What do Batterers say about Substance Abuse What do they do

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What do Batterers say about Substance Abuse?
What do they do?

• Elizabeth C./ McCord, MS, M.D.
• Evelyn Kemp, RN, Psy.D.
• Michael Floyd, Ed.D.
• Kimberly Drage, M.A.
• Department of Family Medicine
• East Tennessee State University

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Special Thanks

• Ryan Outman, MS
• Debi Pfortmiller, MS
• This work was supported in part by grants from
  the Bureau of Health Professions Health Resources
  Administration, awarded toEast Tennessee State
  UniversityJames H. Quillen College of
  MedicineDepartment of Family Medicine Grant
  No. 1 D12 HP 00130 01 Grant No. 1 D 16 HP00145
  01.

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Introduction Definition

• Intimate partner violence is a pattern of
  physical or sexual abuse perpetrated by one
  spouse or intimate partner upon the other

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Introduction Annual Impact of IPV in USA

• 4.8 million female victims
• 2.9 male victims
• 1,830 homicides
• Cost 5.8 billion

• Women
• Outpatients 8-28
• 40 in Johnson City
• ED 10-35 women
• 50 women psych inpatients
• Men
• Victims have similar health problems

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Introduction Substance Abuse is Strongly
Correlated with IPV

• Alcohol most common substance correlated
• Alcohol a factor in over half of all IPV
  incidents (US Department of HHS 93)
• Greater alcohol, greater abuse
• Chronic alcohol abuse stronger predictor than
  acute ( Leonard et al, Haslett, et al)
• gt 2 drinks/ day average when drinking IPV risk
  (Oriel and Fleming)

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Introduction Substance Abuse is Strongly
Correlated with IPV

• Partners Substance Abuse most highly correlated
  with victims injury risk (3.6 relative risk)
  (Kyriaku et al)
• Individual drinks with the intent of becoming
  violent (Kaufman et al 84)
• Alcohol consumption linearly related to level of
  violence (Sugarman et al)

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Introduction Substance Abuse is Strongly
Correlated with IPV

• Alcohol role a complex feedback system men may
  ingest to give excuse for violent behavior
  (Gelles)

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Introduction Study Objectives

• To begin to determine effective communication
  strategies to identify IPV in men.
• To begin to identify the health correlates of
  battering.
• To determine the level of substance abuse
  co-morbidity with IPV in batterers in our area.

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Methodology Design

• Phase 1 -- Focus Group methodology using open
  ended questions about communicating about IPV in
  health settings
• Previous disclosure experiences
• Clues to IPV for physicians
• Experiences with physicians since IPV
• How should physicians ask
• Most important to say, do, what to avoid, most
  helpful, worst thing said or did, physician
  gender
• Consequences if partner disclosed
• Safety issues
• Effective interventions

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Methodology Design

• Phase 2 -- Focus Group methodology using directed
  questions about potential IPV screening
  strategies
• Evaluation of mens IPV scenario and detection
  strategies
• Formal Assessment of Substance Abuse using the
  Substance Abuse Subtle Screening Instrument
  (SASSI)

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Methodology
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Results Response Rate
Continuous participants are included in the
figures for Phase 1 and Phase 2. To calculate
the total participation rate, continuous
participants must be subtracted from the sum of
Phase 1 and Phase 2.
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Study Participation Rates (Site Comparison)
Continuous participants are included in the
figures for Phase 1 and Phase 2. To calculate
the total participation rate, continuous
participants must be subtracted from the sum of
Phase 1 and Phase 2.
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Results Marital Status of Participants
N118 Due to Missing Data
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Results Number of Children
N118 Due to Missing Data
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Results Experiences with violence as child or
adult
49.6 reported at least one child experience with
violence
46.9 reported at least one adult victim
experience
26.1 reported at least one adult perpetrator
experience
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Results Number of court-ordered programs
N69Due to Missing Data
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Results Ethnic Background
N118 Due to Missing Data
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Results Income
N111 Due to Missing Data
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Qualitative Results Substance Abuse emerged in
every group

• No focus group question or prompts on SA Every
  focus group mentioned substances
• Alcohol 7/8 groupsgt 6x in 3/8
• Illicit drugs 6/8 groups
• Alcohol emerged as a topic in 4/7 groups in
  response to disclosure questions.

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Alcohol Response to Disclosure

• You know, they wanted me to stop drinking and
  you know hanging out with my old friends that I
  used to hang out with but Id go out and drink
  with them and just mess up my relationship and
  thats what got me here.

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Qualitative Results Personal Substance Abuse

• Self reported substance abuse in 6/8 groups
• Alcohol 5/8
• Illicit drugs 4/8
• Addiction 3/8
• Partners SA (alcohol) in 3/8 groups

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Qualitative Results Personal SA

• Im just the kind of person I love the effects
  of it alcohol. But I cant deal with the
  consequences of it. So Ive had to realize I
  cant drink one without drinking another one,
  etc.
• Ive been running this gauntlet for 22-23 years
  drunk. It was easy to take care of my problems,
  drink and go to bed and not worry about it until
  tomorrow. Now you got to do this sober.
• I mean thats just me being a recovering
  alcoholic

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Qualitative Results Personal SA

• We was married for 7 years and the first two
  years I got strung out on cocaine and went to
  rehab, and hell, I was strung out on oxy 60 days
  later. Just never even stopped seems like.

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Qualitative Results Violence and Substance Abuse

• Connection made between violence and Substance
  Abuse in every group
• Half of the groups 4/8 substance use was
  identified as key factor in IPV
• Two groups identified alcohol as a clue to IPV
• Substances described in a negative way in 6/8
  groups

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Qualitative Results IPV and SA

• Well my incident was because I was drinking too
  much and I just let it get out of hand. And she
  kept running her mouth and arguing and arguing
  and I was going to leave and she just kept on and
  onSee if I wouldnt have been drinking it
  wouldnt have gotten no further. It wouldnt
  have went that far.

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Qualitative Results IPV and SA

• Well, my problems started before the drugs, but
  the drugs did become involved. But I mean thats
  when it got pretty serious with me.

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Qualitative Results IPV and SA

• I mean alcohol is definitely an accelerant.
  Its an accelerant to the problem
• That stuff illicit drugs makes you do stuff you
  normally wouldnt do
• Theres withdrawals, theres a lot of things
  that go with drinking and its gonna blow up.
  Theres going to be incidents

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Qualitative Results IPV and SA

• Substance use as a coping mechanism emerged as a
  theme in 3/8 groups

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Qualitative Results IPV and SA

• Definitely made it IPVworse. But everybodys
  got their way of hiding from things and that was
  my way of hiding from it.
• I used alcohol as a way to drown it out
  violence in home as a child
• And see my biggest problem started we lost our
  first two children and thats my drinking problem
  right there.

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Qualitative Results IPV and SA

• You know, I thought I need to calm down Im
  upset, I started drinking and it becomes the only
  thing on your mind.
• I used alcohol as a way to like if I was
  stressful or a lot of stress at work or I just
  wanted to get lost, I would drink until I was
  obliviated

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What do Batterers doSASSI results
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Results Significant Substance Dependence
Correlations

• More court ordered programs p0.045
• Marital status single or separated more than
  married, divorced, cohabitating p0.033
• Victim by family member other than parent p0.031

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Results Significant Substance Abuse Correlations

• Have more children p0.003
• More court ordered programs p0.043
• Marital status single or separated more than
  married, divorced, cohabitating p0.045

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Discussion

• First Batterer study using focus group
  methodology
• Substance Abuse emerged as a theme in every focus
  group despite no prompts
• Alcohol specifically came up in nearly every
  group
• Most groups described substance use in a negative
  way

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Discussion

• Respondents connected violence and SA at least
  once in every group
• Half the groups identified SA as a key factor in
  IPV
• Two groups indicated alcohol concerns should be a
  clue to IPV

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DiscussionSome findings similar to literature

• Batterers often blame alcohol or drugs because
  there is less stigma (Adams 96)
• Batterer blames one symptom (violence) on another
  (alcohol) both are symptoms of abusive
  personality (Mintz and Cornett 97)
• Cyclically emotionally volatile batterers tend to
  cope with their stress by excessive drinking,
  smoking, use of legal or illegal drugs (Mintz and
  Cornett 97)

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Discussion Some findings similar to literature

• Rates of Substance dependence (46.9) are similar
  to previous studies (Bevan and Higgins 50
  alcoholic)
• Rates of Substance abuse (68.2), if confirmed,
  exceed previous studies (33-50) (Gerlock 99,
  Hamberger and Hastings 88, Hamberger et al 88,
  Tolman and Bennett 90)

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Discussion Findings in contrast with some
literature

• Batterers may drink with the intent of battering
  (Gelles Kaufman et al 84)

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Discussion Intergenerational factors and SA

• Focus group comments related to the connection
  between alcohol and violence as a child,
  consistent with literature for women
• Correlations between alcohol abuse and violent
  experiences as a child consistent with the
  literature (Hamberger and Hastings 91)
• More children among batterers with alcohol abuse
  not found in literature

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Discussion

• More court ordered programs may be proxy for
  increasing levels of violence
• Previous research shows increasing levels of
  violence with increasing amounts or chronicity of
  alcohol (Sugarman et al, Pan et al 94, Leonard et
  al 85, Van Hasslett et al 85, Kyriaku et al 99)
• Recividism increased with alcohol relapse
  (OFarrell et al 95)

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Discussion Recommendations

• Levels of alcohol abuse and dependence similar to
  or higher than that found in the literature.
• SA, especially alcohol was identified as an
  accelerant, worsening IPV
• Patients alcohol use should serve as a clue to
  explore IPV in men.

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Discussion Recommendations

• Additional analysis is needed to determine
  whether CTS2 scores and SASSI scores are
  correlated
• Additional studies are planned to evaluate health
  status and clues in men related to IPV
  Recommend using instruments that more effectively
  evaluate substance abuse
• Additional study is needed to assess regional
  differences in alcohol abuse and IPV rates.