent behavior one or more days in the last 30. 34% male, 66% female • At 6 month follow-up 1 person reported trouble controlling violent behavior • At 12 months 0 reported trouble controlling violent behavior
II Project Data • Current successful completion rate is 48% for meth users. • At 6 months follow-up of approximately 92% of clients (successful and not successful) 58% reported no and an additional 35% reported less use. • At 12 months 82% of clients were contacted and of those 55% said no use and an additional 32% said less use.
IIIClient and Counselor Experience • The longer a person has been using meth the more violence is always just under the surface. • As the disease progresses and when the person moves to injecting meth this is the lowest that a meth user can get. It is at this time that the more aggressive person-to-person violence is the highest. • Longer into the addiction users really become influenced by peers (other meth users). The user gets into a time of “emotional disregulation”. • Two examples are: 1) aggressive and risky sexual practices; and 2) aggression and violence.
IV Mental Health Issues: • Meth psychosis including paranoia can last months past the end of use and can trigger a violent reaction months after abstinence. • The impact of the meth psychosis is one of the long-term neurological effects of meth use. One example is a man with 7 months clean having psychotic memories of the imagined affair his wife did not have. • Meth use heightens and frees traits that are already there but are kept in check most of the time by “emotional regulation”. • The withdrawal time between runs is also a time when violence is more likely to occur. The irritability due to lack of sleep, lack of nutritious food, lack of fluids makes this an explosive time.
V Gambling and Intimate Partner Violence • Of women admitted to emergency rooms who reported IPV, 23% had partners who were problem gamblers • 10.5 times more likely to be a victim of IPV if partner was a problem gambler. • 43% of gamblers anonymous members reported being emotionally, verbally and physically abused. • Six of the 10 communities surveyed in a 1999 case study reported an increase in domestic violence relative to the opening of casinos.
INTIMATE PARTNER VIOLENCEAND METHAMPHETAMINE USE TREATMENT/INTERVENTION IMPLICATIONS
A COMPLEX QUESTION When interpersonal violence is connected to methamphetamine use, what is the relationship? How can they both be approached with best practices by service providers?
Do we think alcohol and drug use cause Domestic Violence? • What would we say to the man who said to his partner, “My drinking and drugging caused me to over-react. I wouldn’t have done that sober. I’m just a nasty drunk. Now that I’m clean and sober, everything will be O.K.”? • What do we think the safety issues might be for women and their children when they live with an abusive man who abuses substances? • How do we think alcohol and drug use might be used as a control tactic in an abusive relationship?
A COMPLEX QUESTION • Many people agree that A&D use is not the cause of intimate partner violence but exacerbates the situation. • Allowing an intimate partner violence perpetrator to blame his A&D use for his violence would be far from best practices. • Using A&D as a control tactic. • Setting a precedent of abuse • A scare tactic • Addiction as control • Safety issues for perpetrators, victims and children
Although substance abuse may not be the direct cause of battering, most evidence based risk assessments such as the SARA, ODARA and the Campbell Danger Assessment see alcohol and drug abuse as a primary risk factor. • Research that simply pairs DV with A&D use is not asking the “Complex Question”. What is the whole picture? • Research design needs to consider a broad scope of personal and environmental factors preceding and concurrent with methamphetamine use.
The Gondolf Study; Begins Asking The Right Questions • System Matters • Volunteers More Likely To Re-assault Than Mandated Clients • Best Overall Predictors – Victim Predictions And Drunkenness • BIP’s Add To The System • Longer Program Not Significant • Recommends - Gender Based CBT Intervention, Swift And Certain Response From Courts, Support And Safety Planning For Women
A COMPLEX QUESTION • Meth – not the cause, but certainly connected to interpersonal use. • A big enough connection that ChangePoint puts Batterer Intervention together with Substance Abuse Treatment • Clients do better when clean and sober • Use monitored by drug testing is an important piece of accountability when connected to interpersonal violence.
DV Politics • Coordinated Community Response • Standards for Batterer Intervention Providers - Oregon Administrative Rules – “A BIP shall be part of a wider community response to battering and not a “stand alone” form of response. A BIP shall interface with VPs, the Council, the criminal justice system including the LSA, other BIPs, members of the Council, and entities recommended to be part of the Council.”
Treatment vs. Education • (absence of “treatment” or “therapy” language in State Standards) • “Inappropriate Intervention Strategies: d) Identifying any of the following as a primary cause of battering or a basis for batterer intervention: poor impulse control, anger, past experience, unconscious motivations, substance use or abuse, low self-esteem, or mental health problems of either participant or victim.” • Insurance, Evidence Based Practices and Funding.
DV politics BATTERER INTERVENTION AND SUBSTANCE ABUSE (A position presented to SB81 Advisory Committee for combining batterer intervention with substance abuse treatment) • 1. A clear statement must be made to batterers that they cannot blame their battering on alcohol and drug use. • 2. Although substance abuse is clearly not the cause of battering, most evidence based risk assessments such as the SARA and the Campbell Danger Assessment see alcohol and drug abuse as a primary risk factor. • 3. Battering should never be treated as an addiction.
4. A combination program addresses both primary issues immediately. • 5. Cost. • 6.State funding for Alcohol and Drug treatment should never be used for stand-alone batterer intervention.In a combination group, funding should only be used in Level 2 intensive out patient treatment where the primary focus is on the client’s recovery from substance abuse. • 7. SB81 mandates that BIP groups be gender specific.It also follows that batterers who are required to do substance abuse treatment, especially those who have not completed a batterer intervention program, should also be required to be in gender specific substance abuse groups.
Women in TreatmentSAFETY FIRST • Elements of treatment for women who are in substance abuse programs and are survivors of domestic violence – the need for a “safety first” approach.
Substance Abuse Because… • Survival/Coping: Self Medication as a means of coping with abuse • Prescription Drugs: Victims may become addicted because the cause is not addressed • Coercion: Batterers often force use to continue to control • Cultural Oppression: Studies indicate higher substance use in most oppressed communities • Chemical Dependency: Addiction may precede adult abuse, especially if there is a history of incest, sexual assault or child abuse • Freedom: short-term binge for newly free victim
Barriers to Successful Treatment • Substance Abuse Treatment Programs Not Well-Trained in Domestic Violence • Double Standard for Female Substance Abusers • Obstacles to Services for Victims May lack money, transportation, child care, job security, etc. . May fear losing their children. • Lack Of Culturally Appropriate Services Some programs may be culturally insensitive, lack diverse staff Recovery tough if nobody else in group shares experiences Similar issues for elders, lesbians, prostitutes.
Improving Services for Victims who Abuse Substances • Screening: Initiate inquiry about abuse with every client Interview partners separately Standardize abuse questions • Intake and Treatment Planning which focuses on Victim Safety Well-trained, empathetic staff make disclosure more likely Safety Planning Encourage DV support Create a manageable treatment plan Discuss implications of treatment on custody determination, ability to get insurance or job later on
3. Counseling and Case Management Offer female only groups Know community info and referrals Offer literature Inform about legal options Make child care available • Crisis Intervention With victim and offender clients Safety planning with clients and staff • Client Education DV education for all clients Invite domestic violence advocates to speak with substance abuse groups • Report and Record Keeping Keep in mind that records may be subpoenaed by batterer Stick to the facts, not judgments
Evidence Based Practices- Use What Works - • CBT – Criminality, Substance Abuse Treatment • Matrix Model • Duluth Model • Motivational Interviewing • Coordinated Community Response
The Use of Motivational Interviewing with Clients in Abusive Relationships • Working With High Ambivalence • Roll with Resistance • Alliance not Collusion • Develop Discrepancy • A Client Centered Approach • Self-assessment • Respect