Purpose. Since SAMHSA's 1997 treatment protocol Substance Abuse Treatment and Domestic Violence, an increasing number of state and local efforts to link substance abuse and domestic violence services have emerged, almost all of which have occurred without the benefit of research or evaluation. Coordination and integration of these often disparate programs hinge on a number of key issues, such as whether to require abstinence at admission and during the domestic violence program, focusing on acute v. distal episodes of violence, and the preferred sequence of services. In this paper we address three practice questions important to coordinating substance abuse treatment and domestic violence services: (1) Do women who are abstinent prior to the onset of DV services show greater improvement in domestic violence outcomes than women who are drinking or drugging prior to program admission? (2) How does proximity of violence impact domestic violence outcomes and substance use? And, (3) In dual service settings, are different “doors” to service associated with different substance use and domestic violence outcomes?

Method. As part of a state demonstration project, women who were both victims of domestic violence and abusing alcohol or drugs were interviewed at program entry (n=255) and six months after program entry (n=128, 50%). Key outcome measures were the number of days substances were used in the past month (SUD), women's perceptions of harm from battering (WEB), and domestic violence self-efficacy (DVSE). ANCOVA and MANCOVA procedures were applied to these questions, with baseline values of outcome variables employed as covariates. Models of substance abuse and domestic violence outcomes were considered separately.

Results. Overall, participants in the coordinated and integrated programs used substances less frequently over time and experienced themselves as more efficacious following services, but they were also more fearful of the consequences of domestic violence. Controlling for baseline values, abstinence at baseline was not a significant predictor of domestic violence outcomes. Acuity of the violent episode was not a significant factor in either substance use or domestic violence models. Finally, there was no difference in either substance use or violence attitude after the program between those participants entering service through a domestic violence agency, through a substance abuse agency, or through an agency providing both services.

Implications. Within the limits of a quasi-experimental design, our findings may help accelerate efforts to coordinate domestic violence and substance abuse programs. Our data suggest both abstinence and non-abstinence, both proximal and distal violence, and entering the program at any service point do not decrease the chances of successful outcomes. The federal slogan of No Wrong Door, which has been applied to the treatment of co-occurring psychiatric and substance use disorders, may also apply to the treatment of the co-occurring problems of domestic violence and substance abuse.