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Domestic Violence Awareness Month: Responding to the Needs of Those in Treatment and Recovery

Domestic Violence Awareness Month: Responding to the Needs of Those in Treatment and Recovery

October is just around the corner, and while most people equate October with Halloween, Columbus Day, and Nevada Day (if you live in Nevada), it is also Domestic Violence Awareness Month. According to the National Coalition Against Domestic Violence (NCADV),  “On average, nearly 20 people per minute are physically abused by an intimate partner in the United States. During one year, this equates to more than 10 million women and men.” More data on this important topic is available on the NCADV website.

What is Intimate Partner Violence?

Intimate Partner Violence (IPV) is defined by the World Health Organization (WHO) as “any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship” and pointed it out as the most common form of violence against women worldwide (WHO, 2012). IPV affects both genders and every type of intimate relationship, including marital, dating, parental, heterosexual and same-sex relationships. The WHO reports that approximately 35% of people claim to have experienced violence from their intimate partners (Garcıa-Moreno et al., 2013).

Important Issues Identified by IPV Research

IPV is a multidimensional issue (Santambrogio et al., 2019). Research shows that this type of violence is the result of volatile dynamics between individual, relational, community, and societal influences (Garcıa-Moreno et al., 2006) Different forms of violence benefit from clinical treatment based on the type of violence involved (e.g., physical, psychological, and sexual violence (Garofalo & Velotti, 2017; Gillespie et al., 2018). What puts two people in a relationship at risk for IPV is a complex interplay between systems, the influence of different system levels, and the interactions between the individuals and contexts, and are different for victims and perpetrators. One theoretical approach that has been used to understand the relational dynamics in IPV is attachment theory, or the need for a bonding relationship with a meaningful person (Castellano, Velotti, & Zavattini, 2014; Velotti et al., 2020). A meta-analysis of studies examined the relationship between attachment and IPV perpetration for two dimensions of attachment: anxiety and avoidance. The meta-analysis found that most of the included studies found support for the anxiety dimension of attachment being a trigger for violence. The same analysis of the avoidance dimension found weaker evidence of it being a trigger (Velotti et al., 2020). More research is needed for confirmation and particularly to explore potential mediators of these triggers. The study authors offered the following implications for treatment for clinicians treating IPV couples:

  • Difficulty in regulating negative emotions needs to be treated.
  • Dysfunctional expectations of significant others should be assessed and treated.
  • Interventions to reduce recidivism need to include accurate assessment of anxiety and avoidance.
  • The transgenerational nature of attachment dimensions and the tendency to perpetrate should be considered during treatment and in future research.
  • Interventions should be specific to the type of violence (i.e., physical, psychological, or sexual).
  • While age was “not a significant moderator of the association between attachment and IPV perpetration…gender did have a significant role” and future studies would clarify attachment mechanisms at the base of IPV perpetration to separate the two issues (Velotti et al., 2020).

Risk and protective factor theory has been applied to IPV perpetration, and exists in multiple contexts: individual, relational, community, and societal. Risk and protective factors are also correlated and cumulative, meaning that risk factors tend to be positively correlated with other risk factors and negatively correlated with protective factors. Risk and protective factors are cumulative in that the more risk factors present in a person’s life, the less likely they are to have protective factors and the more influence risk factors are likely to have, as is illustrated in the video Moving Forward, provided by the Centers for Disease Control (CDC). Some of the risk and protective factors for IPV by category are:

Individual Risk Factors

  • Low self-esteem
  • Low income
  • Low academic achievement/low verbal IQ
  • Young age
  • Aggressive or delinquent behavior as a youth
  • Heavy alcohol and drug use

Relationship Risk Factors

  • Dominance and control of the relationship by one partner over the other
  • Economic stress
  • Unhealthy family relationships and interactions
  • Association with antisocial and aggressive peers
  • Parents with less than a high-school education
  • Social isolation/lack of social support

Community Risk Factors

  • Low social capital-lack of institutions, relationships, and norms that shape a community’s social interactions
  • Poor neighborhood support and cohesion
  • Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)
  • High alcohol outlet density

Societal Risk Factors

  • Traditional gender norms and gender inequality (e.g., women should stay at home, not enter workforce, and be submissive; men support the family and make the decisions)
  • Cultural norms that support aggression toward others
  • Societal income inequality
  • Weak health, educational, economic, and social policies/laws

Relationship Protective Factors

  • High friendship quality
  • Social support (e.g. tangible help, support from neighbors)

Community Protective Factors

  • Neighborhood collective efficacy (i.e., community cohesiveness/support/connected-ness, mutual trust, and willingness to intervene for the common good)
  • Coordination of resources and services among community agencies

A complete list and additional information can be found on the CDC Intimate Partner Violence website.

Professional Development Opportunity

For clinicians and other providers who want to learn about the consequences of IPV on mental health and substance use disorder treatment and recovery, the following webinar is available pm October 23. 2020 from 11:00 am – 1:00 pm PST: Domestic Violence Awareness Month: Responding to Intimate Partner Violence in Treatment and Recovery Services

Presenter: Gabriela Zapata-Alma, LCSW, CADC

“It has long been recognized that abuse by an intimate partner can have traumatic mental health and substance use effects. Research has found high rates of both past and current intimate partner violence (IPV) among people in substance use disorder and mental health treatment settings. A growing body of evidence has found that abuse is often targeted at a partner’s substance use and mental health in deliberate attempts to undermine and control survivors and keep them from achieving their recovery goals. These forms of abuse, known as substance use coercion and mental health coercion, not only jeopardize the well-being of survivors and their children, but also compromise the effectiveness of mental health and substance use disorder treatment. All of this is further complicated by escalating rates and severity of IPV during the COVID-19 pandemic. This session will provide treatment and recovery specialists with a conceptual framework for understanding survivors’ patterns of substance use within the context of IPV, will prepare practitioners to recognize and respond to substance use coercion and mental health coercion within treatment and recovery services, and will equip practitioners with strategies and resources to better serve survivors and their children.”

  • As a result of participating in this session, attendees will be able to:
  • Describe coercion related to substance use and mental health within the context of intimate partner violence.
  • Become familiar with evidence-supported interventions to treat substance use, mental health, and trauma in the context of intimate partner violence.
  • Identify at least three strategies to increase responsiveness to survivors of intimate partner violence within treatment and recovery services.

Resources

Selected Phone and Internet Resources

Hotlines

National Domestic Violence Hotline (800) 799­SAFE (800) 799­3224

Rape, Abuse, and Incest National Network (RAINN) (800) 656­4673

Child Help USA/National Child Abuse Hotline (800) 4A­CHILD

General Resources

National Coalition Against Domestic Violence (303) 839­1852

National Victim Center (NVC)/Infolink  (800) FYI­CALL

American College of Obstetricians and Gynecologists (ACOG) (202) 638­5577

Other Services

Center for the Prevention of Sexual and Domestic Violence (206) 634­1903

Domestic Violence Project/Face to Face (800) 842­4546

Domestic Violence Training Project (800) 865­3699

Family Violence and Sexual Assault Institute (903) 534­5100

American Bar Association Commission on Domestic Violence

From the U.S. Department of Defense:

Relevant Catalyst blog posts from CASAT OnDemand:

Find more resources, links, and materials in the CASAT OnDemand Resources & Downloads page.

Do you have resources to share with your colleagues on this important topic? Please post them in the comments section.

References

Castellano, R., Velotti, P., & Zavattini, G. C. (2014). What makes us stay together? Attachment and the outcomes of couple relationships. Karnac Books

Center for Substance Abuse Treatment. Substance Abuse Treatment and Domestic Violence. Treatment Improvement Protocol (TIP) Series, No. 25. HHS Publication No. (SMA) 12-4076. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1997.

Garcıa-Moreno, C., Jansen, H. A., Ellsberg, M., Heise, L., & Watts, C. H. (2006). WHO multi-country study on women’s health and domestic violence against women study team. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet, 368(9543), 1260–1269. https://doi.org/10.1016/S0140-6736(06)69523-8

Garcıa-Moreno, C., Pallitto, C., Devries, K., Stockl, H., Watts, C., & Abrahams, N. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.

Garofalo, C., & Velotti, P. (2017). Negative emotionality and aggression in violent offenders: The moderating role of emotion dysregulation. Journal of Criminal Justice, 51, 9–16. https://doi.org/10.1016/j.jcrimjus.2017.05.015

Gillespie, S., Garofalo, C., & Velotti, P. (2018). Emotion regulation, mindfulness, and alexithymia: Specific or general impairments in sexual, violent, and homicide offenders? Journal of Criminal Justice, 58, 56–66. https://doi.org/10.1002/ab.21868

Santambrogio, J., Colmegna, F., Trotta, G., Cavalleri, P. R., & Clerici, M. (2019). Intimate partner violence (IPV) and associated factors: An overview of epidemiological and qualitative evidence in literature. Rivista di Psichiatria, 54(3), 97–108. http://dx.doi.org/10.1708/3181.31598

Spencer, C. M., Stith, S. M., & Cafferky, B. (2020). What puts individuals at risk for physical intimate partner violence perpetration? A meta-analysis examining risk markers for men and women. Trauma, Violence & Abuse, , 152483802092577. doi:10.1177/1524838020925776

Velotti, P., Rogier, G., Beomonte Zobel, S., Chirumbolo, A., & Zavattini, G. C. (2020). The relation of anxiety and avoidance dimensions of attachment to intimate partner violence: A meta-analysis about perpetrators. Trauma, Violence & Abuse, 152483802093386. doi:10.1177/1524838020933864

World Health Organization. (2012). Understanding and addressing violence against women: Overview. Author. https://apps.who.int/iris/handle/10665/77433

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