Counselor Treatment of Coexisting Domestic Violence and Substance Abuse: A Qualitative Study. (Articles)

Article excerpt

This study explored the philosophical issues hindering the linkage of substance abuse and domestic violence treatment. Results suggest that counselors tend to use treatment models that could not concurrently assign responsibility and address either present or past victimization.

The link between substance abuse and domestic violence has been extensively documented in the last decade (American Medical Association [AMA], 1992; Jacobson & Gottman, 1998; Lee, Gottheil, Sterling, Weinstein, & Serota, 1997; Leonard & Blane, 1992; Maiden, 1997; Rosenbaum & Majuro, 1990; Schafer & Fals-Stewart, 1997; Stith, Crossman, & Bischof, 1991; Warshaw, 1993). It has been estimated that at least 59% of men in inpatient detoxification units have behaved violently toward their partners (Lee & Weinstein, 1997; Stith et al., 1991). In addition, up to 70% of abused wives describe their husbands as alcohol dependent (Fagan, Stewart, & Hansen, 1983; Roy, 1982), and 75% of surveyed wives of alcoholics report being threatened with physical harm (AMA, 1992). Similarly, additional research found that 92% of arrested domestic violence assailants had used alcohol or other drugs on the day of the attack (Brookoff, O'Brien, Cook, Thompson, & Williams, 1997).

Despite the onslaught of information correlating the two problems, it must be noted that causality has not been clearly established. Although it may be possible that certain individuals do lose control of their hostile impulses when inebriated, other individuals may use drunkenness to justify an already planned attack or to excuse a prior assault (Jacobson & Gottman, 1998). Phil, Peterson, and Lau (1993) suggested that intoxicated individuals were not more aggressive because they were unaware of what they were doing but because knowledge of the potential consequences of their actions no longer served an inhibitory function.

To complicate the issue further, there is evidence that battered women are more likely than their peers who have not been battered to suffer from a chemical dependency (Blume, 1986; Kaufman-Kantor & Straus, 1989; Levy & Brekke, 1990; Miller & Downs, 1993). Again, the relationship between victimization and alcohol abuse has not been clearly delineated. It is possible that substance-dependent women align themselves with partners who drink heavily or that women in abusive situations seek escape by self-medicating with alcohol or other drugs (Gomberg & Nirenberg, 1991). In addition, substance-dependent women may stay with hostile partners who provide alcohol or drugs, or they may be battered, in part, because of social prejudice against female intemperance (Gomberg, 1993).

Although the co-occurrence of domestic violence and alcohol abuse is substantial, few counseling programs are equipped to address both issues simultaneously (Collins, Kroutil, Roland, & Moore-Gurrera, 1997). Collins et al. further argued that the traditional separation of alcohol abuse and domestic violence treatment facilities has generated deep philosophical differences, which impede the linkage of services. Although domestic violence workers may consider alcohol abuse to be a symptom of victimization or believe it is proffered as an excuse for battering, they may generally view chemical dependency as a secondary issue. Similarly, substance abuse counselors may be ill equipped to treat domestic violence (Collins et al., 1997) or they may regard battering as a manifestation of a primary addiction (Irons & Schneider, 1997).

Although the joining of domestic violence and alcohol abuse treatment services has been a historical rarity, there have been calls for increased efforts to link the services (Collins et al., 1997; Schlenger, Kroutil, & Roland, 1992; Schlenger, Kroutil, Roland, & Dennis, 1992). Although treatment is often focused on the management of one specific issue, troubled individuals typically suffer from multiple psychological problems (Collins et al. …