Promises and Pitfalls of Trauma Informed Care As a Framework for Addressing Co-Occurring Intimate Partner Violence and Substance Use Disorders

Background & Purpose:  Trauma-informed care (TIC) has gained attention as promising framework for addressing complex needs of vulnerable populations. Literature suggests that TIC may be a useful organizing framework for bridging interventions for intimate partner violence (IPV) and substance use disorders (SUD). Although IPV and SUD co-occur extensively at the individual level and evidence suggests addressing them together may improve client retention rates and outcomes, they are rarely addressed together. This paper analyzes organizational characteristics and practitioner perspectives to explore the promises and pitfalls of TIC as a bridging strategy for IPV and SUD.

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 IPV or AOD organizations in the region (N = 314). Interviews were transcribed verbatim and, alongside archival materials, analyzed using grounded theory principles using Atlas.TI. SPSS was used to characterize patterns within and across organizations in each field.

Results:  Organizations offering services for both IPV and SUD were significantly more likely to incorporate TIC (22%, N = 12) than those addressing either IPV or AOD (11%, N = 24). IPV and SUD practitioners described TIC models as promoting an understandings of IPV and SUD as both a risk factor and outcome of the other issue. How practitioners conceptualized trauma in relation to IPV or SUD in general differed by field, reflecting lingering ambivalence towards mental health approaches. SUD providers saw trauma—conceptualized as past trauma—as a significant contributor to SUD and tended to use manualized evidence-based practices. In contrast, practitioners in IPV settings focused on trauma in relation to current safety, seeing an emphasis on past trauma as contributing to victim-blaming and mitigating against perpetrator accountability. They were more likely to see TIC as requiring deeper organizational changes. Practitioners in both settings described participant trauma histories as reason to limit engagement with the other issue. IPV service noted potential re-traumatization of survivors in non-trauma-informed SUD programs while SUD providers felt addressing trauma in early recovery might lead to relapse. In both settings, practitioners expressed concern that TIC models imposed externally as a funding requirement tended to result in surface-level changes, potentially undermining the potential promise of these approaches.

Conclusions & Implications: How practitioners in IPV and SUD organizations understand TIC is shaped by each field’s historical relationship to mental health in general. While results suggest attention to trauma enhance's organizations' abilities to address both IPV and AOD together, doing so in practice is much more complex. Findings suggest need for further education around TIC in both IPV and SUD organizations coupled with support in the larger organization change efforts necessary to support such interventions.