This document discusses the relationship between substance use and domestic abuse. It defines key terms and outlines prevalence data showing high rates of overlap between substance use problems and experiencing or perpetrating domestic abuse. The relationship is complex, with substance use increasing the frequency and severity of abuse, while victims also use substances to cope with abuse. Treatment targeting only substance use or domestic abuse is insufficient, and myths can undermine safety if they are not addressed. Practitioners must recognize this complexity to avoid unintentionally increasing risks, especially for women and children.

1. Substance use and
domestic abuse

2. Definitions
• Substance use – use of alcohol and other drugs (AOD).
• Problematic substance use – where the use of alcohol and other drugs
is becoming problematic in at least one area of the person’s life, e.g.
financial, relationships, health, caring responsibilities.
• Domestic abuse (DA) is any incident or pattern of incidents of
controlling, coercive, threatening behaviour, violence or abuse between
those aged 16 or over who are, or have been, intimate partners or
family members regardless of gender or sexuality. The abuse can
encompass, but is not limited to: psychological, physical, sexual,
financial, emotional. (Home Office, 2013, online)
• Pattern of abusive and controlling behaviour

3. Domestic abuse in the general
population
• Crime Survey data (ages 16-59 only) estimates:
– 7.1% of women have experienced DA (1.2 million) in last year
– 4.4% of men (700,000).
• Any form of domestic abuse since age 16
– 30% of women (4.9 million)
– 16.3% of men (2.7 million).
• Women are more likely to have experienced all types of abuse
– Non-sexual partner abuse and stalking were most common
• 2% of women and 0.5% of men had experienced some form of sexual
assault in previous year.
(Crime Survey for England and Wales (CSEW) 2012/13 reported by ONS 2014)

4. General population – taken from Crime Surveys for England and Wales
(CSEW)
• Victims of DA in last year reported 24% of the perpetrators were under
the influence of alcohol; 9% under the influence of drugs (CSEW 2012/13)
• Victims of serious sexual assault (since age 16) – reported 36% of
perpetrators under influence of alcohol; 9% drugs (CSEW 2011)
• 10% of victims reported they had been using alcohol at time of their
assault
• 1% of victims reported their own use of other drugs at time of their
assault
Prevalence: DA and substance use

5. • The evidence below looks at rates of overlap in particular populations,
i.e. those in substance use or DA or substance use services (see Galvani
2010 for review).
• Substance use services (last 6-12 months)
– Extremely high rates of domestic abuse and substance use
– More than 60% of female substance use service
users on average have experienced DA in the
last 6-12 months
– Male perpetrators of DA – 50% on average
Prevalence: DA and substance
use (cont.)

6. Prevalence: DA and substance
use (cont.)
Domestic violence services
– Substance use is a reason to exclude women from many DV
services so caution is needed with these data.
– Approx. 30-50% of women in DV services have problems with
substance use.
– Within perpetrator programmes – 60-70% of perpetrators use
substances; 40% of perpetrators use problematically.

7. Practitioner’s perspective
In this film clip Jennifer Holly talks about what we know about the
gender differences in people’s experience of substance use and
domestic abuse.

8. Theoretical perspectives
(see Galvani 2003 for review)
There are a range of theories about the relationship between substance
use and domestic abuse. The following are summaries of the key theories:
• Deviance disavowal theory:
– drinking/using a substance is as an excuse for abuse – behave
badly and blame the substance.
• Expectancy theory:
– prior to any substance use, the person believes/expects the
substance use to lead to violence or abuse.
• Disinhibition theory:
– “I didn’t know what I was doing” – therefore can’t be held
responsible.
• Cognitive disorganisation hypothesis:
– responding to particular triggers only, as a result of being
intoxicated – therefore misreading other people’s behaviour.

9. Theoretical perspectives (cont.)
• Social learning/socialisation
– people behave according to what they’ve learnt about what type of
behaviour reaps rewards.
• Theory of responsible disinhibition
– alcohol can have disinhibiting effects on people.
However, other individual and contextual factors
contribute to abusive behaviour and, ultimately,
It remains a person’s choice to behave violently.
• ‘Best’ explanation of links between substance use and domestic
abuse
– combines substances’ effects, context/setting, individual drinker
characteristics, gender roles and expectations, costs and benefits,
learned behaviour.

10. Nature of relationship
 Complex
 No simple explanation
 No simple solution
 Quest for simplicity leads to risky beliefs and risky responses
In this film clip, Stella Project Coordinator, Jennifer Holly talks about the
relationship between substance use and domestic abuse from a
practitioner’s perspective. Listen to Jennifer discuss the relationship
between substance use and domestic abuse.

11. Myths and realities #1
• Myth: Alcohol and drugs cause people to be violent and abusive to
their partners
• Response: Stop using, or reduce, substances and all will be well
• Reality: No evidence of direct causal link.

12. What the research says…
• Substance use by the perpetrator has been found to:
– increase the frequency of DA (Brookoff et al. 1997, Fals-Stewart 2003,
Leonard and Quigley’s 1999, Leonard and Senchak 1996)
– increase severity of injuries inflicted (Brecklin 2002, Graham et al. 2004,
Leonard and Senchak 1996)
– increase mental and physical health problems of partner (Dawson
et al. 2007)

13. Myths and realities #2
• Myth: Women who use alcohol or drugs deserve, or could provoke,
violence from their partner
• Response: She needs to change. Provide treatment or mandate the
woman into substance use treatment
• Reality: Women who use alcohol or drugs often do so to cope with
the violence from their partner
• In the following film clip, Jennifer Holly talks about women who are
victims of domestic abuse under the influence of substances.

14. What the research says…
• Women drink/use other drugs to numb or escape the physical and
psychological pain (Clark and Foy 2000; Corbin et al. 2001; Galvani 2006; Miller
2001; Miller et al. 2000)
• Pre-existing alcohol problems may be worsened by suffering DA
(Downs and Miller 1994)
• Victim intoxication can increase a person’s vulnerability to suffering
abuse (Mirrlees-Black 1999, Hall 2011, Rossow 1996, Room et al. 1995)

15. Woman survivor of DA:
“Well, the past few months I think it's just made me
miserable really. ... I think it's because of the situation
what we've like been through that's made me feel like
that. Because actually, I have been sitting on a night
drinking quite a bit and that's not me neither. And that's
been the past three or four months, the odd times, two or
three times during the week I've been sat having a drink
and I think that's to drown out my hurt really.”
(Galvani 2003)

16. Using substances to cope
• The impact of DA on victims can be traumatic and long lasting, both
psychologically and emotionally.
• Research shows there are clear links between:
– Suffering domestic abuse and mental ill health including depression,
anxiety, PTSD and suicide attempts (Barron 2004, Kaysen et al. 2007,
Mechanic et al. 2008)
– Suffering adult or child abuse and substance use (Bear et al. 2000; Clark
and Foy 2000; Corbin et al. 2001; Galvani 2006; Min et al. 2007)
– Substance use and mental ill health (Department of Health 2002, Kaysen et
al. 2007)

17. Psychologist, DA service
“We know that [women] often struggle with highly intrusive recollections
about abuse. So, just 2 examples…a woman who just kept seeing her
husband’s fists coming towards her, or another woman whose partner
pinned her with his knees on her chest to the ground and repeatedly
lifted a knife above her head and stabbed it into the carpet, so close to
her head that it shaved hairs off her head. He did that 9 or 10 times and
each time she thought she was going to die. Every time she closed her
eyes, she saw the knife coming towards her face again.
So, I am just trying to illustrate the power of the flashback as intrusive
events. I know that many women will use – particularly alcohol or
marijuana – or other drugs, be they prescribed or otherwise, … to try
and manage the effects of the flashbacks and the intrusive
memories …”
(From: Galvani and Humphreys 2007)

18. Myths and realities #3
• Myth: Men who abuse women after using drugs or alcohol are not
wholly responsible for their actions.
• Response: Didn’t know what he was doing/let him sleep it off/needs
help.
• Reality: Men abuse women with and without alcohol or drugs and
also carefully select who they are abusive to.

19. Woman survivor of DA
“A. Some time like...he was alright when he had a drink.
Some days he used to lose his temper, that’s all.
Q. But did he lose his temper without the alcohol?
A. Yeh, so it didn’t make a difference in this case.”
(Galvani 2003)

20. What the research says….
• Pharmacological effects – affects a person’s cognition and motor
coordination. No evidence for substances directly causing violence.
• Expectancy effect – the effect people expect a substance to have
on their behaviour, has a key role in its impact of on their
behaviour.
• Cultural influences –cultural messages about the impact of
substances and acceptable behaviour under their influence are
important determinants of behaviour as well as expectations about
what is or isn’t acceptable behaviour within gender roles.
• The fact that perpetrators carefully select their victims of violence/
abuse demonstrates their ability to control their behaviour.

21. Myths and realities #4
• Myth: Getting help with the alcohol or drug problem will make it all
better.
• Response: See how things are when he has been through
treatment. She begins to hope things will change.
• Reality: Perpetrators are abusive before and after substance use
interventions.
• Watch Jennifer Holly talking about the impact of treatment on the
perpetration of domestic abuse.

22. What the research says…
• Behavioural Couples’ Therapy (O’Farrell and Murphy 2002)
– decreases [not stops…] severity and
frequency of physical and verbal abuse
– evaluations showed level of abuse
remained higher than control group
– relapsers returned to high levels of violence and abuse
• There is the potential for DA to worsen during withdrawal from, or
treatment for, substance use.

23. Myths and realities #5
• Myth: Children can be protected from the violence and abuse (and the
messages about substance use that go with it)
• Response: Try to make sure they’re not around/ remove them from
the situation.
• Reality: The children do know, are often scared for themselves and
their parent/s, are feeling guilty and/or want to make it all better.

24. Woman survivor of DA:
“You see at one point...because they’d been through so
much I started protecting them and not letting them see
what was going on and then it just got worse and they
know. Especially when they turn round and say ‘oh but me
dad had a drink he didn’t mean it, it’ll be alright won’t it
tomorrow’.”
(Galvani 2003)

25. What the research says…
• There are clear links between perpetrating adult domestic abuse and
child abuse (Cawson 2002, Morley and Mullender 1994; Hester et al. 2000, Barth et
al. 2005).
• Children have reported witnessing, and often experiencing, extreme
violence (Cawson 2002, Mullender et al. 2002, Stanley et al. 2010, Wales and Gillan
2009).
• There are high levels of witnessing/suffering DA among young people
in:
– the care system (McAuley and Young 2006)
– in substance use treatment (many of whom report depression,
suicide attempts, victimisation and perpetration of DA).

26. What the research says…(cont.)
• There are high levels of victimisation among young people who drink
more frequently (Hamburger et al. 2008).
• There are clear links between child abuse and adolescent and adult
substance use/problems.
• Cleaver et al. (2006) in a study of 357 social work cases found
“domestic violence or parental substance misuse rarely exist in
isolation” and that the resulting negative effect “on all aspects of
children’s lives was more serious”.
– 85% of these children had parents who could not fulfil key
parenting tasks.

27. Impact on children
• As separate issues parental alcohol problems and DA have negative
impact on:
1. parenting skills and capacity,
2. children’s health and well-being.
• Children are at increased risk of all forms of abuse.
• Children are often living in fear, feeling guilty, feeling responsible,
socially isolated, developing emotional and behavioural problems, and
taking on inappropriate age roles, eg. a carer.
• Parental substance problems combined with domestic abuse means
the harm to children is compounded.

28. Impact of DA & SU on children
The combination of domestic abuse and substance use has an increased
negative impact on:
• the child’s development,
• their experiences in adolescence,
• their relationships & parenting abilities as adults,
• prediction of adolescent psychopathology,
• perpetrating child abuse themselves,
• perpetrating or suffering domestic violence in own adulthood,
• developing own substance problems.
(Templeton, Zohhadi, Galvani and Velleman 2006)

29. Implications for practice
• These overlapping issues result in people facing multiple and complex
needs.
• Complex needs means complex issues for service providers to
respond to.
• Majority of UK services – and policies - not engaging with ‘other’
issues – single focus.
• Health and social care practitioners need to know about both issues –
they do not need to be experts.
• Safety and safeguarding needs to be
priority – whatever your job and
professional focus.

30. Implications for practice (cont.)
• These are not new service users or patients - if you work with one
issue or the other – it is likely you will be working with both.
• You need to ensure you know what you hear when you hear it and
what questions to ask and not to ask.
• You need to know how to get support for your service users and for
yourselves.
• You need to work in partnership with other
specialists - based on mutual respect and an
understanding of each other’s priorities.
• You can develop joint working protocols and
training exchanges.

31. Messages for practitioners
In this film clip, Jennifer Holly offers advice on how to talk about
domestic abuse when you’ve had little training and experience of it,
particularly the relationship between substance use and domestic use.

32. Working with perpetrators
• Working with perpetrators of domestic abuse in order to address their
abusive behaviour is a specialist role.
• However, there are guidelines for general good practice with
perpetrators that all health and social care professionals can adopt.
• Watch this film clip, where Jennifer Holly, Stella Project Coordinator,
provides advice for health and social care professionals about how to
work with perpetrators.
• It is important to remember that perpetrators are not people who are
new or completely unknown to health and social care professionals.
• Perpetrators of abusive behaviour are there already among our
patient and service users as well as our family and friendship groups.

33. Families and couples’ work
• Families and couples’ work is not recommended where there is
domestic abuse for safety reasons.
• There is the potential to increase risk/retribution if victims disclose
abusive behaviour during the intervention.
• This fear can result in a lack of openness from victim/s and thus being
viewed as uncooperative or not engaging by the professionals
concerned.
• Families work is developing in UK alcohol/drug
services but safety has to be a priority.

34. Families and couples’ work
(cont.)
• The good news is that positive social support helps people change
problematic substance using behaviour.
• The bad news is that the risks, particularly in relation to domestic
abuse, are not recognised.
• We must find a way forward that works with the family or couple but
does so only when a risk assessment has been conducted.
• Safety is priority otherwise children and adults can be made more
vulnerable to abuse .

35. Summary
• Drugs and alcohol alone are not to blame for domestic violence and
abuse.
• Myths – usually over simplify or excuse behaviour or reflect our hopes.
• Policy and practice must be grounded in evidence and users’
perspectives to avoid risks, primarily to women and children.
• We need to pay critical attention to societal and cultural messages
about links between substance use and violent behaviour and not
reinforce myths.

36. Summary
• The relationship between substance use and domestic abuse is a
complex relationship combining:
– Individual choice
– Substance effects
– Expectations (culturally defined)
– Environment/triggers
– Gender roles/assumptions
• To respond safely and appropriately we need to:
– Consider all elements in our assessment and interventions.
– Identify/address the impact on individuals and their families
– Develop trusting, multi-agency partnerships.

37. Final words from the experts
To finish this resource two of our experts offer some advice to health
and social care professionals about how they can support people living
with domestic abuse and substance use.
• Watch Jennifer Holly, AVA, summarising what professionals can do
to support people.
• Watch Liz, survivor of domestic abuse and substance use, who
suggests a holistic approach from professionals is what’s needed.

38. References
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