Substance Use Coercion Among Victims of Intimate Partner Violence: An Exploratory Mixed Methods Approach

Background: Substance abuse problems are prevalent among women who have experienced domestic violence (DV). The relationship between DV and substance use is complex and poses several questions that have yet to be answered. It is crucial to understand how substance use coercion plays out in abusive relationships.The primary purpose of this study was to: 1) determine the prevalence estimates of substance use coercion among DV survivors in residential settings, and 2) examine how substance use coercion is manifested in DV situations from the perspectives of survivors and DV service providers (staff and administrators).

Methods: Our interdisciplinary research team collaborated with the statewide coalition of domestic violence in Ohio, which is an organization representing Ohio’s 72 domestic violence direct service agencies. This study was conducted in two phases. Phase I entailed a qualitative study conducted using focus groups (N=7) with shelter staff as participants (N=55), and phase II was a quantitative study conducted using phone surveys with DV survivors (N=51). Shelter staff participants for the focus group discussions were purposively sampled from 40 domestic violence shelters from rural and urban areas across the state of Ohio. Women survivors of DV were also purposively recruited through these agencies. Qualitative data analysis for focus group data was coded using team-based analyses in Atlas ti software. Descriptive statistics were used to analyze data on the prevalence of substance use coercion.

Results: A predominant theme that emerged from the focus group discussions with shelter staff was that abusers use opioids and other substances to exert control over victims. The abuser was frequently the supplier of substances in the relationship and would threaten to report the survivor’s drug use to authorities, creating a barrier to seeking help. The abuser also coerced survivors to stay in the relationship and conceal the violence with threats of alerting officials--including law enforcement or child protective services. Staff also perceived that some survivors used opioids and other drugs as a way to cope with their experiences of DV and lifetime trauma.

Quantitative findings from phone based survivor interviews revealed that 56% of DV survivors reported that their partner or ex-partner made them use alcohol or other drugs more than they wanted. Approximately 40% of DV survivors also reported that their partner or ex-partner forced them to use alcohol or drugs through threats to harm them if they did not. In addition, about 52% of DV survivors reported that their partner or ex-partner controlled their access to alcohol or other drugs; manipulated them by making them go into withdrawal; stopped them from cutting down or quitting when they wanted to; and prevented them from attending recovery meetings, substance abuse treatment, or sabotaged their recovery in other ways.

Conclusions and Implications: Based on these findings, the development of trauma-informed best practices that incorporate substance use coercion for professionals working in domestic violence shelters is critical to promote effective service provision, address substance use concerns, provide access to treatment and recovery resources, and facilitate survivor healing and improved quality of life.