SUBST ANCE AB USE

AN D
DO MESTI C
VIO LE NCE
Comm on Characteri st ics of
Al cohol and Drug Abuse and
Domesti c Vio lence
 They both can be passed from generation to
generation.
 Both involve denial and minimization of the
problem.
 Both may involve isolation of the
perpetrator and the victim and/or family
 Both revolve around power and control.
The Scope of the Problem
 There are more deaths and disabilities each year in the U.S.
from substance abuse than from any other cause.

 About 18 million Americans have alcohol problems; about

5 to 6 million Americans have drug problems.

 More than half of all adults have a family history of

alcoholism
or problem drinking.

 More than nine million children live with a parent dependent

on alcohol and/or illicit drugs.
The Consequences
¥One -quarter of all emergency room admissions, one -third
of all suicides, and more than half of all homicides
and incidents of domestic violence are alcohol -related.

¥Heavy drinking contributes to illness in each of the top

three causes of death: heart disease, cancer and stroke.

¥Almost half of all traffic fatalities are alcohol -related.

¥Between 48% and 64% of people who die in fires have

blood alcohol levels indicating intoxication.

¥Fetal alcohol syndrome is the leading known cause of

mental retardation.
http://www. ncadd .org/facts/ numberoneprob .html
The Cost
¥Alcohol and drug abuse costs the American economy an
estimated $276 billion per year in lost productivity,
health care expenditures, crime, motor vehicle crashes
and other conditions.

*Untreated addiction is more expensive than heart disease,

diabetes and cancer combined.

¥Every American adult pays nearly $1,000 per year for the
damages of addiction.

http://www. ncadd .org/facts/ numberoneprob .html

Acute Alcohol Withdrawal
Group 1
Tremors, general irritability, nausea, vomiting, flushed, tachycardia,
anorexia, insomnia
Treatment: Adequate medical examination, adequate rest, good nutrition,
multiple vitamins, benzodiazepines PRN for severe tremor.

Group 2
Alcohol Hallucinosis: frequently visual illusions, auditory hallucinations
despite an otherwise clear sensorium (most common from is human
voices, most prominent at night), other types of hallucinations.
Treatment: neuroleptics.

Group 3
Withdrawal seizures : over 90% of the seizures occur during the 7 - 48 hour
period
following the cessation of drinking. Grand mal seizures. In the majority of
cases, the
seizures occur in bursts of 2 - 6. 2% of patients develop status epilepticus.
Treatment: anticonvulsants
Acute Alcohol Withdrawal (cont)

Delirium Tremens: Usually appear 2 - 4 days after cessation of drinking.

The duration is about 72 hours. Very seldom lasts 4 - 5 weeks. Without
treatment, between 5 -15% of DT's end fatally.

Symptoms: Reduced ability to maintain attention, disorganized thinking,

reduced level of consciousness, vivid hallucinations (mainly visual),
delusions, tremor, agitation, increased overactivity of the autonomic
nervous system (dilated pupils, hypertension, tachycardia,
perspiration, fever).

Treatment: drugs that have cross tolerance and dependence with alcohol
such as benzodiazepines (Librium or lorazepam), hydration, thiamine,
multiple vitamins
Post Acute Withdrawal Syndrome (PAWS)
-Symptoms peak 3 -6 months after abstinence begins

-Symptoms persist up to 24 months after abstinence begins

-Symptoms:

Inability to solve simple problems

Inability to think clearly
Emotional overreaction or numbness
Sleep disturbances and drinkers dreams
Inability to handle stress
Memory impairment

-Important for patient to realize this is transient

Def init ion of Al cohol
Abus e
 A person's maladaptive alcohol use causes clinically
important distress or impairment, as shown in a single
12-month period by one or more of the following:
 failure to carry out major obligations at work, home,
or school because of repeated alcohol use,
 repeated use of alcohol even when it is physically
dangerous to do so,
 repeated experience of legal problems, or
 continued use of alcohol despite knowing that it has
caused or worsened social or interpersonal
problems.
Def ini tion of Alcohol
Dependence
 A person's maladaptive pattern of alcohol use leads to clinically
important distress or impairment, as shown in a single 12-month
period by three or more of the following:
 tolerance;
 withdrawal;
 amount or duration of use often greater than intended;
 repeatedly trying without success to control or reduce alcohol
use;
 spending much time using alcohol, recovering from its effects,
or trying to obtain it;
 reducing or abandoning important work, social, or leisure
activities because of alcohol use; or
 continuing to use alcohol, despite knowing that it has probably
caused ongoing physical or psychological problems.
MET HA MPHE TAM INE AND
DOM EST IC VIO LENC E
 Police in Contra Costa County, California,
report that methamphetamine is involved in
almost 90 percent of the domestic dispute
cases investigated by that agency

 Extreme agitation and paranoia associated

with chronic use often lead to situations
where violence is more likely to occur.
 ME TH AMPH ET AMIN E A ND
DOMES TIC VIO LEN CE
(c ont)
CHARACTERISTICS
Methamphetamine ­ a powerful, long­acting, physical,
and psychological stimulant.
 Known by a variety of street names meth, speed,
crank, crystal, CR, vitamin C, ice, go­fast, chalk,
and glass.
 Often powdery, meth may be found in a variety of
colors, and it may emit a chemical odor.
 Meth is swallowed, snorted, injected, or smoked.
 Meth is a highly addictive drug.
SYMPTOMS

Short­term use can result in

 increased heart rate, blood pressure, and
respiration;
 excessive sweating;
 flushed or tense appearance;
 a chemical odor on the breath;
 rapid speech;
 dilated pupils;
 bloodshot eyes; and
 inability to sleep or eat.
SYMPTOMS (cont)

Prolonged use can cause severe physical and

psychological problems, including
permanent damage.
Physical symptoms include:
 Severe weight loss
 Rotting or missing teeth
 Scars
 Open sores
 Offensive body odor.
BEHA VIO RAL PROB LE MS
Meth can:
Overwhelm and overstimulate the user's
nervous system

Create serious psychological/behavioral

problems, including
 VIOLENCE,

 AGGRESSION

 HYPERACTIVITY
BEHA VIO RAL PROB LE MS
(cont)
Chronic meth users experience any or
all of the following:
 initial euphoria ­ a feeling of well­being;
 depression ­ feelings of sadness;
 paranoia ­ a chronic psychosis
characterized by delusions of
persecution or of grandeur; and
 aggressive behavior leading to violence.
ADDI CTIO N
Meth modifies the brain's pleasure receptors
­ producing excess levels of dopamine
 With prolonged use, the user's ability to
experience normal levels of pleasure
declines significantly.
 The user suffers extreme boredom with
normal day­to­day activities.
 Meth creates a powerful craving in the user.
 The psychological urge to use meth can cause a
user to become dependent on the drug.
NOTE: For the purposes of this
presentation “substance abuse”
refers to the use of
 Any illicit drugs, prescription medicines,
solvents or alcohol, which harm health or
functioning.
 It may take the form of physical or
psychological dependence or be part of a
wider spectrum of problematic or harmful
behavior.
DOMES TIC VIO LEN CE
PER PETR ATOR S AND SUB STANC E
ABUSE
Working with AOD abusing perpetrators in
Batterers’ Intervention Programs
 The incidence of substance abuse among men
in batterers’ programs is between 50 percent
and 100 percent, depending on the proportion of
the men who were referred by the criminal
justice system (Bennett, 1995).
 Batterers referred through the courts are more
likely to also be substance abusers than self­
referred men.
 Men who are violent outside their families are
more likely to have substance abuse problems
than men who are violent only within their
families.
AO D Abusi ng Perp etrators I n
Batter er’s Progra ms (cont)
Alcohol or drug abuse does not cause the
abusive behavior. However, for most
batterers, alcohol and drug use may:
 Increase the risk that he will misinterpret his
partner’s behavior.
 Increase his belief that violent behavior is due to
alcohol or drugs
 Make him think less clearly about the
repercussions of his actions.
 Reduce his ability to tell when a victim is
injured.
 Reduce the chance that he will benefit from
punishment, education, or treatment.
Screenin g Batterer s f or
Sub stance Abuse
A screening for substance abuse is a
preliminary step that determines the
probability of an alcohol or drug
problem.
 Because so many batterers are also
substance abusers, all batterers should
be thoroughly screened for substance
abuse problems.
Batterers’ Intervention Programs screen
for substance abuse through:
 Initial Interviews:
 Program staff ask established questions
and are trained to interpret responses.

 Direct questioning about alcohol and

drug use often makes substance abusers
deny the importance or effect of alcohol
or drugs in their lives.
Screenin g Batterer s
(cont)
 Observations of behavior and interactions:
 Lateness, fatigue, aggression, or the smell of alcohol point
toward the need for formal alcohol and other drug assessment.
 Interactions with any recovering alcoholics and addicts in the
batterers’ program ­ recovering men can often identify
substance abuse patterns in others.
 Existing records:
 The contract signed between the batterer and the program
should include access to criminal justice, mental health, and
medical records.

 Evaluate abstinent batterers:

 Abstinent batterers with no observable supports for staying
sober should be considered at high risk for relapse, and
consequently, a safety risk.
 DOM EST IC VIO LENC E
VICTI MS A ND SUBST ANCE
AB US E
 80% of women with substance abuse disorders had been the
victim of domestic violence (Research Institute on
Addictions, 1997)
 42% of victims of domestic violence contacting the police had
used alcohol or other drugs on the day of the assault
(Brookhoff et al., 1997)
 Approximately 50 percent of all female alcoholics have been
victims of domestic violence (Miller and Downs 1993).
 A research study of nighttime calls for assistance in Memphis
found that:
 42 percent of victims of domestic violence used alcohol or drugs
on the day of the assault
 In a study of murder in families, half of the victims in spouse
murders had consumed alcohol before the crime (Dawson
and Langan 1994).
 Having a partner who abuses chemicals is more likely to
generate substance abuse in women (Wilsnack and Wilsnack
1991, as cited by Goldberg 1995).
 Drug or alcohol­involved victims of partner abuse may not be
taken as seriously by professionals (Stark and Flitcraft 1991).
 Victims of domestic violence are more likely to receive
prescriptions for and become dependent on tranquilizers,
sedatives, stimulants, and painkillers and are more likely to
abuse alcohol (SAMHSA 1997b).
 The presence of both substance abuse & domestic violence
increases the severity of injuries & lethality rates
Perp etra tors m ay pose in creased
risk t o subst ance abusing part ners
by:
 Introducing partner to drugs
 Forcing or coercing partner to use
 Isolating partner from help
 Coercing partner to engage in illegal acts
 Using withholding drugs as a threat
 Blaming abuse on partner’s alcohol or drug
use
 SU BSTAN CE ABU SE AS A
PRE- VICTI MI ZATI ON FACTO R

Use of alcohol and illicit drugs

increases one’s likelihood of being
victimized.
 Substance use or abuse –
 impairs perception, judgment, and mental
faculties,
 may have a detrimental effect on ability to
maintain personal safety.
SUB STA NCE A BUS E A S A
PRE-V IC TIMIZA TION FACT OR (c ont)
 A women’s use of drugs nearly doubles the
likelihood she will experience an assault when
compared with those who did not use drugs.
 The greatest risk was to women who used drugs
AND had experienced an assault previously
 For hard drug users and marijuana users the odds
of being assaulted were 5.06 and 1.46 times those
of nonusers, respectively.
 Alcohol and drug abusers are about 1.5 times as
likely to experience traumatic events as nonusers.
 A study of emergency room trauma found that
patients with violence­related injuries were at least
twice as likely to have been drinking than patients
with injuries from other causes
SU BSTAN CE ABU SE AS A
PO ST- VI CTI MI ZATI ON FACTO R
 The trauma of victimization leads a
considerable number of victims to use
alcohol and other drugs as a means of
coping with the trauma
 Women who have been assaulted are twice
as likely as non­assaulted women to use or
abuse substances
 Nearly nine in ten alcoholic women were
physically or sexually abused as children
(Miller and Downs 1993).
SUB STA NCE A BUS E A S A
POS T-V IC TIM IZA TION FAC TOR (c ont)
 Exposure to sexual or physical abuse often
contributes to the development of a variety
of short­ and long­term psychological
disturbances, for example:
 PTSD,
 Depression,
 Anxiety,
 Anger,
 Self­destructiveness,
 Suicidal behavior,
 Low self­esteem, and
 Difficulties with interpersonal relationships
BARRI ERS TO SU BSTAN CE
ABU SE TREATMEN T FO R
VI CTI MS
1. Economic ­ the cost of treatment
 no insurance
 insurance doesn't cover substance abuse
treatment.
2. Social stigmatization ­ makes them less
likely to disclose the problem.
3. Lack of social and emotional support
 Family, friends, employers and co­workers
often enable the substance abuse
 Denial
 Minimizing
BARRIE RS TO SUBS TANC E ABUSE
TREA TME NT FOR VIC TIMS (cont)
1. Special concerns relating to children or child
custody:
• Lack of safe and accessible childcare
• Fear that no one will protect their children if they enter
treatment
• Women in criminal justice system ­ fear of loss of
custody of children (disclosure of a substance abuse
problem will be the last straw)
• Pregnant women – fear legal ramifications, unfit mother
label
• Homeless women – fear that Child Welfare will remove
kids.
• Lesbian women – fear the disclosure of their lifestyle
will result in loss of custody.
BARRIE RS TO SUBS TANC E ABUSE
TREA TME NT FOR VIC TIMS (cont)

1. Fear of dealing with authority figures

­ particularly women from:
• Poverty, welfare recipients
• Ethnic populations, language barrier
• Women in the criminal justice system,
• Illegal aliens
BARRIE RS TO SUBS TANC E ABUSE
TREA TME NT FOR VIC TIMS (cont)

1. Fear of retaliation by the batterer –

including:
 Cutting off financial support,
 Threatening to report them as unfit
mothers,
 Telling others about their alcohol or
drug problems,
 Threatening physical violence or death.
SUP PO RTIN G D V VIC TIMS IN
SUB STA NCE A BUS E R ECOV ERY
DV advocates, counselors and case managers
can help by:
 Exploring resources for support in recovery from
drugs/alcohol with client.
 Strongly encouraging client to attend all her
drug/alcohol groups and to keep her individual
counseling sessions with the substance abuse
counselor.
 Exploring with client possible drug/alcohol­free
leisure activities.
 Providing positive feedback to client as she copes
with stress that could trigger a relapse.
SUP PO RTIN G D V VIC TIMS IN
SUB STA NCE A BUS E R ECOV ERY
(c ont)
 Supporting client in her efforts to find an AA or NA
group where she feels safe and welcomed. Also
suggesting that she ask the substance abuse
counselor for resources.
 Assisting client with budgeting money to decrease
impulsive buying of drugs/alcohol.
 Assisting client with housing by providing
resources so that client may live in a drug­free
environment.
 Discussing client’s struggle with wanting to drink.
SUP PO RTIN G D V VIC TIMS IN
SUB STA NCE A BUS E R ECOV ERY
(c ont)
 Offering options ­ but recognizing that substances
impair judgment, making advocacy­based
counseling more challenging.
 Recognizing that euphoric recall and blackouts
make safety planning harder.
 Recognizing that denial of use is not about fooling
the provider. Facing the truth is scary and painful
for the alcoholic or addict. Always be honest and
direct, but remember tact and dignity.
 Examining their own beliefs about alcohol and
other drug use, abuse and addiction to ensure
“addictophobia” is not impairing their ability to
effectively advocate for recovering or actively
using victims of violence.