11

22

WHAT TODAY IS, WHAT TODAY ISN’TWHAT TODAY IS, WHAT TODAY ISN’T

Dual Emphasis on Research and Dual Emphasis on Research and PracticePractice

Emphasis on Content, Not Practicing Emphasis on Content, Not Practicing SkillsSkills

Emphasis on Videotaped Examples, Emphasis on Videotaped Examples, Not “Live Examples”Not “Live Examples”

33

INTIMATE PARTNER VIOLENCE (IPV): INTIMATE PARTNER VIOLENCE (IPV): CAVEATS AND CONTROVERSIESCAVEATS AND CONTROVERSIES

IPV Research and Practice are FragmentedIPV Research and Practice are Fragmented

Many “Stakeholders” with Competing Many “Stakeholders” with Competing AgendasAgendas

Many Claim to Have “The Answer” and Many Claim to Have “The Answer” and Claim to be “Right”Claim to be “Right”

Pre-Paradigmatic AreaPre-Paradigmatic Area

People in Glass Houses…People in Glass Houses…– History of Alcoholism TreatmentHistory of Alcoholism Treatment

Everyone Is Right, Everyone Is WrongEveryone Is Right, Everyone Is Wrong

44

SUBSTANCE USE &SUBSTANCE USE &INTIMATE RELATIONSHIPSINTIMATE RELATIONSHIPS

Is It All Bad?Is It All Bad?

How Do They Influence Each Other?How Do They Influence Each Other?

Are Intimate Partner Violence (IPV) Are Intimate Partner Violence (IPV) and Substance Use Related?and Substance Use Related?

Can We Manipulate Aspects of Each Can We Manipulate Aspects of Each to Influence the Other?to Influence the Other?

SUBSTANCE USE AND SUBSTANCE USE AND RELATIONSHIPS:RELATIONSHIPS:

It Is Not All BadIt Is Not All Bad……

BUT WHEN IT GETS BAD:BUT WHEN IT GETS BAD:IT’S A FAMILY AFFAIRIT’S A FAMILY AFFAIRThinking About Drinking and Thinking About Drinking and

Drug Use SystemicallyDrug Use Systemically

77

Substance UseSubstance Use Family ProblemsFamily Problems

Denial, Poor Problem Solving, Cognitive Distortions,

“Checking Out”

Nagging, Fighting,“4 O’Clock Happy Hour”

Inadvertent Reinforcement of Use

88

THEMES: EASY AND HARDTHEMES: EASY AND HARD

Easy (or at Least Easier)Easy (or at Least Easier)– Drug UseDrug Use

– Relationship AdjustmentRelationship Adjustment

Hard (or at Least Harder)Hard (or at Least Harder)– Psychiatric ProblemsPsychiatric Problems

– ViolenceViolence

– SexSex

– ChildrenChildren

IPV & SUBSTANCE ABUSEIPV & SUBSTANCE ABUSE

Controversies Controversies and and

QuestionsQuestions

1010

IPV AND SUBSTANCE ABUSEIPV AND SUBSTANCE ABUSE

Part of a Family PicturePart of a Family Picture

Co-Exists and Interacts with Other Co-Exists and Interacts with Other Elements of the Bio-Psycho-Social Elements of the Bio-Psycho-Social ContextContext– GeneticsGenetics

– Family & FriendsFamily & Friends

– NeighborhoodNeighborhood

– CulturalCultural

Much That We Do Not KnowMuch That We Do Not Know

““Unfortunately, Being Unfortunately, Being Stupid Can Make You Stupid Can Make You

Powerful Because You Just Powerful Because You Just Don’t Know Any Better.”Don’t Know Any Better.”

John Stuart MillJohn Stuart Mill PhilosopherPhilosopher

1212

EXAMPLE:EXAMPLE: FIRST SURVEY OF IPV FIRST SURVEY OF IPV IN DRUG ABUSE TREATMENTIN DRUG ABUSE TREATMENT

Conducted Survey of Drug-Abusing Conducted Survey of Drug-Abusing Couples (Couples (N N = 140) Regarding = 140) Regarding Prevalence of Intimate Partner Prevalence of Intimate Partner Violence (IPV)Violence (IPV)

60% Reported 1 or More Episodes 60% Reported 1 or More Episodes

Protocol Stopped by Agency!!!Protocol Stopped by Agency!!!

1313

COMMON STANCE:COMMON STANCE: DON’T ASK, DON’T TELLDON’T ASK, DON’T TELL

Most Substance Abuse Treatment Most Substance Abuse Treatment Programs Assess IPV Poorly or Not At Programs Assess IPV Poorly or Not At AllAll

Most Marital Therapists Don’t Most Marital Therapists Don’t Systematically Ask About IPVSystematically Ask About IPV

– 40%-60% of Partners Entering Marital 40%-60% of Partners Entering Marital Therapy Report Episodes of IPVTherapy Report Episodes of IPV

Most Batterers Programs Assess Most Batterers Programs Assess Substance Use Poorly or Not at AllSubstance Use Poorly or Not at All

1414

WHY DON’T WE WANT TO WHY DON’T WE WANT TO KNOW?KNOW?

Clinical ConcernsClinical Concerns

– Can We Treat This Effectively?Can We Treat This Effectively?

– Is It Acceptable To Ignore It?Is It Acceptable To Ignore It?

Legal/Economic/Political ConcernsLegal/Economic/Political Concerns– Do We Have the Expertise To Treat This?Do We Have the Expertise To Treat This?

– If We Refer, Will We Lose the Patients?If We Refer, Will We Lose the Patients?

– For Marital Therapists, Should We Use For Marital Therapists, Should We Use Couple Therapy with Partner Violent Couple Therapy with Partner Violent Dyads?Dyads?

CONVENTIONAL WISDOM AND CONVENTIONAL WISDOM AND ARMCHAIR SPECULATIONARMCHAIR SPECULATION

1616

SUBSTANCE USE AND VIOLENCE:SUBSTANCE USE AND VIOLENCE:FOUR “WORKING” ASSUMPTIONSFOUR “WORKING” ASSUMPTIONS

Intoxication is an Excuse, Not a CauseIntoxication is an Excuse, Not a Cause

Alcoholics and Drug Abusers Are Very Alcoholics and Drug Abusers Are Very ViolentViolent

Substance-Abusing Men in Violent Couples Substance-Abusing Men in Violent Couples Should Be Referred to Batterers TreatmentShould Be Referred to Batterers Treatment

Couples Treatment is “Never Appropriate” Couples Treatment is “Never Appropriate” for Partner-Violent Couples, Including for Partner-Violent Couples, Including Those with Alcohol or Drug ProblemsThose with Alcohol or Drug Problems

ARE THESE ASSUMPTIONS ARE THESE ASSUMPTIONS ACCURATE?ACCURATE?

Available Evidence That Available Evidence That Speaks to These AssumptionsSpeaks to These Assumptions

1818

IS INTOXICATION CAUSALLY IS INTOXICATION CAUSALLY CONNECTED TO IPV?CONNECTED TO IPV?

No Randomized Clinical Trial EvidenceNo Randomized Clinical Trial Evidence– Research Ethics BarrierResearch Ethics Barrier

Hill’s Evidence of Causality in Observational Hill’s Evidence of Causality in Observational StudiesStudies– Consistency of AssociationConsistency of Association– Strength of AssociationStrength of Association– Dose-ResponseDose-Response– Theoretical CoherenceTheoretical Coherence– Temporal PrecedenceTemporal Precedence– Experimental EvidenceExperimental Evidence– Elimination of Plausible Alternative ExplanationsElimination of Plausible Alternative Explanations

1919

EXPLAINING THE CAUSAL LINK:EXPLAINING THE CAUSAL LINK:MULTIPLE THRESHOLD MODELMULTIPLE THRESHOLD MODEL

We Have a Threshold for Aggression We Have a Threshold for Aggression That is Influenced by Levels of That is Influenced by Levels of ProvocationProvocation

Various Factors Influence This Various Factors Influence This ThresholdThreshold

Intoxication May Lower the ThresholdIntoxication May Lower the Threshold

2020

Low Moderate High

Sober Threshold

Intoxication Threshold

ASPD

2121

INTOXICATION AS A CAUSAL INTOXICATION AS A CAUSAL FACTOR IN IPVFACTOR IN IPV

Certainly “Looks” Like a Causal FactorCertainly “Looks” Like a Causal Factor

Not the Only Causal Factor—One of ManyNot the Only Causal Factor—One of Many

Cannot Fully Escape the “Homunculus Cannot Fully Escape the “Homunculus Explanation”Explanation”

Yet, We Should All Agree Intoxication Is, At Yet, We Should All Agree Intoxication Is, At Very Least, A Marker for Increased Likelihood Very Least, A Marker for Increased Likelihood of IPVof IPV

2222

ARE SUBSTANCE ABUSERS VERY ARE SUBSTANCE ABUSERS VERY VIOLENT IN THEIR RELATIONSHIPS?VIOLENT IN THEIR RELATIONSHIPS?

How Frequent is IPV in These How Frequent is IPV in These Relationships?Relationships?

What Does This Violence Look Like?What Does This Violence Look Like?

– Is it All Male-to-Female?Is it All Male-to-Female?

– Is it All Severe Violence?Is it All Severe Violence?

2323

CHARACTERISTICS OF CHARACTERISTICS OF VIOLENCE IN SUBSTANCE-VIOLENCE IN SUBSTANCE-

ABUSING COUPLESABUSING COUPLESVast Majority is Low-Level, Bi-DirectionalVast Majority is Low-Level, Bi-Directional– 75% Report This Kind of Violence75% Report This Kind of Violence

Some Report Uni-Directional Low-Level Some Report Uni-Directional Low-Level ViolenceViolence– 20% Report This Kind of Violence20% Report This Kind of Violence– Female-to-Male Violence Common HereFemale-to-Male Violence Common Here

Some Report Severe Uni-Directional ViolenceSome Report Severe Uni-Directional Violence– 5% Report This; Mostly Male-to-Female Violence5% Report This; Mostly Male-to-Female Violence

2424

FEMALE-TO-MALE VIOLENCEFEMALE-TO-MALE VIOLENCE

Very CommonVery Common

In Our Samples, Slightly More In Our Samples, Slightly More Frequent Than Male-to-Female Frequent Than Male-to-Female Violence!Violence!

Calendar Interview Reveals It Is Not All Calendar Interview Reveals It Is Not All Defensive RespondingDefensive Responding

Often See It When Male Partner Often See It When Male Partner Drinks, Usually Before He Hits HerDrinks, Usually Before He Hits Her

2525

VIOLENCE TYPOLOGYVIOLENCE TYPOLOGY

””Battery” is a Unitary Phenomenon, With Battery” is a Unitary Phenomenon, With Differences Occurring on a Single Differences Occurring on a Single ContinuumContinuum

VERSUSVERSUS

Distinct Sub-Groupings of IPVDistinct Sub-Groupings of IPV– Common Couple (Situational) ViolenceCommon Couple (Situational) Violence

Most common among substance abusersMost common among substance abusers

– ““Patriarchal” TerrorismPatriarchal” Terrorism– Non-Physical AggressionNon-Physical Aggression

2626

CLINICAL IMPLICATIONSCLINICAL IMPLICATIONS

Implicitly, Many Providers Treat All IPV as Implicitly, Many Providers Treat All IPV as Patriarchal TerrorismPatriarchal Terrorism– Assumes IPV Arises Out of Power and Assumes IPV Arises Out of Power and

ControlControl

Yet, Among Substance Abusers, Common Yet, Among Substance Abusers, Common Couple Violence Is Far More TypicalCouple Violence Is Far More Typical– Also True in DV Treatment ProgramsAlso True in DV Treatment Programs

Is There a Treatment-Problem Mismatch?Is There a Treatment-Problem Mismatch?

2727

INTERVENTION STANCE: INTERVENTION STANCE: TREAT ALL IPV AS PATRIARCHAL TREAT ALL IPV AS PATRIARCHAL

TERRORISM TERRORISM

ASSUMPTION: ASSUMPTION: If It Works For If It Works For Patriarchal Terrorism, It Will Work For Patriarchal Terrorism, It Will Work For Less Severe Variants of IPVLess Severe Variants of IPV

– Assumption Is Correct IF IPV Consists of Assumption Is Correct IF IPV Consists of One Type of Behavior That Lies on a One Type of Behavior That Lies on a Single ContinuumSingle Continuum

– Assumption Is Not Correct IF the Assumption Is Not Correct IF the Heterogeneity Reflects Different Types of Heterogeneity Reflects Different Types of ViolenceViolence

WHAT IS THE EVIDENCE WHAT IS THE EVIDENCE REGARDING THE REGARDING THE

EFFECTIVENESS OF DV EFFECTIVENESS OF DV TREATMENT?TREATMENT?

2929

TREATMENT FOR DOMESTIC VIOLENCE:TREATMENT FOR DOMESTIC VIOLENCE:DOES IT WORK?DOES IT WORK?

Studies Are Riddled With ProblemsStudies Are Riddled With Problems– Drop-Outs Are Sometimes Not IncludedDrop-Outs Are Sometimes Not Included– Brief Follow-Ups (or Only Follow-Up Brief Follow-Ups (or Only Follow-Up

During Treatment)During Treatment)– Contact Often Not ConsideredContact Often Not Considered– Use of a Single InformantUse of a Single Informant

Comprehensive Reviews Indicate Effects of Comprehensive Reviews Indicate Effects of Treatment for DV Are Very SmallTreatment for DV Are Very Small

3030

IMPLICATIONSIMPLICATIONS

Should We Refer Substance-Abusing Should We Refer Substance-Abusing Patients to Standard DV Treatment?Patients to Standard DV Treatment?

– Does the “Chicken Soup” Philosophy Does the “Chicken Soup” Philosophy Apply Here (i.e., It Couldn’t Hurt?)Apply Here (i.e., It Couldn’t Hurt?)

– Is DV Treatment Harmful if Ineffective?Is DV Treatment Harmful if Ineffective?

What Else Can We Do?What Else Can We Do?

3131

TREATING IPV AMONG SUBSTANCE-TREATING IPV AMONG SUBSTANCE-ABUSING PATIENTS: OPTIONSABUSING PATIENTS: OPTIONS

Treat the Substance Abuser OnlyTreat the Substance Abuser Only

– Treatment-As-Usual (TAU)Treatment-As-Usual (TAU)

Treat the Partners TogetherTreat the Partners Together

– Couples Therapy + TAUCouples Therapy + TAU

Treat the Partners SeparatelyTreat the Partners Separately

– ““Separate-But-Equal” Separate-But-Equal” + TAU+ TAU

3232

TREAT THE SUBSTANCE ABUSER TREAT THE SUBSTANCE ABUSER ONLY (TAU)ONLY (TAU)

Relatively Effective if Substance Relatively Effective if Substance Abuse Treatment is EffectiveAbuse Treatment is Effective

Relies Almost Exclusively on Relies Almost Exclusively on Abstinence as the Curative Abstinence as the Curative MechanismMechanism

3333

REDUCING VIOLENCE REDUCING VIOLENCE EVEN IN THE FACE OF INTOXICATIONEVEN IN THE FACE OF INTOXICATION

Treatment-As-Usual Is An Ineffective Treatment-As-Usual Is An Ineffective Treatment for IPV When Relapse Treatment for IPV When Relapse OccursOccurs

Given High Rate of Relapse After Given High Rate of Relapse After Treatment for Substance Abuse, Treatment for Substance Abuse, Methods for Reducing IPV, Even Methods for Reducing IPV, Even When Substance Use Occurs, Are When Substance Use Occurs, Are NecessaryNecessary

3434

COUPLES THERAPY WITH COUPLES THERAPY WITH PARTNER VIOLENT COUPLESPARTNER VIOLENT COUPLES

Highly ControversialHighly Controversial

AdvantagesAdvantages– Systemic View of ViolenceSystemic View of Violence

– Can Provide Nonsubstance-Abusing Can Provide Nonsubstance-Abusing Partners with Strategies to Avoid ViolencePartners with Strategies to Avoid Violence

Safety planSafety plan

No arguments when someone is No arguments when someone is intoxicatedintoxicated

No ‘Angry Touching’No ‘Angry Touching’

3535

COUPLES THERAPY WITH SUBSTANCE COUPLES THERAPY WITH SUBSTANCE USERS WHO ENGAGE IN IPV:USERS WHO ENGAGE IN IPV: WHAT SHOULD WE EXPECT?WHAT SHOULD WE EXPECT?

Compared to Individual Treatment Compared to Individual Treatment Approaches for Drug Use, We Should Approaches for Drug Use, We Should Expect:Expect:– Comparable Likelihood of IPV on Days of Comparable Likelihood of IPV on Days of

No Substance UseNo Substance Use

– Smaller Likelihood of IPV on Days of Smaller Likelihood of IPV on Days of Substance UseSubstance Use

Wives have strategies to avoid violence Wives have strategies to avoid violence on days of husbands’ substance useon days of husbands’ substance use

3636

WHAT DO WE FIND?WHAT DO WE FIND?Fewer Days of IPV Among Couples Who Fewer Days of IPV Among Couples Who Receive Couples Therapy Compared to Receive Couples Therapy Compared to Individual TxIndividual Tx

– Due to Less Substance Use Among Those Due to Less Substance Use Among Those Who Receive Couples TherapyWho Receive Couples Therapy

Comparable Likelihoods of Violence For Both Comparable Likelihoods of Violence For Both Groups on Days of No Substance Use, BUTGroups on Days of No Substance Use, BUT

Lower Likelihood of IPV on Days of Male Lower Likelihood of IPV on Days of Male Partner’s Substance Use for Those Who Partner’s Substance Use for Those Who Receive Couples TherapyReceive Couples Therapy

3737

PROBLEMSPROBLEMS

Requires Complex and Subtle Requires Complex and Subtle Decision-MakingDecision-Making

– ““Should I Resolve Conflict or Should I Should I Resolve Conflict or Should I Avoid it”Avoid it”

– Miscalculation Can Contribute To ViolenceMiscalculation Can Contribute To Violence

Assumes Sobriety on the Part of the Assumes Sobriety on the Part of the Nonsubstance-Abusing PartnerNonsubstance-Abusing Partner

3838

““SEPARATE-BUT-EQUAL”SEPARATE-BUT-EQUAL”

Treat Both Partners, But Not in a Treat Both Partners, But Not in a Couples FormatCouples Format

Address Violent Partners’ Drinking Address Violent Partners’ Drinking and Drug Useand Drug Use

Provide Nonviolent Partner With Provide Nonviolent Partner With Coping Strategies to Reduce Coping Strategies to Reduce Likelihood of ViolenceLikelihood of Violence

3939

COMPARISON OF STRATEGIES:COMPARISON OF STRATEGIES: INITIAL PILOT DATAINITIAL PILOT DATA

TAU vs Referral vs Couples Therapy TAU vs Referral vs Couples Therapy vs Separate-But-Equalvs Separate-But-Equal

80 Partner-Violent Couples (Male-to-80 Partner-Violent Couples (Male-to-Female Violence)Female Violence)

Couples Therapy and Separate-But-Couples Therapy and Separate-But-Equal Are Doing Better Than TAU and Equal Are Doing Better Than TAU and ReferralReferral

ASSESSMENT: ASSESSMENT:

Theoretical and Practical Theoretical and Practical ConsiderationsConsiderations

One Size Does Not Fit All…One Size Does Not Fit All…

4141

ASSESSING SUBSTANCE USE AND ASSESSING SUBSTANCE USE AND RELATIONSHIP PROBLEMSRELATIONSHIP PROBLEMS

(INCLUDING IPV)(INCLUDING IPV)

Severity of Relationship ProblemsSeverity of Relationship Problems

Severity of Violence (Explore Safety)Severity of Violence (Explore Safety)

Severity of Substance UseSeverity of Substance Use

Evaluation of Implicit and Explicit ViolenceEvaluation of Implicit and Explicit Violence

Type of Violence (Uni- Versus Bi-Directional)Type of Violence (Uni- Versus Bi-Directional)

The Interrelationship of Relationship The Interrelationship of Relationship Problems /Violence & Substance UseProblems /Violence & Substance Use

4242

METHODS OF ASSESSMENT:METHODS OF ASSESSMENT:“TRIANGULATING IN ON THE TRUTH”“TRIANGULATING IN ON THE TRUTH”

Communication SamplesCommunication Samples

-Partner Interaction Often Hidden in the Context -Partner Interaction Often Hidden in the Context of of Conjoint Delivery Conjoint Delivery Approach Approach

Clinical InterviewClinical Interview

--Highly Structured to UnstructuredHighly Structured to Unstructured

--With Partners Together and SeparatelyWith Partners Together and Separately

QuestionnairesQuestionnaires

-Assess Substance Use, Relationship Adjustment, -Assess Substance Use, Relationship Adjustment, Psychological Adjustment, and ViolencePsychological Adjustment, and Violence

4343

COMMUNICATION SAMPLECOMMUNICATION SAMPLE

Have Couple Identify a Topic of Have Couple Identify a Topic of Conflict Between ThemConflict Between Them

Observe a 10-min Discussion of TopicObserve a 10-min Discussion of Topic

DebriefDebrief

4444

CLINICAL INTERVIEW:CLINICAL INTERVIEW:UNSTRUCTUREDUNSTRUCTURED

The Seven “Cs”: A Helpful HeuristicThe Seven “Cs”: A Helpful Heuristic– CommitmentCommitment

– CaringCaring

– CommunicationCommunication

– Conflict ResolutionConflict Resolution

– Character FeaturesCharacter Features

– Cultural & Ethnic FactorsCultural & Ethnic Factors

– Contract FeaturesContract Features

UNDERSTANDING THE UNDERSTANDING THE ROLE OF SUBSTANCE USE ROLE OF SUBSTANCE USE

IN EPISODES OF IPVIN EPISODES OF IPV

4646

4747

MEETING WITH PARTNERS MEETING WITH PARTNERS SEPARATELYSEPARATELY

Often Done as Part of a Violence Often Done as Part of a Violence AssessmentAssessment

Obtain Each Partners’ View Without Obtain Each Partners’ View Without the Other Person in the Roomthe Other Person in the Room

DISCUSS ISSUES RELATED TO DISCUSS ISSUES RELATED TO CONFIDENTIALITYCONFIDENTIALITY

4848

CONFIDENTIALITY MODELSCONFIDENTIALITY MODELS

No Confidentiality in Individual SessionsNo Confidentiality in Individual Sessions

– All Things Said in Individual Sessions Can All Things Said in Individual Sessions Can be Revisited in Conjoint Sessions at the be Revisited in Conjoint Sessions at the Discretion of the TherapistDiscretion of the Therapist

Limited ConfidentialityLimited Confidentiality

– Material is Treated as Confidential Unless, Material is Treated as Confidential Unless, in the Opinion of the Therapist, it has in the Opinion of the Therapist, it has Significant Implications for the CoupleSignificant Implications for the Couple

4949

SEMI-STRUCTURED CLINICAL SEMI-STRUCTURED CLINICAL INTERVIEWINGINTERVIEWING

Calendar InterviewingCalendar Interviewing

Timeline Followback MethodTimeline Followback Method– Substance Use VersionSubstance Use Version– Spousal Violence VersionSpousal Violence Version– Other BehaviorsOther Behaviors

Provides a Temporal Sequence of Provides a Temporal Sequence of BehaviorsBehaviors– VisualVisual– Reveals PatternsReveals Patterns

5050

  Key:    Yellow- Wife report of non severe husband to wife violence

Red- Wife report of severe husband to wife violence

Green X - Substance use by husband

SunSun MonMon TueTue WedWed ThuThu FriFri SatSat11 22 33 44 55 6 6 77

88 99 1010 11111212 1313 1414

1515 1616 1717 1818 1919 2020 2121

22222323

2424 25252626

2727 2828

29293030

22 Days of No Substance Use 8 Days of Husband Substance Use

20 Days of No Violence 7 episodes of Non- Severe Violence3 episodes of Severe Violence

5151

CALENDARCALENDAR

Key:Key:Heavy DrinkingHeavy Drinking

Husband to wifeHusband to wife

violenceviolence

Child ExposureChild Exposure

Unprotected Sex Unprotected Sex

with Wifewith Wife

Unprotected SexUnprotected Sex

with Otherwith Other

PaydayPayday

ChurchChurch

5252

PAPER-AND-PENCIL (SELF-REPORT)PAPER-AND-PENCIL (SELF-REPORT)MEASURESMEASURES

Relationship AdjustmentRelationship Adjustment– Dyadic Adjustment ScaleDyadic Adjustment Scale– Marital Happiness ScaleMarital Happiness Scale

Substance UseSubstance Use– Addiction Severity IndexAddiction Severity Index– MASTMAST

IPVIPV– Conflict Tactics Scale--IIConflict Tactics Scale--II– Response to Conflict Scale (RTC)Response to Conflict Scale (RTC)

5353

PRESENTATION & MATERIALSPRESENTATION & MATERIALS

These Materials are Available Through theThese Materials are Available Through the

Information Site:Information Site:

www.info.addictionandfamily.orwww.info.addictionandfamily.orgg

INTERVENTION INTERVENTION CONSIDERATIONSCONSIDERATIONS

5555

INDIVIDUAL SUBSTANCE ABUSE INDIVIDUAL SUBSTANCE ABUSE TREATMENTTREATMENT

Various Types:Various Types:– 12-step Facilitation12-step Facilitation– Cognitive-Behavioral Treatment (CBT)Cognitive-Behavioral Treatment (CBT)– Motivational Interviewing (MI)Motivational Interviewing (MI)– Contingency Management (CM)Contingency Management (CM)

Comparable EfficacyComparable Efficacy

Necessary But Not SufficientNecessary But Not Sufficient– What Happens When Someone Uses?What Happens When Someone Uses?

5656

SYSTEMIC APPROACHESSYSTEMIC APPROACHES

Couples (Conjoint) Therapy ModelsCouples (Conjoint) Therapy Models

““Separate-But-Equal” ModelsSeparate-But-Equal” Models

5757

VICTIM STRATEGYVICTIM STRATEGY

Simple StrategiesSimple Strategies– Safety PlanningSafety Planning– De-EscalationDe-Escalation– Don’t Argue With a DrunkDon’t Argue With a Drunk– Talk When Everyone Is SoberTalk When Everyone Is Sober– Don’t Hit to Get Partner’s Attention or to Don’t Hit to Get Partner’s Attention or to

Demonstrate FrustrationDemonstrate Frustration

Is this Victim Blaming?Is this Victim Blaming?

5858

BUILDING MOMENTUM TOWARD BUILDING MOMENTUM TOWARD NONVIOLENCENONVIOLENCE

““No One Ever Deserves to Get Hit”No One Ever Deserves to Get Hit”

VersusVersus

““No Angry Touching Now”No Angry Touching Now”

5959

WHEN COUPLES THERAPY IS WHEN COUPLES THERAPY IS NOT APPROPRIATENOT APPROPRIATE

Severe ViolenceSevere Violence

Fear Expressed By One or Both PartnersFear Expressed By One or Both Partners

Injury Potential HighInjury Potential High

Couple Therapy Sought as ControlCouple Therapy Sought as Control

6060

SPOTTING PATRIARCHAL SPOTTING PATRIARCHAL TERRORISM:TERRORISM:

RULES OF THUMBRULES OF THUMB

Violence Used to ControlViolence Used to Control

Creates FearCreates Fear

Alcohol/Drug Use May Make It Worse, But Alcohol/Drug Use May Make It Worse, But Violence Happens Regardless of UseViolence Happens Regardless of Use

Often Extreme Mismatch in Violence Often Extreme Mismatch in Violence Reports, Particularly When Partners Reports, Particularly When Partners Evaluated SeparatelyEvaluated Separately

Couple Therapy and Couple Therapy and Patriarchal TerrorismPatriarchal Terrorism

The Need for ControlThe Need for Control

6262

IMPORTANT IMPORTANT ACKNOWLEDGEMENTSACKNOWLEDGEMENTS

Victims Return Home, Whether We Victims Return Home, Whether We Like It or NotLike It or Not– Needs a Harm Reduction StrategyNeeds a Harm Reduction Strategy

““Treatment” Is Not a PanaceaTreatment” Is Not a Panacea

Coordinated Response IncludesCoordinated Response Includes– Prevention (Broad and Targeted)Prevention (Broad and Targeted)– TreatmentTreatment– Legal (Incarceration, Orders of Legal (Incarceration, Orders of

Protection)Protection)

SPECIAL TOPICSSPECIAL TOPICS

CHILDRENCHILDREN

6565

CHILDREN:CHILDREN:

Exposure to IPV is Corrosive To ChildrenExposure to IPV is Corrosive To Children

Evaluation of IPV Must Include Discussion of Evaluation of IPV Must Include Discussion of Children’s ExposureChildren’s Exposure– Evaluate the Role of Parental IntoxicationEvaluate the Role of Parental Intoxication

Low-Level Violence May Be a Big ProblemLow-Level Violence May Be a Big Problem

Children’s Exposure to Violence Is Children’s Exposure to Violence Is Influenced by Alcohol and Drug Use by Influenced by Alcohol and Drug Use by ParentsParents

Interaction of Genetics and EnvironmentInteraction of Genetics and Environment– Implications?Implications?

THE HIDDEN VICTIMSTHE HIDDEN VICTIMS

6666

INTERVENTION INTERVENTION CONSIDERATIONSCONSIDERATIONS

Address Violence and Substance Use Address Violence and Substance Use FirstFirst

Understand “Trickle Down Effects”Understand “Trickle Down Effects”

Understand Perpetuation of Marital Understand Perpetuation of Marital Conflict Across GenerationsConflict Across Generations– Comment for ParentsComment for Parents

Consideration Younger Versus Older Consideration Younger Versus Older ChildrenChildren

SUBSTANCE USE AND SUBSTANCE USE AND SEXUAL ASSAULTSEXUAL ASSAULT

6868

PROBLEMS UNDERSTANDING PROBLEMS UNDERSTANDING THIS ASSOCIATIONTHIS ASSOCIATION

Sexual Assault is Under-ReportedSexual Assault is Under-Reported– EmbarrassmentEmbarrassment– Unclear Personal Definition of Sexual AssaultUnclear Personal Definition of Sexual Assault

Self-Belief That Drinking or Drug Use Self-Belief That Drinking or Drug Use Makes It the Victim’s FaultsMakes It the Victim’s Faults

6969

PREVALENCE OF PREVALENCE OF SEXUAL ASSAULTSEXUAL ASSAULT

25% of Women Have Been Sexually 25% of Women Have Been Sexually AssaultedAssaulted

18% Have Been Raped18% Have Been Raped

20% of Men Report Engaging in Sexual 20% of Men Report Engaging in Sexual AssaultAssault

5% of Men Have Committed Rape5% of Men Have Committed Rape

Rates of Female Victimization is Much Rates of Female Victimization is Much Higher on College CampusesHigher on College Campuses

7070

SEXUAL ASSAULT AND SEXUAL ASSAULT AND ALCOHOL USEALCOHOL USE

Roughly Half of Sexual Assault Roughly Half of Sexual Assault Victimizations Involve DrinkingVictimizations Involve Drinking

Roughly Half of Sexual Assault Roughly Half of Sexual Assault Perpetrations Involve DrinkingPerpetrations Involve Drinking

Most Commonly Victims and Perpetrators Most Commonly Victims and Perpetrators Are Drinking at the Time of AssaultAre Drinking at the Time of Assault

7171

WHY ARE THEY LINKED?WHY ARE THEY LINKED?

ExpectanciesExpectancies

DisinhibitionDisinhibition

Occurs in Contexts that May Not Prohibit Occurs in Contexts that May Not Prohibit Sexual AssaultSexual Assault

Misattribution of Cues About SexMisattribution of Cues About Sex

7272

INTERVENTION/PREVENTION INTERVENTION/PREVENTION CONSIDERATIONCONSIDERATION

When With Non-Intimate PartnersWhen With Non-Intimate Partners– Focus on Avoiding High Risk SettingsFocus on Avoiding High Risk Settings– Raise Awareness About Drinking and Sexual Raise Awareness About Drinking and Sexual

Assault; Encourage Drinking ReducitonAssault; Encourage Drinking Reduciton

When With Intimate PartnersWhen With Intimate Partners– Increasing Sexual AssertivenessIncreasing Sexual Assertiveness– Discourage Getting Into or Maintaining Discourage Getting Into or Maintaining

Sexually Coercive RelationshipsSexually Coercive Relationships

7373

WHERE DO WE GO FROM HERE?WHERE DO WE GO FROM HERE?

Broaden the Research AgendaBroaden the Research Agenda

Recognize that Nothing Will Always Recognize that Nothing Will Always WorkWork– Failures are DisastersFailures are Disasters

– Creates Desire to Abandon Potentially Creates Desire to Abandon Potentially Effective Approaches PrematurelyEffective Approaches Prematurely

Intervene at Multiple LevelsIntervene at Multiple Levels

Move Beyond Stifling DebateMove Beyond Stifling Debate

7474

Please visit us:Please visit us:

www.addictionandfamily.orgwww.addictionandfamily.org

CONTACT INFORMATIONCONTACT INFORMATION

William Fals-Stewart, Ph.D.William Fals-Stewart, Ph.D.William_Fals-Stewart@URMC.Rochester.eduWilliam_Fals-Stewart@URMC.Rochester.edu