Domestic Violence & Substance Use Disorder

What Is Domestic Violence?

It’s been estimated more than 10 million Americans experience domestic or intimate partner violence every year. For comparison, in 2019 the population of the state of Georgia was estimated to be 10.6 million, so that’s like imagining every resident was a victim of abuse.

The National Coalition Against Domestic Violence estimates one in four women and one in nine men have experienced some form of intimate partner violence. It can take the form of intimidation, physical violence, or sexual assault.

Domestic Violence High Risk Teams

One promising approach toward curbing domestic violence deaths poses the question: what if you could predict which victims were in the most danger?

That’s what’s at the heart of Domestic Violence High Risk Teams. These task forces operate on the local level, where area shelters work with law enforcement and the courts to identify and protect those who are most at risk by helping various components communicate with one another.

Kelly Dunne and Suzanne Dubus, chief of operations and chief executive officer, respectively, of the Jeanne Geiger Crisis Center in Massachusetts formed the first DVHRT in 2005. Dunne was inspired by a conference she attended in 2003.

Jacquelyn Campbell, a professor at Johns Hopkins University School of Nursing and a leading expert on domestic homicide, was the speaker that day. For her doctorate, Campbell interviewed 2,000 domestic violence survivors and combed through homicide files, searching for patterns.

Some of Campbell’s findings include:

• Half of the victims had sought help.
• Previous physical domestic abuse was the biggest red flag for potential homicide.
• The risk was highest when the victim tried to leave the abuser, or when there was some other significant change brewing at home — a pregnancy, for example.
• The danger was highest for approximately three months post-split, then tapered slightly. After a year, usually the most imminent threat had passed.

Campbell’s work led her to create a Danger Assessment tool, a list of 20 potential risk factors for homicide. It includes substance use disorder, gun ownership, a history of violence, and threats to kill.

The higher the Danger Assessment score, the greater the danger. The DVHRT Model operates on the principle that most intimate partner homicides are predictable and therefore preventable.

Risk assessments are folded into a local community’s domestic violence response system to identify the most urgent cases. The domestic violence agency then partners with law enforcement and the courts while finding alternatives to a shelter (private accommodations or safe homes). Instead of all components operating independently of one another, the task force fills communication gaps and keeps information flowing.

DVHRTs are still relatively new, but they appear to work. There are more than 100 communities in Massachusetts who have adopted them. They’ve also been established in California, Texas, Ohio, and New York, among other places.

In its first 12 years, the Jeanne Geiger Crisis Center handled 172 high-risk cases. The results were highly promising, including:

• Zero homicides
• 95% of victims stayed in their communities, as opposed to entering shelters
• 90% reported no further assaults

To start a DVHRT, core partner organizations must be on board, and a community assessment must be performed. Each task force is designed to fit the area’s jurisdiction, and training, implementation, and evaluations follow. More information about creating a DVHRT can be found here.

Types of Domestic Violence

Domestic violence can take on many forms. When it’s called intimate partner violence it involves the abuse of a spouse or partner. Domestic violence can also involve a child, an older relative, or other members of the family. It even occurs between former couples.

Domestic abuse can be subdivided into many forms, including:

• Physical: Bruises and broken bones
• Sexual: Any form of sexual activity performed without consent
• Emotional: Threats, name-calling, insults, humiliation
• Economic: Access to money is controlled
• Stalking: Unwelcome, repeated contact

The true extent of domestic and intimate partner violence is hard to gauge. A lot of it is never reported. It’s a problem that can affect both men and women — that includes LGBTQ individuals and transgender individuals as well.

Signs of Domestic Violence

Some symptoms may be obvious, like unexplained injuries and bruises, but abuse manifests in many ways. Women tend to be the majority of victims — an estimated 85% — of intimate violence.

Signs of being abused include:

• Controlling behaviors (what to wear, what to eat, etc.)
• Preventing you from doing things
• Isolating you from others
• Hurting you physically (includes punching, pushing, kicking — with or without a weapon)
• Monitoring communication (phone, email, social networks) without approval
• Destroying possessions
• Mocking you in front of others
• Forcing you to have sex
• Making birth control decisions for you
• Keeping you from seeing family or friends
• Threatening you, your loved ones, or your pets
• Accusing you of cheating on them
• Blaming you for their violent outbursts
• Threatening to hurt themselves and blaming the impulse on you
• Saying they’ll report you for (often made-up) crimes
• Telling you that if they can’t have you, neither can anyone else

In cases of same-sex relationships, many of the same warning signs may occur, but with a few additional red flags:

• Threatening to “out” you
• Saying that women are not prone to violence
• Telling you that it’s not domestic violence if you’re not legally married
• Stating that police won’t help LGBTQ individuals
• Forcing you to perform sex acts you aren’t comfortable with under the guise of “proving” your sexuality

Effects of Addiction and Domestic Violence

Domestic violence and unhealthy relationships exact a toll on individuals, families, and society as a whole.

Victims of sexual assault are at a higher risk of contracting sexually transmitted diseases due to forced intercourse (and the option of protecting themselves being stripped away). Domestic violence also makes its sufferers more prone to depression and suicidal tendencies.

Female victims of intimate partner violence may drink or use more drugs — sometimes being coerced into it by their partners, or sometimes resorting to it as a way to dull the ache of emotional or physical battery.

In some cases, more than half of women who experience such abuse have been diagnosed with psychiatric problems. It can manifest in substance use, eating disorders, and reproductive health problems.

Studies have found some women who had experienced violence were more likely to abuse multiple substances prior to and during pregnancy, which can put newborns at risk of fetal alcohol syndrome and other health concerns.

Families and children also suffer. One in 15 children in 2010, or more than 5 million children, were exposed to intimate partner violence. A third of those children were victims of abuse themselves.

One in three adolescent girls in the U.S. has experienced some form of abuse — physical, verbal, or emotional — in dating relationships.

Children who see or experience domestic violence typically have greater anxiety, sleeplessness, nightmares, separation anxiety, anger issues, and problems concentrating. Abusers may use children as pawns in relationships to better control their victims by threatening to take the children away or even kill them.

Economically, domestic violence costs the U.S. economy an estimated $6 billion every year. In 2016, the global cost of violence against women was an estimated $1.5 trillion, or about 2% of the global gross domestic product.

That number could be higher, due to under reporting of abuse. Some women fear speaking up; other groups, like shelters, may withhold data in order to protect the women they help.

Care International says the costs of domestic abuse are both direct and indirect:

• Survivors and families pay medical costs (both for immediate treatment and in counseling), for legal help, and to escape from violence
• Perpetrators pay fines and fees
• Time and money go to run and federal, state and local programs

Indirectly, victims lose income and productivity due to injuries. The perpetrators may not be productive members of society due to substance use disorder (sleeping it off, etc.) or may be imprisoned for acts of violence.

Causes of Domestic Violence

It’s hard to pinpoint one true cause of domestic violence, but there are circumstances that may increase the likelihood.

Children who are exposed to intimate partner abuse while they are growing up are three times more likely to engage in the same behaviors than their peers. In such a setting, they may learn to view violence as normal. That means they’re more likely to become victims of abuse or perpetrators of it.

Young witnesses of household violence also may develop any number of adult health problems. The problems include a greater likelihood of  depression, obesity, cancer, heart disease, substance use disorder, tobacco use, and unplanned pregnancies.

Addiction and Domestic Violence

Substance use disorder factors into a high number — 40-60% — of intimate partner violence incidents. Alcohol and drugs seem to lessen the abuser’s self-control, making him or her more prone toward aggression. Also, spousal abuse seems to be a strong predictor of substance use or addiction. The abused individual may be forced into using drugs or alcohol, or they may resort to use to cope with their emotions.

Physical violence was found to be 11 times more likely when drugs or alcohol were abused. There are doubts as to whether drug and alcohol use causes the abuse, or whether the substances are used as an excuse for the violence. The U.S. surgeon general report Facing Addiction in America notes that “substance use is both a risk factor for and a consequence of intimate partner violence.”

The type of substance use disorderd can play a factor as well:

• Alcohol can change mood and behavior, both with short-term and long-term abuse.
• Cocaine can lead to anxiety, violent behavior, and psychosis.
• GHB (gamma-hydroxybutyric acid) can cause aggressive behavior. Also used sometimes as a date rape drug.
• Inhalants can cause delusions and, with long-term use, brain damage.
• LSD can trigger mood swings and impair rational thinking.
• MDMA (ecstasy) can spike anxiety and long-term abuse may result in aggression.
• Methamphetamine (meth), with long-term use, can cause anxiety, mood problems, and violent episodes.
• Prescription stimulants can cause violent behavior and hallucinations.
• Steroids, used long-term, can cause mood swings, anger, hostility, and aggression.
• Synthetic cathinones (bath salts) can generate paranoia, agitation, and psychotic and rage-filled episodes.

Just about any illicit or improperly used substance can trigger aggressive or violent behaviors. It depends on the individual, the dose, and if there is a dependency. (Withdrawal can be painful and set some people off.)

Treatment for Addiction and Domestic Violence

There is no easy fix for addiction or domestic violence. Each case is unique.

Improved or more widespread awareness of and treatment options for substance use disorders may slow addiction and relapse rates. It also may help reduce violent behaviors. Making a concerted effort to protect victims — including children — from domestic violence will build a better, more secure foundation for the current and upcoming generations.

Supporting programs, policies, and legislation designed to put an end to violence against women (really, all victims of domestic abuse, regardless of age or gender) — by educating, preventing, and intervening — are steps in the right direction.