AOD use has been associated with both the perpetration and victimisation of domestic and family violence [347-350]. Evidence suggests that up to 80% of women attending AOD treatment have experienced violence . Although domestic and family violence is commonly characterised as males using violence against females, this is not the only form of family violence. Other relationships can experience family violence, including same-sex, non-spousal, and carer relationships, and can involve children .
The high prevalence of AOD clients who have experienced domestic and family violence highlights the need for AOD workers to conduct thorough and effective assessments, and respond to the problem. Key factors that have implications for AOD workers are illustrated in Table 25.
Table 25: Key issues in domestic and family violence and implications for AOD workers
||Implication for AOD workers
||Among women in AOD treatment, the relationship between AOD use and family violence is thought to be bi- directional (i.e., AOD use can increase the risk of violence and vice versa) [352, 353].
||Attempt to identify power and control strategies employed by those using violence, whilst supporting and preserving the abused person's safety .
||In general, women and children are victimised more than men, and men are more likely than women to use violence in relationships. Women are also more likely than men to be injured through family violence, and therefore express fear [351, 355, 356].
||Family violence also occurs in non-spousal, same-sex, and carer relationships, and can involve children. Risk assessment is warranted for all clients, which should include exposure to, and use of, violence in relationships 
||Not all families with AOD and mental health conditions have family violence, but families with AOD and mental health conditions and family violence are at increased risk of experiencing other problems, such as psychiatric comorbidity, physical health problems, housing and/or employment problems, socioeconomic disadvantage, and social isolation .
||Responding to AOD and mental health conditions need to be broad, comprehensive, and involve multiple services in a cohesive, coordinated response (see Chapter B4).
AOD workers should also have an understanding of the dynamics and complexities involved in domestic and family violence, and the reasons why many people remain in violent relationships. These include :
- Fear, arising from the violent person’s threats or behaviour, that the person subjected to violence will face further violence, increased danger, or loss of life.
- Fear of stalking or abduction.
- Isolation or rejection from family, friends, and community.
- Loss of home, income, pets and possessions, or having a reduced standard of living.
- Negative impacts on children such as loss of school, friends, community, relationship with parent or family.
- Grief for loss of partnership.
- Feelings of guilt and self-blame.
- Fear of losing children or having children removed.
The strategies listed in Table 26 may be helpful for AOD workers managing clients experiencing domestic or family violence. AOD workers should be familiar with their organisational policies and procedures relating to domestic and family violence, with access to supervision if needed, and knowledge of appropriate referral and clinical pathways. Further information on domestic and family violence and child protection guidelines specific to each Australian jurisdiction can be found via state and territory websites.
Table 26: Dos and don’ts of managing a client experiencing domestic and family violence
- Be open, approachable, and trustworthy.
- Take the client seriously. Tell them you believe them, and emphasise that it is not their fault.
- Let the client know how much you appreciate how difficult it is to talk about.
- Seek to build the client’s confidence and empower them – it takes courage and strength to survive violence.
- Let the client dictate the pace, and encourage their progress.
- Listen to what the client says about what they want, and how they view their level of danger. Most people only reveal a small amount of the abuse they have endured – only they know how much danger they are in.
- Explore options and choices, including ways of increasing the client’s safety – whether they choose to leave the situation or not.
- Undermine the client by making them feel inadequate for not seeking help earlier. Remember he/she may have sought help earlier, or may not have been able to.
- Patronise or speak down to the client.
- Give your own opinion, be judgemental, or decide who in the relationship is to blame.
- Rush the client, or tell them what they should do.
- Give up or become frustrated if things are taking longer than you think they should. It may be frustrating seeing the client hurt or subjected to violence, but their actions and choices are their decision. They must not sense your frustration.
- Act as a go-between, provide details to his/her partner, pass on letters or messages, or facilitate contact in any way. This is not only unethical, but places you both in danger.
Adapted from the Stella Project .