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Title: Getting Safe and Sober: Real Tools You Can Use


1
  • Getting Safe and Sober Real Tools You Can Use
  • Patricia J. Bland, M.A. CCDC
  •  
  •  
  •  

This project was supported by the Office of
Womens Health Region X Grant HHSP233200400566P
and by Grant s 2003-MU-BX-0029,
2004-MU-AX-0029 awarded by the Office on Violence
Against Women, U.S. Department of Justice. The
opinions, findings, conclusions and
recommendations expressed here are those of the
presenters and authors and do not necessarily
reflect the views of the Department of Justice,
Office on Violence Against Women or the Office of
Womens Health.
2
Introduction
  • The primary goal of this workshop is to help
    advocates, counselors and other professionals
    better address the safety and recovery needs of
    women impacted by DV and their own or anothers
    substance use, misuse or addiction
  • This workshop also provides participants with
    tools to better address service needs and options

3
Overview
  • Scope of CD/DV
  • Statistics
  • CD-Gender Issues

4
Safety or Sobriety What do we do first?
5
1 1 10 Tons of Trouble
  • Safety is strongly compromised when DV, substance
    abuse or chemical dependence co-occur
  • Together, severity of injuries and lethality
    rates climb for chemically dependent battered
    women (Dutton, 1992)
  • While these problems frequently co-occur, most
    research indicates neither causes the other
  • Individually, each can be chronic, progressive
    and lethal together they are especially dangerous

6
DV and Substance Abuse
  • Are different problems requiring different
    interventions
  • Denial serves different purposes
  • Victims fear for their safety or may be coerced
    into denying the truth / Batterers avoid
    accountability and may falsely blame their
    behavior on their partner, substance abuse or
    anger
  • Alcoholics/addicts fear they wont survive
    without using and deny to avoid pain

7
Domestic Violence and Chemical Dependency
  • Involve power and control dynamics
  • Impact entire families, often harming 3 or more
    generations
  • Thrive in silence and isolation
  • Carry great societal stigma and shame
  • Limit freedom for members of our community
    resulting in oppression

8
Scope of the Problem
  • A correlation between substance abuse and DV
    occurs in 44 to 80 of reported DV incidents
    depending on what research you cite (Mackey,
    1992)
  • Over 1/2 of reported DV cases involve drinking
    (Drug Strategies, 1998)
  • 1 study found in 94 of DV calls to police
    --assailant had used ETOH alone or ETOH
    w/cocaine, marijuana or other drugs w/in 6 hrs of
    assault
  • 92 of assailants and
  • 42 of victims had used alcohol or other drugs on
    the day of the assault (Brookhoff et al, 1997)

9
Statistics
  • 1 in 4 women will be assaulted by an intimate
    partner (US DHHS)
  • 74 of women in substance abuse treatment have
    experienced sexual abuse (Covington Kubbs, 2000)
  • _______________________________________________
  • Nearly 75 of wives of alcoholics have been
    threatened and 45 have been assaulted by their
    partners (AMA, 1994)
  • ________________________________________

10
DV and Substance Abuse
  • A NIDA study noted 90 of women in drug treatment
    had experienced severe DV from a partner during
    their lifetime (Miller, 1994)
  • Similar findings have been noted on monthly
    client service reports from the Alcohol/Drug Help
    Line Domestic Violence Outreach Project in
    Washington State (Bland, 2003)

11
Substance Abuse and DV
  • The Womens Action Alliance found 60-75 of women
    seeking shelter services over a 15 month period
    developed problems with their original coping
    mechanisms alcohol and drugs (Roth, 1991
  • A recent study of IL DV shelters reveals 42 of
    service recipients abuse alcohol or other drugs
    (Bennett Lawson, 1994).
  • 1 in 4 women in an IA shelter/safe home sample
    had a lifetime diagnosis of alcohol dependence
    and another 1 in 4 had alcohol or other drug
    problems (Downs, 2002).

12
Trauma and Gender Issues Domestic Violence and
Substance Abuse
13
Substance Abuse and Addiction are Womens Issues
  • According to the WSCWSAI, the physiological
    impact of substance abuse in women needs more
    attention
  • Women have higher blood alcohol levels than men
    after consuming equal amounts of alcohol
    (LaGrange, 1994 Lieber, 1993)
  • Women have a higher prevalence and greater
    severity of alcohol-related liver disease with
    shorter duration of alcohol use and lower
    consumption levels than men (Kubbs, 2000)
  • Women also have higher death rates from
    alcohol-related damage (CSAT, 1994)
  • In AK, FASD is highly correlated with DV

14
Prescription for Trouble
  • Women are likely to use prescription medication
    much more often than men
  • 70 of prescriptions for tranquilizers,
    sedatives and stimulants are written for women
    (Roth, 1991)
  • And psychotropic medication is over-prescribed
    for battered women (Minnesota Coalition for
    Battered Women, 1992)

15
Important Gender Differences in Substance Use,
Abuse and Dependence (Sharon Ametetti, MPH, CSAT)
  • Women often initiate use as result of traumatic
    life event, such as past physical or sexual abuse
    (Ashley et al., 2003 Weiss et al., 2003)
  • Women are often drawn into use by partners
    (Ashley et al., 2003)
  • Women use for different reasons for example,
    young women use to improve mood, increase
    confidence, lose inhibitions, enhance sex or lose
    weight, while young men use for sensation seeking
    or to enhance social status (Weiss et al., 2003
    National Center on Addiction and Substance Abuse,
    2003)

16
Women Experience More Serious Health Problems
  • Greater proportion of female alcoholics die from
    suicides, alcohol-related accidents, circulatory
    disorders, and liver cirrhosis (Smith Weisner,
    2000)
  • Drug abuse is nearly twice as likely to be
    directly or indirectly associated with AIDS in
    women than in men (Weiss et al., 2003)
  • Alcohol and other drug use is major risk factor
    for coronary heart disease and various forms of
    cancer (Harwood et al., 1999)

17
Other Factors Substance Use and Infectious
Diseases
  • Women with SUDs are more likely to have high-risk
    and multiple sex partners (U.S. DHHS, 1999)
  • Women with SUDs are at increased risk for HIV,
    TB, Hepatitis and other STDs (Francis Cargill,
    2001)
  • 35 of women living with AIDS in 2003 were
    exposed via injection drug use (HRSA, 2005)

18
Barriers to Accessing, Entering and Remaining in
Treatment
  • Lack of gender-specific, family-focused services
  • Caregiver responsibilities fear losing children
  • Social stigma and guilt
  • Fewer economic resources
  • Domestic Violence

19
Relapse Prevention Needs (Sharon Ametetti, MPH,
CSAT)
  • Importance of social supports and networks
    (National Womens Health Information Center,
    1999 Walton et al., 2001)
  • Depression and negative feelings are more common
    triggers among women (vs. anxiety and positive
    feelings among men) (Stocker, 1998)
  • Need to address violence/abuse issues while in
    treatment to help prevent relapse (Finkelstein et
    al., 2004 Fullilove et al., 1993 )

20
Substance Abuse and Violence/Trauma
  • In one study, 104 of 105 women drug users
    experienced physical/sexual abuse trauma
    (Fulilove et al,1993)
  • 59 reported PTSD symptoms including
  • Sleep Disturbances
  • Anxiety
  • Hypervigilance
  • Numbing of responsiveness

21
Substance Abuse and Violence/Trauma (Sharon
Ametetti, MPH, CSAT)
  • Physical and sexual abuse among women in
    substance abuse treatment programs ranges from
    30 to more than 90 (Finkelstein et al., 2004)
  • Illicit drug use rates among women in violent
    relationships are 2-3 times those of women in
    general population (Cunradi, 2000)
  • In one recent study, 59 of women with drinking
    problems experienced past year severe intimate
    partner violence (vs. 13 with no drinking
    problem) (Weinsheimer et al, 2005)

22
Working with Women Affected by DV and Substance
Abuse Issues
  • Screening and Identification
  • Barriers to Safety and Sobriety
  • Model Protocols
  • Real Tools

23
Each woman will tell you what she wants…
  • When I was using, I didn't have the ability to
    reach out for help, nor did I feel I needed it.
    Not using made me feel again, and when I felt
    again, I knew I needed help, because the pain was
    there. And that's when I reached out (for help
    with the violence). If I would continue using, I
    would never have reached out.
  • Once I walked away from that abuse (violence), I
    knew the next thing I had to do was do something
    about the substance abuse. And then, when I made
    up my mind that I wanted to quit the drugs also,
    the advocates at the shelter were right there for
    me, and got me into a treatment program.

24
  • I don't think I could deal with one issue alone.
    It was critical that I deal with the domestic
    violence, to get away from it, because it was
    just getting worse and worse. But I couldn't deal
    with the domestic violence if I was still getting
    all drugged up.
  • You've got to be sober, at least a little bit,
    to be able to even look at the domestic violence.
    But if you get sober, and you don't look at those
    issues, you're not going to stay sober, not in
    the long run.
  • I couldn't recover from substance abuse if I was
    still being physically abused, mentally abused,
    because I would be right back to using. So they
    walk hand in hand. I would not recover from one
    unless I address the other, and vice versa.

25
Working with Women Impacted by Co-Occurring
Problems
  • A successful culturally competent intervention
    incorporates
  • Awareness of ones own biases, prejudices and
    knowledge about the people we serve and their
    culture
  • Recognition of professional power (power
    differential between you and the shelter or
    treatment program participant) in order to avoid
    imposing ones own values on others
  • There is no typical substance abuser or
    victim, provide universal screening

26
Discussing DV and Substance Abuse
  • DV and Substance abuse or other issues impacting
    safety and sobriety may be easily missed if we
    dont ask about these concerns in a
    non-threatening manner
  • Women may find it easier to talk about stress in
    their relationships or their partners substance
    use before talking about DV, sexual assault or
    their own substance use
  • They may also be willing to discuss concerns
    about their children if we are not perceived as
    judgmental

27
Discussing DV and Substance Abuse
  • Conversations must be respectful, private and
    confidential
  • Children should not be present
  • Communication should be age and developmentally
    appropriate as well as culturally relevant
  • Use an interpreter when necessary
  • Normalize questions find a way to discuss safety
    and sobriety issues that is comfortable for both
    of you
  • Note Substance use in and of itself does not
    require a mandatory CPS report unless there are
    other factors (e.g. drinking and drunkenness are
    not crimes being drunk and having a designated
    driver is not a crime, drunk driving is a crime,
    drunk driving with a child in the car is
    reportable) DV against an adult generally does
    not require mandatory reporting.

28
Sample Screening Questions for DV
  • How safe you feel in your daily living gives us
    important information about you and your safety.
    Please answer these questions as well as you can.
  • Do you feel safe? In your personal relationship?
    Within your home? In your own neighborhood?
    Other?

29
More Sample Screening Questions
  • Have you ever had your feelings repeatedly hurt,
    been repeatedly put down, or experienced other
    kinds of hurting?
  • Are you being, or have you ever been, hit,
    slapped, kicked, pushed or otherwise physically
    hurt? If yes, by whom?

30
Screening Questions Continued
  • Are you experiencing, or have you ever
    experienced uncomfortable touching or forced
    sexual contact? If yes, by whom?
  • Husband Multiple persons
  • Ex-husband Stranger
  • Partner Other (specify)_______

31
ASK - Sample Screening Questions
  • Women often report feeling stress in their
    relationship
  • How does your partner show disapproval?
  • When was the last time you felt threatened by
    your partner?
  • How often do you feel scared or hurt by your
    partner?
  • Remember to ask direct questions tactfully and
    respectfully!

32
ASK - Sample Framing Statement
  • Domestic Violence and sexual assault are major
    problems for women. Because abuse is such a
    common experience for women, I ask everyone I see
    whether they feel safe at home.
  • Women in treatment often tell me their partners
    complain about their using. How does your
    partner show disapproval?

33
ASK - Sample Direct Questions
  • Do you feel controlled or isolated by your
    partner?
  • Is your partner jealous?
  • Has your partner complained about your weight?
  • Has your partner sabotaged your recovery?

34
ASK - Sample Indirect Questions
  • You mentioned your partner loses his temper with
    the kids. Can you tell me more about that? Have
    you ever felt afraid for yourself or your
    children -- can you tell me more about that?
  • All couples argue sometimes. Does your partners
    behavior ever frighten you?

35
Sample Screening Question if Partner is User or
Abuser
  • Many women tell me their partners dont want to
    drink/drug/smoke alone. How often do you find
    yourself using when you dont really want to?
  • When a partner spends family money on drug use,
    that is a form of economic abuse. Has your
    partner ever used food or rent money to drink or
    score drugs?

36
Sample Framing Questions for Substance Abuse
  • Women I see often tell me they feel stress.
    There are several ways to deal with stress. What
    works best for you?
  • Many women tell me they try to sleep more, eat
    better or shop for baby things. Have you tried
    any of those ways of coping?
  • Many women also tell me the best way to cope is
    to smoke a cigarette, have a drink or take
    something else. How often has that worked for
    you? Do you find it is still working?

37
Sample Framing Questions for Substance Abuse
  • Being involved in a custody dispute can be
    stressful. Your partner may attempt to undermine
    your parenting skills. Can you identify any
    reasons why drinking or using drugs right now
    could be harmful to your case? Can you share with
    me what your partner might say about your
    drinking or drug use?

38
CAGE-D
  • Have you ever felt you ought to cut down or stop
    using drugs?
  • Has anyone annoyed you or gotten on your nerves
    by telling you to cut down or stop drinking or
    using drugs?
  • Have you felt guilty or bad about how much you
    drink or use?
  • Have you been waking up wanting to have an
    alcoholic drink or use drugs?

39
CAGE-DV
  • Have you ever felt Controlled or threatened by
    your partner?
  • Has anyone Annoyed you or gotten on your nerves
    by expressing concern about your partners
    behavior towards you?
  • Have you felt Guilty or bad about how your
    partner treats you?
  • How often do you wake up anxious, afraid or
    wanting to Escape your partner?

40
4 Ps
  • Have you ever used drugs or alcohol during
    Pregnancy?
  • Have you had a problem with drugs or alcohol in
    the Past?
  • Does your Partner have a problem with drugs or
    alcohol?
  • Do you consider one of your Parents to be an
    addict or alcoholic?

41
4 Ps DV
  • Have you ever been hit or hurt by your partner
    during Pregnancy?
  • Has your (current or former) partner been violent
    or abusive in the Past?
  • Does your (current or former) Partner have a
    problem with anger, violence or abuse now?
  • Do you consider one of your Parents to be violent
    or abusive?

42
What do I do if she says, Yes?
  • Offer alternatives
  • Explore safety, legal, shelter and other options
  • Include as recovery options gender specific
    treatment, support groups addressing multiple
    problems, safety planning, linkage to advocate or
    shelter
  • Discuss options for children such as Alateen,
    Alatot, ADHL Teen Line and other counseling
    options
  • Discuss financial issues, insurance, etc.
  • But before you do any of this….

43
ABCs of Advocacy Based Counseling
  • Acknowledge harm has been done and say this is
    not your fault. Your childrens safety is
    important and so is your safety
  • Believe addiction and domestic violence are
    traumatic, painful and unsafe
  • Believe people do their best to survive
  • Credit each individual for finding a way to cope
    and offer options to make coping and surviving
    safer

44
Avoid Revictimizing
  • People do not choose to develop the
  • disease of addiction any more than they
  • pick out batterers
  • Think before speaking...how would you
  • like to be spoken to?
  • Remember to offer respect, not rescue options,
    not orders, safe treatment rather than
    revictimization

45
Validate
  • You did not deserve this and neither do your
    children
  • Im so glad you found a way to survive. Drinking
    or drugging can kill pain for a while but there
    are safer ways of coping that can cause you less
    grief
  • You deserve a lot of credit for finding the
    strength to talk about this
  • Addressing the drinking/DV may help you get
    safer/sober your health and safety can improve
    your childrens safety and well-being, too

46
Acknowledge Successes Identify Options
  • You are here to day and you are doing quite a bit
    right. What have you done to keep safe/sober up
    until now? What have you been able to do to care
    for yourself and the welfare of your children?
  • What has worked well for you and the children
    what has given you problems?
  • Many people tell me they have tried_________.
    How often has this worked for you?

47
ACKNOWLEDGE - You Hear
  • Make person comfortable as possible assure
    confidentiality of records when applicable
  • Affirm autonomy and right to control
    decision-making, validate concerns and use
    supportive statements
  • Im sorry this happened its not your fault
  • Right now you may be feeling stress but there
    may be some safer coping tools you might like to
    consider
  • Give yourself credit. Youve been doing your
    best in these circumstances

48
Express Concern
  • Express concern about risks for both the
    individual and any children
  • Assume the attitude that she is doing the best
    she can and wants what is best for herself and
    her children
  • Provide objective information about legal and
    health consequences of DV and specific substances
  • Affirm her choices and explain benefits of safety
    planning/ stopping use for both her and her
    children
  • Offer options and support

49
Be Positive
  • Emphasize the benefits of
  • A.) Reducing or stopping use as soon as possible
  • B.) Developing a safety plan
  • If woman is pregnant, convey message that
  • A.) Any substance use is not safe during
    pregnancy and lactation
  • B.) DV Homicide is leading cause of injury death
    for pregnant women
  • Explore options
  • Explain any legal ramifications
  • Tailor resources to meet her needs

50
ASSESS - Safety of Children
  • Children often blame themselves for DV or a
    parents substance use.
  • Have your children ever tried to stop it? How
    does your child cope?
  • Sometimes children get hurt too.
  • What concerns do you have for your childs
    safety?
  • Does your partner use the kids to monitor your
    drinking?
  • Is your child afraid to leave you alone?
  • How often does you partner force you or the kids
    to ride in a vehicle after there has been
    drinking going on?

51
Safety Planning for Children
  • Leaving or hiding if there is fighting, heavy
    drinking/drugging
  • Telephone a friend, the Alcohol Drug Help Line,
    or 911 in an emergency (e.g. battering episode or
    parent passed out)
  • Run to get someone such as a friend, neighbor or
    an older sibling for help
  • If the children do not know who to go to to get
    help, work with them to identify specific
    individuals and agencies who can assist and how
    to contact them (Source Alaska Family Violence
    Prevention Project, 1998)

52
Messages for Children
  • Its not the childs fault
  • Each of us are responsible for our own behavior
  • Feelings need not lead to substance abuse or
    violence
  • Source Pediatric Family Violence Awareness
    Project, 1996

53
Escaping Chemical Dependency
  • Survivors of both abuse and addiction can find
    safety and recovery options
  • People escape both abusers and addiction when it
    is safe to do so
  • Offer supportive options for those seeking safety
    and sobriety

54
Service Barriers and Safety Issues
55
Challenges
  • Our challenge as advocates and counselors is to
    provide an environment to support both safety and
    sobriety

56
Some Survival Skills Work for a While but may
Lead to More Troubles
  • Being devious to survive, lying to the abuser and
    others
  • Encouraging an abuser to drink until the pass out
    point so no one gets hurt
  • Reasoning with abusers, expressing disapproval
  • Lying about abusers criminal behavior
  • Trying to improve the relationship
  • Creating internal space through fantasy that
    abuser cant touch
  • Having sex to placate abuser and protect children
    from violence
  • Drinking and using drugs to numb pain (Ganley and
    Schector, 1996)

57
The Wrong Questions
  • Why doesnt she just leave?
  • Why doesnt she just quit using?
  • Why doesnt she just pull herself together?

58
Safety Concerns
  • Acute and chronic effects of alcohol and other
    drug use may prevent one from accurately
    assessing levels of danger
  • Under the influence, one may feel an increased
    sense of power and erroneously believe
    self-defense against physical assaults is
    possible, not realizing the impact of substances
    on gross motor functioning and reflexes
  • Substance use and misuse can impair judgment and
    thought processes (including memory) making
    safety planning more difficult
  • Alcohol and other drug use may be encouraged or
    forced by an abusive partner or perpetrator as a
    mechanism of control (Bland, 1997 Illinois Dept.
    of Human Services, 2000)

59
More Safety Concerns
  • Abstinence and recovery efforts may be sabotaged
    (For example, someone receiving methadone on a
    daily basis could easily be stalked )
  • There may be reluctance to seek assistance or
    contact police for fear of arrest, deportation or
    referral to CPS
  • Compulsion to use and withdrawal symptoms may
  • make it even more difficult for
    substance-abusing or addicted individuals
    impacted by DVSA to keep scheduled appointments
    for advocacy or access shelter or other services
  • Recovering women may find the stress of securing
    safety leads to relapse
  • If using now or in the past, a person may not be
    believed (Bland, 1997 Illinois Dept. of Human
    Services, 2000)

60
Abusers Pose Risk to Partners
  • Introducing partner to drugs
  • Forcing or coercing partner to use (e.g.dirty
    needles, cottons, noxious substances)
  • Isolating partner from recovery and other helping
    resources
  • Coercing partner to engage in illegal acts (e.g
    dealing, stealing, prostitution)
  • Sabotaging recovery efforts
  • Using drug history as threat (deportation,
    arrest, CPS, custody, job, etc.)
  • Blaming abuse on partner use and benefiting from
  • Lack of services for chemically dependent
    battered women
  • Societal beliefs re women, addiction and
    parenting

61
(No Transcript)
62
Separation Violence
  • 65 - homicide victims physically separated
    from abusers prior to death
  • Over 17 - DV homicide victims had protection
    orders against abusers at the time of killing
  • (FL Mortality Review, 1997)
  • Up to 75 DV assaults reported to police are
    made after separation (US Dept. of Justice, 1995)
  • One of every 12 women is stalked at some point
    in life
  • 59 - DV victims are stalked by intimate
    partners (National Institute of Justice and CDC,
    1998)

63
WA State Fatality Review Project
  • 40 of cases woman was trying to leave or had
    left
  • 16 of cases woman had a protection order
  • 90 of the homicides were committed by a male
    abuser
  • 20 involved murder suicide
  • 42 involved guns
  • 60 of victims were female intimate partners of
    murderer
  • 16 children of an abused woman
  • 16 friends and family of abused woman
  • 1 police officer lost his life (WSCADV Fatality
    Review Project 2/1/00)
  • Note In 2001a police officer lost his life in
    Alaska due to DV

64
Barriers to Services
  • Battered women, with substance abuse or addiction
    issues typically experience barriers to services
    and discrimination
  • Employment, housing, health insurance or child
    custody may be threatened by public disclosure of
    current or past substance abuse problems
  • Access treatment due to parenting
    responsibilities or shelter because of the
    substance abuse issues may be denied
  • Societal attitudes tend to view addiction and DV
    as moral failings (instead of as public health
    issue)
  • This can lead to isolation, blame and shame
  • And is compounded when a woman is battered,
    substance abusing and a mom

65
Reducing Service Barriers to Provide Safety
  • Battered women impacted by chemical dependence
    are often ill-served in our programs.
  • They may be perceived as disruptive or not
    serious when their substance use becomes evident
    in shelter or their abusers behavior becomes an
    unmanageable factor in treatment
  • They face tremendous stigma and are often
    considered bad mothers, bad people, bad victims
    and resistant to treatment
  • They often need our services the most and yet are
    among those who are least likely to seek or
    receive services
  • When they do not receive services their children
    also remain invisible and at risk

66
Bidermans Chart of Coercion
  • Isolation
  • Humiliation
  • Enforcement of Trivial Demands
  • Omnipotence
  • Intermittent Re-enforcement

67
Forging Partnerships
Integrated Stages of Social Change
  • Screening for Substance Abuse and Mental Health
    Issues
  • Information and Education
  • Advocacy based counseling, consider link with
    counselor
  • 1-1 and Group
  • Practical non-judgmental options and support
  • Referral and Linkage
  • Safety linked with sobriety and wellness
  • Social Change Model
  • Screening for Intimate Partner Violence
  • Information and Education
  • Solution Based Counseling, consider link with
    advocate
  • 1-1 and Group
  • Practical non-judgmental options and support
  • Referral and Linkage
  • Sobriety and wellness linked with safety
  • Social Change Model

68
B.A.D.A.S.S. is now our WIRC
69
Re-Cap How can we help women dealing with DV
and Substance Abuse?
  • Listen
  • Advocacy and treatment may look different
  • Shelter Provide structure, consistency
  • Treatment Provide flexibility, options
  • Ensure unconditional positive regard is provided
    by someone recommend options
  • Shelter 12 step programs, treatment options,
    other support systems, sobriety planning for
    safety
  • Treatment DV support groups, shelter options,
    legal advocacy, safety planning for sobriety
  • Provide positive messages
  • Know and partner with local treatment and victim
    service resources

70
Support Group Format and Topics
71
Confidentiality
  • First names only
  • Limited notes (can be subpoenaed)
  • Document topic covered and attendance only
  • Require signed release of information to disclose
    above information
  • Advise group participants about what you are
    mandated to report e.g. CPS/APS issues, suicide
    threats etc.
  • Some group members dont want to be greeted or
    acknowledged outside of group due to safety
    constraints. Be sure to address this with the
    group. Some groups come up with a code.

72


Have Easy Access to Group - Dont Create Barriers
  • There is no right way to do this…be open
  • Prioritize child care
  • Have food, de-caffeinated coffee and tea
  • Assist with transportation
  • Dont screen out…Prepare for arrival!
  • Have enough staff or volunteers available to deal
    with unexpected issues (2)
  • Have women create their own resource book of
    referrals

73
General Tips
  • Co-facilitate
  • If possible one advocate, one chemical dependency
    counselor (the more the merrier, embrace
    diversity)
  • Be flexible
  • Think kitchen-table, have topic but be willing to
    change. The women own the group.
  • Leave time for women to address practical issues
    such as housing, legal or childrens issues
  • Yes, they can use the copy machine, telephone,
    fax etc.

74
Things to Keep in Mind
  • You may only see a group member once or you may
    have the member for 3 or more years…be solution
    based and friendly
  • Make the most of your interaction because it may
    be the only one you get.
  • For our drop in groups the average member comes
    about 12 times all are welcome to return
  • Stage 2 groups are groups led by the women
    themselves and are good options for long term
    group members

75
General Goals
  • Safety and Sobriety
  • Note Safety requires more than a physical space
    away from an abuser and sobriety is not merely
    abstinence
  • Safe place to tell story without judgment and to
    be believed
  • Opportunity for connection
  • Note Foster notion of recovery partners. Does
    she have or has she had in the past a sponsor,
    mentor? Encourage women to support each other,
    develop phone lists etc. when safe to do so

76
Adjust Group Guidelines and Topics Depending on
Setting
  • Battered Women Shelter or THP
  • Community Based DV Program
  • In-patient CD Treatment Facility
  • Out-patient CD Treatment Facility
  • Self Help Group
  • Elsewhere

77
Overall Format For Groups
  • Check In
  • Identification of Problems, Challenges or Goals
    and Resources
  • Educational Component
  • Closure

78
Check In
  • Begin group with discussion of confidentiality
    and group guidelines for safety and sobriety
  • Open the session by asking each group member to
    briefly state one thing she did right, or was
    proud of achieving during the previous week.

79
Identification of Problems, Challenges, Goals
and Resources
  • Ask participants if anyone is facing a special
    challenge, or has a particular goal shed like to
    achieve.
  • Identify resources currently utilized by group
    members
  • Develop additional options to resolve problems,
    meet challenges and achieve goals.

80
Educational Component
  • Use a portion of the session to educate
    participants aspects of IPV or substance abuse.
  • Topics may include power and control dynamics,
    safety issues, sobriety issues, childrens
    issues, healthy boundaries, coping skills, etc.

81
Closure
  • Close by asking each person to name one thing she
    can do to keep safe and sober for the coming
    week.
  • Include an evaluation component

82
Sample Topics For Educational Component
83
Topics and Handouts
  • Each of these topics can stand alone
  • Topics may be used in any order
  • These are examples only! Nothing here is carved
    in stone feel free to be creative with these
    topics and come up with some of your own.

84
1- The Relationship between Substance Abuse and
Violence
  • Discuss relationship between substance use and
    DV. Does substance abuse cause violence? Will
    treatment stop it?
  • Are victims who abuse substances asking for
    trouble? Does abuse cause development of AOD
    problems?
  • Discuss tools to address both problems.

85
1- Handouts
  • Woman Abuse, Substance Abuse What is the
    Relationship?
  • Survivors of Chemical Dependence, Domestic
    Violence and Sexual Assault

86
2- Naming the Problem
  • Discuss definitions of DV, sexual assault/sexual
    abuse, and substance abuse.
  • Encourage women to discuss signs or indicators
    theyve experienced.

87
2 - Handouts
  • Naming the Problem
  • Manifestations of Violence

88
Definitions
  • Domestic Violence is a pattern of assaultive and
    coercive behaviors, including physical, sexual
    and psychological attacks, as well as economic
    coercion, that adults or adolescents use against
    their intimate partners to gain or maintain power
    and control.
  • (Ann Ganley, Ph.D, 1998)

89
Definitions
  • Substance Abuse - a destructive pattern of drug
    use including ETOH which leads to clinically
    significant impairment or distress. Often the
    substance abuse continues despite significant
    life problems (Definitions developed by APA
    ASAM adapted by DV/SA Task Force of IL DHS,
    7/2000)
  • When a person exhibits tolerance and withdrawal
    the person has progressed from abuse to Addiction

90
  • Addiction
  • Tolerance
  • Loss of Control
  • Continued use despite adverse consequences
  • Withdrawal Symptoms
  • (Has altered brain chemistry, which leads to
    stress, craving, denial and relapse potential)

91
Chemical Dependence - Addiction
  • Addiction - is characterized by continuous or
    periodic impaired control over drinking alcohol
    or using other drugs, preoccupation with use, use
    despite adverse consequences and distortions in
    thinking, (e.g. denial)
  • The neurochemical function dysfunction in
    addiction is best described as a chemical
    deficiency in pathways of the brain

92
Tolerance and Withdrawal
  • Tolerance - the need for significantly larger
    amounts of substance to achieve intoxication
  • Withdrawal - adverse reaction after a reduction
    of substance

93
The Liver
94
Distortions in Perception Defined
  • Euphoric recall - memories formed under the
    influence (Johnson, 1980)
  • May be used as inappropriate excuse to minimize,
    rationalize or deny behavior
  • Blackout - an amnesia like period often
    associated with heavy drinking
  • While blackouts impact memory, there is no
    evidence to support contention that blackouts
    alter judgement or behavior at the time of
    occurrence (Kinney Leaton, 1991)

95
Reward System of the Brain
96
3 - Overlapping Elements of Abuse and
Addiction
  • Help participants identify overlapping elements
    of DV/CD
  • Review patterns of DV and signs/symptoms of CD
  • Explore coercion and compulsion
  • Help develop tools to address accountability and
    avoid self-blame
  • Discuss other issues impacting safety and
    sobriety (e.g. mental health issues, poverty and
    oppression).

97
3 - Handouts
  • Merry-Go-Round of Addiction
  • Merry-Go Round of Violence
  • 1 1 10 Tons of Trouble
  • Other Issues What Else Impacts Safety and
    Sobriety?
  • Power and Control Wheel for Womens Substance
    Abuse

98
Merry-Go-Round of Addiction
99
Merry-Go-Round of Violence
100
4 - Getting Help
  • Discuss services offered by DV/sexual assault
    programs, substance abuse treatment providers and
    support groups
  • Offer resources and referrals
  • Ask participants to share helpful
    information/resources

101
4 - Handouts
  • Getting Help
  • Note You may also wish to provide brochures and
    meeting schedules from agencies/support groups in
    your community

102
5 - Sorting Out Messages
  • Women receiving services may hear conflicting
    messages posing risks to safety in treatment and
    to sobriety in DV programs.
  • Discuss ways to overcome risks and reconcile
    conflicting philosophies.
  • Promote understanding that substance abuse and
    violence are different problems requiring
    different approaches.

103
5 - Handouts
  • Sorting Out Messages
  • Safety and Sobriety Risk Factors in Traditional
    Advocacy and Treatment Programs

104
6 - Using Support Groups
  • Discuss benefits of support groups, and ways for
    women to feel more comfortable using them.
  • Safety Tips women may need to do the same
    safety planning they use when going to work,
    visiting relatives or using public transportation
    to feel safe in group.
  • Boundary Issues - women may want reassurance they
    have the right to protect their boundaries in
    group.

105
6 - Handouts
  • Safety at Support Group Meetings
  • Etiquette in Groups

106
7 - Using the 12 Steps
  • Discuss 12 Step concepts
  • Identify concept strengths and challenges for
    survivors of DV and sexual abuse
  • Know resources in your community for 12 Step
    groups plus alternatives such as New Beginnings,
    Women For Sobriety or 16 Step Empowerment Groups,

107
7 - Handouts
  • Using 12 Step Groups
  • Alternative Support Groups

108
8 - Safety and Sobriety Planning
  • For women with co-occurring issues of substance
    abuse and IPV both safety and sobriety must be
    priorities.
  • Review impact of safety on sobriety and sobriety
    on safety.
  • Discuss how participants can make relapse
    prevention part of their safety plan, and safety
    part of their relapse prevention plan.

109
8 - Handouts
  • Safety Plan
  • Mini-Safety/Sobriety Plan

110
Mini-Safety/Sobriety/Wellness Plan
  • Strategize Steps to reduce risk/use/harm
  • Develop Options to keep safe/sober/well
  • Identify Trusted allies/safe sponsors/supports
  • Plan Means to escape abuser/drugs/harm
  • Discuss Referral resources
  • Avoid Danger/persons, places,things/isolation
  • Tools HALT/One day at a time/medication
  • Caution Written materials, referrals can place
    DV victims in danger

111
9 - Childrens Issues
  • Children may not talk about problems they witness
    in the home, so it can be tempting to think they
    are not affected by whats going on.
  • Help participants recognize impact of both
    substance abuse and violence on their children.
  • Discuss strategies to create a more positive
    environment for children.

112
9 - Handouts
  • Children Exposed to DV
  • and Substance Abuse
  • Children Coping With Family
    Violence

113
9 - Childrens Issues
  • Safety Planning Interventions For Children

114
10- Power Control Dynamics
  • Use Power and Control Wheels to illustrate
    various ways power is used and abused in our
    society and in our personal relationships to
    dominate and control others.
  • Discuss what equality and respect would look
    like, both in our personal relationships and the
    larger society.

115
10 Handouts Power and Control Wheels
  • Original wheel and modified versions
  • Model For Womens Substance Abuse
  • Lesbian/Gay
  • Violence Against Native Women Battering
  • Immigrant
  • Children Coping With Family Violence
  • Three Circles
  • Equality Wheel
  • Natural Life-Supporting
  • Community Accountability

116
11 - Creating Change
  • Working for change, providing service to others
    or carrying the recovery message can foster
    empowerment and healing.
  • Discuss simple things participants might do to
    make a difference in society.
  • Choose a group activity (such as making T-shirts
    for the Clothesline Project) to engage
    participants in the art of making a difference.

117
11 - Handouts
  • Personal Change, Social Change
  • Can One Person Make a Difference?

118
12 - Sharing Personal Experience, Strength and
Hope
  • Provide venues for women to tell their story, be
    believed and have opportunity connect with
    others.

119
12 - Handouts
  • Women Talk About Substance Abuse and Violence

120
Conclusion
121
Resources
  • Safety and Sobriety, Best Practices in Domestic
    Violence and Substance Abuse, DV/SA
    Interdisciplinary Task Force, IL DHS
  • Getting Safe and Sober, Real Tools You Can Use by
    Debi Edmund and Patti Bland for the Alaska
    Network on DV/SA

122
  They were right there for
me They were right there for me
 
  • Somebody wanted to show me support, listen to
    me, not yell at me, not scream at me, just look
    at some options instead of that. Through them
    showing love to me, I began to love myself. I
    didn't deserve the punishment for all that had
    happened in my life. The continuous bad
    relationships, continuous abusing the drugs, and
    shame and the guilt I felt from all that. I
    deserved better. It was also OK to heal from all
    that.

123
Community Partners
  • Battered womens advocates are your local experts
  • Refer women to your local DV program!
  • Domestic Violence Hotline 1-800-562-6025 v/TTY
  • (WA only)
  • CDPs and MHPs are your local experts
  • Refer women to your local Chemical Dependency or
    Mental Health programs!
  • Alcohol Drug Help Line 1-800-562-1240 (WA and AK
    only)
  • Crisis Clinic
  • 1-800-244-5767 (King County only)

124
Coordinated Community Response
  • East Side Domestic Violence - My Friends Place,
    Bellevue, WA
  • 425-562-8840
  • SISTR Program, Dillingham, AK
  • 907-842-2320
  • Ginger Baim and EJ Essic
  • New Beginnings Seattle, WA
  • 206-522-9472
  • Cindy Obtinario
  • Alaska Network on DV and Sexual Assault
  • pbland.andvsa_at_alaska.com
  • 907-586-3650 ext 34
  • Patti Bland
  • Alcohol Drug Help Line DV/CD Intervention
    Project, King Co. WA
  • 1-800-562-1240 (WA and AK only) or 206-722-3700
  • Joan Norton or Gerry Coughlin
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