AOD use has been associated with both the perpetration and victimisation of domestic and family violence including physical, sexual and emotional abuse [558–563]. There has also been increasing recognition of coercive control as a form of domestic and family violence.
Evidence suggests that up to two thirds of women attending AOD treatment have experienced violence [564]. 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 [563, 565, 566].
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 34.
Table 34: Key issues in domestic and family violence and implications for AOD workers
| Key Factor |
Significance |
Implication for AOD workers |
| AOD use |
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) [567–569]. |
Attempt to identify power and control strategies employed by those using violence, whilst supporting and preserving the abused person’s safety [570, 571]. |
| Gender |
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 [572–574]. |
Family violence also occurs in non-spousal, same-sex, and carer relationships, and can involve children [565, 566]. Risk assessment is warranted for all clients, which should include exposure to, and use of, violence in relationships [563, 565, 575]. |
| Co-occurring conditions |
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 co-occurring psychiatric conditions, physical health problems, housing and/or employment problems, socioeconomic disadvantage, and social isolation [563, 576]. |
Responding to AOD and mental health conditions needs to be broad, comprehensive, and involve multiple services in a cohesive, coordinated response (see Chapter B5). |
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 reasons include [577, 578]:
- 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.
Additionally, some people may have difficulty recognising that they are in a violent relationship, may have maladaptive internal beliefs about relationships, or may fear reinforcing negative racial stereotypes [579]. Domestic violence may also be normalised within some cultures, which can make it difficult for those involved to recognise the behaviours as abuse [577]. It is also important to recognise that many of these internal beliefs may not fall within a person’s conscious awareness. For all of these reasons, leaving a violent relationship has been described as a process that takes time, rather than being a one-off event [579].
The strategies listed in Table 35 may be helpful for AOD workers managing clients experiencing domestic or family violence. It should be noted that clients may be reluctant to disclose issues relating to domestic or family violence for a number of reasons, such as a desire for privacy, anxiety about the consequences of disclosure (e.g., from the perpetrator or society), anxiety about the impact of disclosure on parental custody, new services being intimidating, and lack of trust in practitioners [580]. 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 35: Dos and don’ts of managing a client experiencing domestic and family violence
| Do: |
|
Be open, approachable, and trustworthy.
|
|
Take the client seriously. Tell them you believe them and emphasise that it is not their fault.
|
|
Affirm the perpetrator’s responsibility for their violence, even in the presence of AOD use. 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 and the safety of any children – whether they choose to leave the situation or not.
|
|
Establish ways to maintain contact safely.
|
| Don't: |
|
Undermine the client by making them feel inadequate for not seeking help earlier. Remember they 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 display frustration 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.
|
Adapted from the Stella Project [578], ATODA [581], and Heward-Belle et al. [570].