Authors
- Fowler, Dawnovise PhD
Article Content
COOCCURRENCE of intimate partner abuse (IPA) and substance use problems, often leading to injury, disability, poor health, mental illness, and even death, is estimated at 38%-85% in various samples of women.1-3 Compared to women who have not experienced IPA, women survivors of IPA are more likely to abuse drugs and alcohol,4-6 and receive prescriptions for and become dependent on drugs.7 Their substance abuse may also place them at risk for subsequent victimization.4,8 Less is known about how to provide services to treat their substance abuse problems. Women in general may underutilize substance abuse treatment services,9 but domestic violence shelters, a primary source of help for IPA women survivors, have either no or limited substance abuse assessment methods and intervention, which results in discontinuous, fragmented service delivery.
PURPOSE
This study assessed the extent of substance use problems (incidence, risk, and type of substance abuse) among a domestic violence shelter-based sample of IPA women survivors.
METHODS
Shelter staff noted drug or alcohol problems in 50% of client files, according to a review of client records. However, no standardized screening procedures were in place. Thus, while it is possible that substance use incidence is overestimated, it is hypothesized that the lack of systematic screening makes this figure an underestimate.
Individual interviews were conducted by using in-depth questionnaires and assessment on substance use problems and partner abuse. The CAGE*-AID (CAGE adapted to include drugs) was used to screen for potential substance use problems.10 This brief screening tool is widely used and requires less than a minute to complete and score, which makes it suitable for use in crisis-oriented environments. Risk levels for substance abuse and use during the past 30 days were measured with the Simple Screening Instrument for Alcohol and Other Drug Use11 and the Addiction Severity Index (ASI),12 respectively. Substance use disorders were diagnosed using module E of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-IV).13 The Partner Abuse Scale-Physical (PASPH) and the Partner Abuse Scale-Non-physical (PASNPH) are 25-item instruments designed to measure the severity of problems with physical (including sexual) and nonphysical abuse in a dyadic relationship.14 Both instruments take approximately 5 minutes to complete, and show high reliability with a Cronbach's [alpha] of .90.
SAMPLE
New intakes and current shelter residents, all women survivors seeking refuge from IPA, were recruited. One hundred two women participated in the study. Participants ranged from 18 to 62 years old, with a mean age of 35 (SD = 10.36). Most had children (average of 2 children). Approximately 30% had a high school diploma; 8.9% had a college degree. The sample was predominantly lower income (eg, 81% earned up to $10,000).
RESULTS
Using SPSS, descriptive and correlational statistics were used to analyze the data. Eighty participants scored positive for further need for substance abuse assessment; 67.7% scored from moderate to high in the degree of risk for substance abuse. More than 75% reported ever using cocaine. More than 80% reported ever using cannabis, 10.8% reporting use in the past 30 days. Nearly 60% were alcohol dependent, and 55% were drug dependent. Cocaine use in the past 30 days was significantly related to physical partner abuse (r = 0.27, P = 0.05). In addition, the number of years of alcohol use was also significantly related to physical partner abuse (r = 0.25, P = 0.05).
DISCUSSION/IMPLICATIONS
Findings are consistent with other studies on substance use problems among IPA women survivors. Likewise, the incidence rates are 5% to nearly 18% higher regarding the risk for substance abuse and dependence in this study than the substance use problems originally noted in the clients' files. Also, significant relationships between physical partner abuse and specified substance use support theoretical perspectives on why women survivors use substances (to self-medicate from physical injury, increased vulnerability to IPA as a result of preceding substance use). Overall, these findings support the need for shelter-based substance abuse assessment and intervention. Effective substance abuse assessments and interventions that are shelter-based advances services and treatment15 by more comprehensively meeting their needs for cooccurring, entangled problems.
FUTURE RESEARCH
Post hoc analyses will be conducted to determine predictive relationships between psychosocial variables, partner abuse, and substance abuse. In the pilot, the effects of a standardized substance abuse intervention to decrease alcohol consumption and/or stop drug use among IPA women survivors with substance use problems will be compared to effects among a standard care group in the shelter. Pilot data will inform a federal application for a larger study.
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*CAGE indicates Cutting down Annoyance by Criticism, Guilty Feeling, and Eye-openers. [Context Link]