Addressing Substance Use Among Survivors and Perpetrators of Intimate Partner Violence: Organizational Approaches

Goals and Specific Aims:  Use and abuse of alcohol/other drugs (AOD) are often intertwined in complex ways with intimate partner violence (IPV), for survivors and perpetrators of IPV. The presence of both increases many problems and barriers to services. Most AOD and IPV organizations do not systematically address both, but some innovative organizations have developed hybrid approaches, defined as addressing both IPV and AOD in ways appropriate for particular populations, settings, and levels of severity. AOD issues may be addressed in AOD specialty organizations, organizations focused more widely on behavioral health, multiservice organizations that address many issues, or in organizations that specialize in addressing IPV. This paper characterizes approaches to addressing AOD in conjunction with IPV, identifying similarities and differences in strategies across organizational types.

Methods:  Examples are drawn from a purposive sample of 35 organizations from 20 states and Canada, identified as engaging in hybrid approaches for addressing AOD and IPV (by funders and experts, via several list serves, internet and literature searches and snowball techniques). Organizations included 9 focused on AOD or behavioral health, 12 primarily IPV, 9 multiservice organizations, and 5 primarily woman-centered. Complex case studies were constructed using data from websites, tax filings, program reports, one or more semi-structured interviews. Examples of how AOD is addressed were extracted from case studies and 10 comparative case study databases, and categorized by populations targeted, approaches used, and how hybridity was accomplished (including policy and organization-wide changes, community relationships, staff training and composition, and many foci and activities with participants).

Results: Some AOD and behavioral health organizations have implemented IPV perpetrator intervention programs, often at the request of probation departments, and in conjunction with local IPV survivor organizations. AOD organizations with significant programming for survivors of IPV often have women-and trauma-specific components, and collaborations with an IPV shelter. All identify safety as an important goal alongside reduction of AOD consequences. Organizations emphasizing work with IPV perpetrators and/or survivors address AOD in varied ways. Some require AOD to be “managed” and facilitate referrals to AOD treatment prior to accepting participants into IPV programming. Other have special tracks for those experiencing AOD, and still others have infused attention to AOD through all aspects of their work. Multiservice organizations address different mixes of AOD and IPV, often with internal coordination. A subset of organizations address AOD using readiness to change and harm reduction approaches, while working for complex changes over time. We classify different types and levels of attention to AOD, and many examples of the challenges of navigating very different paradigms.

Discussion:  With the advent of the Affordable Care Act, which expands options for addressing AOD (and IPV), knowledge about innovative ways of addressing AOD in different settings is increasingly important. This study identifies many approaches, in different settings for different populations, emphasizing how to address AOD and IPV together. This is a purposive sample so results cannot be generalized, but identifying promising practices and practice-informed knowledge from innovative practitioners and organizations is an important early step in services research.