You Can't Just Get up in the Morning and Do It: Field Characteristics and Organizational Efforts to Address Intimate Partner Violence and Substance Use Disorders

Background & Purpose: Intimate partner violence (IPV) and substance use disorders (SUD) frequently co-occur in individuals. While evidence indicates simultaneous, linked interventions improve client retention and outcomes, few organizations address both together. The literature on IPV/SUD co-occurrence treats barriers to combined approaches as largely informational, rooted in lack of knowledge about the frequency of co-occurrence, its implications, and/or models for addressing both together. Data from practitioner surveys suggests differences in core approaches and resources are barriers but these have seldom been studied systematically. Using neoinstitutonal theory, this paper grounds challenges in recursive relationships between field characteristics and organizational efforts to address both issues.

Methods: Data come from a mixed methods study of social service systems for IPV and SUD in a Midwestern metropolitan area. They include in-depth, semi-structured interviews with 53 key informants involved in direct practice, research, or policy-making related to IPV or SUD; archival material from the state’s IPV coalition and department of substance use disorder treatment; and quantitative data on the characteristics of all known IPV or AOD organizations in the region (N = 314). Interviews were transcribed verbatim and, alongside archival materials, coded in accordance with grounded theory principles using Atlas.TI. Quantitative data were analyzed using SPSS to describe patterns within and across fields.

Results: 18% (N = 56) of organizations in the region address both IPV and AOD in some capacity. The largest subgroup of these (N = 41) offer programming for both issues as separate tracks, suggesting meaningful combined approaches remain rare. Interview data indicates developing and sustaining responsive programs is limited by barriers in four areas: practice philosophies, professional cultures, resources, and rules and regulations. Field-level conceptions of IPV as a structural problem of gender-based power and control and SUD as a brain disease shape barriers in each area. While practitioners in both fields observe increasing professionalization, interviewees describe tensions between the feminist bureaucratic approach now common in IPV organizations and the increasingly clinical orientation of SUD organizations. As SUD has become more medicalized, shifts from a grant-based model to performance based contracting de-incentivize admission of clients with complex needs like IPV and engagement in collaborative work necessary to support high-quality IPV/SUD programs. Organizational rules and regulations are a final flashpoint. Couples with policies redistricting access to treatment-related medications, easy access to over the counter medications in IPV shelters may compromise recovery. In a parallel way, the embeddedness of SUD programs in an individualized, medical model of care creates barriers to children entering residential treatment with survivor parents, forcing difficult choices between treatment and family safety.

Conclusions & Implications: Results suggests educationally-focused efforts to promote combined IPV and SUD interventions are limited. Scholars and policymakers should instead focus on reshaping the philosophical, professional, resource, and regulatory regimes at both the field- and organizational levels. Fully addressing participant needs around co-occuring IPV/SUD requires changes in fundamental approaches in both fields likely to benefit participants facing complex challenges beyond IPV and SUD.