Accounting for Intimate Partner Violence in Addiction Treatment: Screening and Referral

Background. Intimate partner violence (IPV) presents a serious health risk in the general population, but is encountered far more frequently in clinical settings such as programs treating substance use disorders (SUD: El-Bassel, et al., 2000). Despite the prevalence and health risks of IPV, SUD providers are less than optimally trained in screening for IPV cases (Klostermann, 2006; Smith, 2000) and non-court referral of SUD clients who are victims or perpetrators to IPV intervention programs is rare (McLellan & Meyers, 2004). The current research explores variables associated with three critical practice behaviors necessary in coordinated approaches to IPV and SUD treatment: (1) screening for IPV, (2) agency procedures supporting screening and managing IPV, and (3) linking SUD services with IPV providers. 

Methods. Key informants (n=294)  employed by addiction agencies in four U.S. states were recruited by electronic postings from the four directors of Single State Agencies responsible for administering substance abuse programs in each state. Consenting participants responded to questions in an online survey with items drawn from an early study of IPV and addiction practitioners (Bennett & Lawson, 1994), various practice manuals on co-occurring IPV and SUD, and issues drawn from the literature on IPV in substance abuse treatment (Easton, Swan, & Sinha, 2000; Herz, Stroshine, & Houser, 2007; Klostermann, 2006; Miller, Wilsnack, &  Cunradi, 2000; Smith, 2000).  Three criterion variables were created using Principal Component Analysis of key survey items: (1) frequency of  IPV screening (Cronbach α= .85), (2) agency procedures to support IPV screening (α=.74), and (3) agency linkage to IPV providers (α=.77). Logistic and ordinary least-squares regression methods were employed to sharpen the analysis. 

Results. Half of participants regularly screen for IPV victimization (58.3%) and perpetration (45.8%), but administrative staff were twice as likely (95% Odds Ratio=2.13) to report screening for IPV than non-administrators and participants employed by agencies in suburban settings were twice as likely (OR=2.44) to report screening than staff employed in urban or rural/small town settings. Agency administrators also reported significantly greater likelihood of being in an agency which provided both formal support for screening and linkage with community IPV providers. Estimated prevalence of male batterers in substance abuse treatment and being over 50 also independently predicted linkage with IPV agencies. Surprisingly, neither gender, proportion of women served by the agency, nor participant beliefs and attitudes about IPV predicted any criterion variables. 

Implications. Despite limitations inherent in an Internet key informant study, a non-probability sample, and the use of study-derived measures, results suggest that systems change targeting organizational, structural, and community factors may offer more useful intervention targets than the personal attitudes and beliefs typical of current training efforts. To the extent we can accept findings that administrators rather than supervisors or practitioners display higher levels of accountability in bringing IPV into SUD practice, we can be cautiously optimistic about enhancing the domestic safety of people served by behavioral health programs.