OVC Provider Forum Transcript

Examining Correlations Between Substance Abuse and Victimization
Steven D. Walker  -  2009/12/8
I see evidence from the literature that not only does antisocial behavior predict victimization, but that victimization itself also predicts substance use. In which direction is the relationship between substance abuse and victimization strongest, in your opinion? Are these things likely to share a bi-directional (or reciprocal) relationship? Thanks.
1.  Steve Walker
 Essentially, the research on the correlation between victimization and substance use is stronger because it has been around for a long time. The more recent research on the post-victimization correlation is newer and less substantial. While both correlations exist, I believe, as we get more research data on the post-victimization relationship, it will be stronger than the pre-victimization correlation.
As a Sexual Assault Nurse Examiner many of the victims I work with are under the influence of drugs and/or ETOH at the time of the assault and I am see them immediately after the assault. Is there any information on how to provide interventions at this time without making the victims feel responsible for the assault as a result of their substance abuse. We usually do not have an opportunity to provide follw-up care and therefore a chance for future prevention may be missed.
1.  Julie Humphrey
 In my own research I have seen a need for there to be assistance and information for victims of violence, which can be accessed through the internet. There exists few support groups for victims of violence, and participating in one online can be therapeutic and informational. Here victims could hear from other victims that substance abuse may be the underlining cause of their victimization, or at the very least, a common factor. Perhaps being able to give victims information about online support groups while under a nurses care may help victims prevent future victimization.
2.  Steve Walker
 This is an excellent question, and I am glad you are willing to respond at this initial contact. We know that, before a person comes into treatment, three or more people have raised concern about a problem. This could be one of the initial concerns raised. The person is somewhat vulnerable at this point and may listen more, so I would encourage you do two relatively low-key things. Have fliers about substance abuse obviously available and hand it to the person or someone with them--along with the other material you hand out. To avoid blame, you could say something like: I am sorry this happened to you and this is not your fault at all. At times, you know, people get in difficult situations because of drinking. If that is a concern of yours, please read this brochure. The key is to generalize their behavior, at this point of contact, with all others. Avoiding blame but raising the issue. Given your limited, focused contact with the victim, this is usually all you can do. If, however, they are more open, less defensive, have a brochure of referral programs available also.
I work with a group of health disparities researchers to better understand the competing needs of homeless women and how they influence health status and victimization. A recent discussion within the group focused on the distinction between drug use that may lead to violence (perhaps through disinhibition or aggression) compared to drug use that results from violence (e.g., self medication). My question is whether a better understanding of this distinction would honestly help providers and, if so, how could such information be used? More broadly, are there specific questions regarding service provision for situations involving both drug use and violence that would be helpful for researchers like us to address?
1.  Elise Riley
 Thanks very much for your input. We have been using multiple measures for both victimization and drug use, but any additional recommendations you have would be greatly appreciated.
2.  Steve Walker
 Pre-victimization research indicates a high correlation between SA and victimization. The more recent research on post-victimization is showing a strong correlation now. By the time providers deal with the two, it really makes no difference. Both need to be treated--simultaneously if possible. Please email me again about a questionnaire to use.
3.  Suzanne
 Absolutely, a better understanding of pre-violence and post-violence drug use (particularly among homeless women) will be of use to health care providers and researchers. I have found the work of Patti Bland in this area to be very insightful and informative. Patti Bland, MA., CCDC, CDP, currently directs the Train the Trainer Project for the Alaska Network on Domestic Violence and Sexual Assault in Juneau. Ms. Bland served as both advocate and lead chemical dependency counselor for New Beginnings, a shelter and community-based program in Seattle, for over 12 years. She developed the Domestic Violence Chemical Dependency Outreach Project for King County at the Alcohol Drug Help Line in 1994. She served as the Domestic Violence Trainer for Providence Health System Family Violence Program in Washington State, as Adjunct Professor at Antioch University (teaching graduate course work in psychology), and as an instructor at Seattle Central Community College. She also served as an instructor for Child Protective Services at CPS Academy in Seattle, WA. Ms. Bland provides training and technical assistance addressing the intersection between domestic violence and substance abuse for programs across the nation. She has published several articles on chemical dependency and domestic violence and completed development of domestic violence curricula for the Washington State Medical Association and the Perinatal Partnership Against Domestic Violence. Recently Ms. Bland co-authored, with Debbie Edmund, Getting Safe and Sober: Real Tools You Can Use, an advocacy teaching kit for working with women coping with substance abuse and interpersonal violence. She is also the author of the Alaska Network on Domestic Violence and Sexual Assault Curriculum for Advocates. Contact information for ANDVSA:Juneau Office130 Seward Street, Suite 214Juneau, AK 99801 907-586-3650907-463-4493 (fax)Sitka OfficeP.O. Box 6631Sitka, AK 99835 907-747-7545907-747-7547 (fax)
IDDT is critical to programs for those with COD. I have stressed the importance of addressing what I believe to be the third part of the therapeutic triangle, namely being a victim of trauma. Would you comment on its importance and if programs already include addressing this or need to pay more attention to including it in the therapeutic milieu?
1.  bhandler
 IDDT is integrated dual diagnosis treatment and started out east for COD, co-occurring disorder, (mental illness and substance abuse). The core is that unless both are addressed by therapists and providers there will be a low rate of recovery.
2.  Steve Walker
 In essence, substance abuse, victimization, and PTSD all need to be address simultaneously when they are co-existent. Unfortunately, that is not always possible. Many time, if the SA problem is not treated, other treatment is not effective. Victims programs do need to attend to SA issues more.
3.  S Chasson
 What is IDDT and COD?
What is the risk of being victimized by intimate partner violence associated with being under the influence of alcohol or illicit drugs compared to not being under the influence?
1.  Steve Walker
 Current research seems to indicate that it at least triples your chances of being abused.
Are persons with cognitive disabilities more vulnerable to a risk of substance abuse with and/or without a past history of victimization (physical? emotional? sexual?) Thank you. K
1.  Katz
 Thank you for your comments- very helpful
2.  Steve Walker
 I don't believe the research shows they are more at risk for substance abuse but are more at risk to be victimized. Generally, among victims, those violent crime victims are at a higher risk of both substance abuse and PTSD.
For many women in treatment for substance dependence, that dependence is part of the victimization. Self-medication due to chronic abuse and violence is a frequent contributor to relapse. Our treatment program uses "Seeking Safety", an evidence based group program, to good effect, but we are looking for some additional strategies to address these interrelated problems.
1.  Steve Walker
 See earlier response.
2.  Steve Walker
 If relapse continues, then what you are doing is not enough, at least for that victim, and a referral is needed for SA treatment. My preference is for both types of treatment to be done simultaneously--as long as you have local SA treatment programs that understand victims' issues.
I am a Counselor Advocate that works with men and woman who are the victims of sexual abuse and many have addiction issues. I would like to learn more about this correlation.
1.  Steve Walker
 The correlations of pre-victimization alcohol use indicate that about one is six rape victims have alcohol use problems. This figure about doubles in relationship to post-victimization. There is also an extremely high correlation between substance abuse and PTSD, varying between 40 and 70, depending on the study. Substance abuse among the victims you deal with obviously needs to be screened for.
In your research on the correlations between substance abuse and victimization, what evidenced based trauma informed addiction treatment modalities have you come across for victims with substance abuse issues?
1.  Steve Walker
 You only need one hand: not many at all. SAMSA would have the current data on such programs. Although research indicates that SA programs are more open to treatment of victims than Victims programs are to SA treatment, there are few SA programs which I would call trauma informed.
Should the focus on understanding substance abuse and victimization also include the environment (degree of disorganization)? What are your thoughts on this?
1.  Steve Walker
 Yes, it should include noting environmental issues. A chaotic, disintegrated environment increases the likelihood of both victimization and substance abuse. And, as noted earlier, the presence of substance abuse increases the likelihood that victimization will occur.
My agency works with victims of domestic violence and sexual assault. When a victim's needs services around two types of abuse, in this instance substance abuse and physical abuse, what is the best approach to take?
1.  Steve Walker
 The best approach, if possible, is to do both types of treatment simultaneously. If you have community alcohol/drug treatment programs that understand PTSD and victims' issues, I would work closely with them. Sometimes, the substance abuse issue is so preeminent that it precludes any other type of intervention, so substance abuse treatment must be done first. A person actively using substances seldom benefits from other types of treatment--legal assistance and support of course are necessary. Again, the ideal is cooperative programs working together for the benefit of the victim.
I represent children in Family Court whose parents are addicts. What is the best course of action for these secondary victims to substance abuse in visiting or living with their addict parents? The parents tend to associate their inability to be sober if they don't see their kids, and a lot of kids don't want to see their parents if they are NOT sober. How do we structure safe visits, re-unifications, etc. without the children feeling responsible for their parents sobriety. Particularly when the kid's inferences in visits are the best judges of whether their parents are using. Thank you.
1.  Steve Walker
 The only way to be assured of safe visits would be if SA treatment was part of the parents plan to see the child. Children can be referred to AA groups for kids so they know it is not their fault. I agree that kids are one of the best barometers of SA.
Are domestic violence cases overwhelmingly due to the use and abuse of substances?
1.  Sandi Pierce
 This is a complex question that calls for complex answers. Having experienced physical and/or sexual abuse as a child is a predictor for both substance abuse and adult victimization, substance abuse is a predictor for adult violent victimization as well as for being a perpetrator of violence, and being a victim of intimate partner physical and sexual violence is a predictor for substance abuse. The social ecology in which domestic violence occurs is another critical factor, particularly for oppressed communities in which involving the police can have social consequences.
2.  Steve Walker
 I meant 80 and 90. The research about perpetrators has been corroborated numerous times. Remember, as I often say, a good reason is not a good excuse. To know the correlation is not to blame the victim or excuse the abuser but to help both.
3.  Suzanne
 Can you give the source of this statistic? Thanks.
4.  Samantha P
 There is no cause for Domestic Violence other than power and control. Many victims of domestic violence use substances as a coping mechanism, but it is not the cause of the problem.
5.  Steve Walker
 Correlation is not causation. About 90 of all DV perpetrators have a substance abuse problem, while about 80 of all DV victims do. What we can say is that substance abuse increases the likelihood of DV and needs to be dealt with in recovery.
6.  Susan Selby
 This has not been the experience at our agency. We are in Louisville KY and serve 11 counties in two states. While there may be a correlation in some cases, it is by far not a high percentage.
Hi! I am an educator and SART (sexual assault response team) coordinator for a SA center in Maine- we are currently looking at implementing a drug facilated sexual assault program for the high school level- and insight from past experience on implementing this type of program?
1.  Steve Walker
 I think this is an excellent idea to start at this level. Work with some local Alcohol/Drug Counselors about how to present the issue and use the shotgun approach--inundate them with both messages--sexual assault issues and substance abuse issues.
We usually think of persons with tbi being more likely to have impulsivity and substance abuse problems than other persons who have intellectual disabilities. Does the data support this view and what is the comparative correlation?
1.  Steve Walker
 Research now seems to indicate that those with intellectual disabilities do not have a higher level of substance abuse, but they do have a higher level of victimization, so post-victimization studies are now needed to show the level of post-victimization substance abuse in this group of victims.
Return to Discussion