Increase Efforts to Incorporate Awareness of Co-occurring Issues and Participate in Cross-training Among Allied Professionals
Abusive relationships are often compounded by co-occurring issues. Substance abuse or mental health issues complicate already troubled relationship dynamics, often exacerbating existing problems or creating new ones. The presence of these issues can also affect how systems and stakeholders perceive or respond to violence in the relationship. Most notably, substance abuse and mental health issues present additional barriers to safety and accountability for victims and perpetrators, respectively.
One primary problem caused by co-occurring issues is the perpetuation of the myth that substance abuse and mental health issues cause domestic violence. This common misconception leads to false expectations of what needs to happen to end the abuse: “If they would just get off drugs, this would be better” or “If they could only stop drinking, the violence would stop” or “If they would only go back on their meds, they would be able to control their actions.” These commonplace statements are unfortunately misguided because, while substance abuse and mental health issues may exacerbate and contribute to abuse, they do not cause it.
CO-OCCURRING DRUG OR ALCOHOL ABUSE
While the co-occurrence of substance abuse and domestic violence are common, we must recall that one issue does not cause the other. To properly mitigate risk of lethal violence, a perpetrator who is experiencing issues of addiction must be referred to treatment for the substance abuse as well as Family Violence Intervention Program.
One factor consistently associated with intimate partner violence in both adults and adolescents is the use and misuse of alcohol. After numerous research studies, it has become increasingly clear the misuse of alcohol can contribute to the occurrence, frequency and severity of intimate partner violence. In their report, “Prevention of Intimate Partner Violence in Substance-Using Populations,” J.R. Temple and coauthors indicate that in a large survey representative of the U.S. population, the number of men who physically abused their female partners was three times higher among binge-drinking men compared to their alcohol-abstaining counterparts. Roughly half of domestic violence incidents are reported to cooccur with drinking by the perpetrator, victim, or both. Beyond that, the amount of alcohol consumed has been shown to be positively related to the severity and lethality of the violence — for example, on drinking days, male partners were over four times more likely to perpetrate violence in the relationship and over five times more likely to perpetrate severe violence (Temple et al., 2009).
Drug use is similarly associated with increased rates of domestic violence (Gilchrist & Hegarty, 2017). Use of street drugs such as cocaine and methamphetamine is often implicated in the perpetration of intimate partner violence. Among men diagnosed with a substance use disorder, the yearly prevalence of domestic violence perpetration is found to be between 50–70 percent, with 20–30 percent classified as severe intimate partner violence resulting in injuries (Capezza et al., 2015).
Some researchers note the relationship between substance abuse and intimate partner violence is spurious. That is, the factors which cause or predispose individuals to have problems with alcohol or drug consumption mirror those contributing to both domestic violence perpetration and victimization (Temple et al., 2009). This complicates how systems respond when dual issues are presented. Criminal justice reform has led to a more holistic approach in addressing substance abuse issues; many courts now follow a disease model for intervention, which assumes relapse is chronic and a part of rehabilitation, and factors in genetic and socialized predispositions to abuse substances based on family of origin. As stakeholders continue to adjust the ways we respond to substance-abusing populations, we must be careful not to address domestic violence using the same disease mode. Many individuals who abuse substances never choose to use violence in their relationships, and similarly, many individuals who use power and control in their relationships to abuse their partner never abuse substances. As we strive for better accountability for perpetrators and safety for victims, we must always remember that partner abuse is not a disease, it is a choice; while the issues often co-occur, substance abuse issues are not the root of abuse.
Despite that, the risk of lethal violence posed to victims when substance abuse is mixed with relationship abuse is clear. In a study of intimate partner femicide, perpetrators were known to use street drugs in 55 percent of cases (Campbell, 2017). This rate was considerably higher than the study’s known 23 percent of abusers who used street drugs in non-lethal abuse cases, suggesting use of drugs increases the likelihood of lethal violence. The same study suggested similar outcomes when alcohol abuse was present: In cases which ended in death of the female victim, the partner was known to be drunk every day in 42 percent of cases, whereas in non-lethal cases of abuse the perpetrators were drunk on a daily basis in only 12 percent of the circumstances.
In cases reviewed by the Project, 52 percent of perpetrators were known to have alcohol and/or drug issues, but only 7 percent of perpetrators were in touch with a substance abuse program in the five years leading up to the fatal incident. Since perpetrators’ substance abuse can increase risk for victims, the fact so few perpetrators were known to have received substance abuse treatment demonstrates a huge gap. Not referring perpetrators to necessary services created missed opportunities to address the co-occurring issues and to reduce the likelihood of a lethal incident of abuse.
Research attributes substance abuse treatment alone to some reduction in rates of intimate partner violence (Capezza et al., 2015). However, many individuals still perpetrate domestic violence following substance abuse treatment. This appears to be particularly true for individuals who relapse, who are three times more likely to perpetrate domestic violence compared to men who remained sober (Capezza et al., 2015). Similar trends are noted amongst participants in batterers intervention programs as well; men with substance abuse issues evidenced greater levels of recidivism for violence in the relationship than did men with no substance abuse issues (Stuart et al., 2009).
CO-OCCURRING MENTAL HEALTH ISSUES
Perhaps there is no better evidence of the highly lethal implications of co-occurring mental health issues with intimate partner violence than the volume of domestic violence murdersuicide incidents which have been studied by the Project. Some 39 percent of cases reviewed by the Project involved perpetrators who, after killing the victim, attempted or completed suicide.
Our findings mirror those established by experts nationwide and point to the presence of suicide threats and attempts as an indicator for increased risk of lethal violence for a perpetrator’s current or former intimate partner. In a national study of cases which ended in the death of a female intimate partner victim, the perpetrator threatened or attempted suicide in 39 percent of cases (Campbell, 2017). In the study, suicide threats and attempts were present at twice the rate as they were in non-lethal abuse cases, where they were present in 19 percent of circumstances studied.
In cases reviewed by the Project, perpetrators were known to have a history of depression 34 percent of the time. Thirty-seven percent of perpetrators were known to have made threats or attempts of suicide prior to the homicide. These factors represent missed opportunities for interventions which may have saved multiple lives. In cases reviewed by the Project, perpetrators were in contact with a mental health provider during the five years prior to the homicide in only 24 percent of cases.
Despite clear connections between threats or attempts of suicide among domestic violence perpetrators and the high rate of murder-suicide incidents, depression and suicidal ideation in domestic violence perpetrators are often overlooked by helping professionals as a serious indicator of danger. It also appears that screening for depression and suicidal ideation in abusers is not routine.
While many factors seem to affect the overlap of these two issues, the most obvious connections exist in the shared indicators of increased risk of suicide and domestic violence lethality. Among the shared indicators are:
- previous suicide threats or attempts
- acquisition or presence of a firearm
- presence of depression and substance abuse
- medical crisis
- financial issues
- impending accountability
- relationship changes
The homicide-suicide connection in lethal incidents of domestic violence was covered in depth in the Project’s 2016 Report, which explores the importance of incorporating suicide-prevention strategies into the work of preventing domestic violence, and vice versa. The Report also lays out strategies for expanding the capacity of service providers who are interfacing with individuals at risk of suicide and domestic violence.
The Project’s 2016 Annual Report is available online at GeorgiaFatalityReview.com/reports/report/2016-report.
STEPS GEORGIA CAN TAKE TO INCORPORATE AWARENESS OF COOCCURRING ISSUES:
- Develop integrated intervention responses which address both domestic violence and substance abuse issues simultaneously. Promising results have been reported for integrated interventions which address domestic violence and substance use simultaneously. There is a push among some researchers and professionals in the field to develop integrated intervention responses which address both issues together to improve outcomes for victims and perpetrators alike (Gilchrist & Hegarty, 2017).
- Cross-train professionals responding to domestic violence, substance abuse or mental health incidents. Because of the high likelihood that their respective populations of clients will experience multiple co-occurring issues, Georgia’s professionals should be equipped not only to provide triage to a co-occurring issue outside of their expertise, but also be knowledgeable on the local, state and national resources appropriate to provide additional support alongside their targeted interventions.
- Expand awareness that co-occurring issues increase risk of lethal incidents of domestic violence. Conduct an awareness campaign and continuing education for stakeholders which includes messaging that while other issues co-occur with intimate partner violence, they do not cause it.