The interplay between substance use and intimate partner violence perpetration: A meta-ethnography

A global review of the impact on women from men's alcohol drinking: the need for responding with a gendered lens

BACKGROUND

Global evidence shows that men's harmful alcohol use contributes to intimate partner violence (IPV) and other harms. Yet, interventions that target alcohol-related harms to women are scarce. Quantitative analyses demonstrate links with physical and verbal aggression; however, the specific harms to women from men's drinking have not been well articulated, particularly from an international perspective.

AIM

To document the breadth and nature of harms and impact of men's drinking on women.

METHODS

A narrative review, using inductive analysis, was conducted of peer-reviewed qualitative studies that: (a) focused on alcohol (men's drinking), (b) featured women as primary victims, (c) encompassed direct/indirect harms, and (d) explicitly featured alcohol in the qualitative results. Papers were selected following a non-time-limited systematic search of key scholarly databases.

RESULTS

Thirty papers were included in this review. The majority of studies were conducted in low- to middle-income countries. The harms in the studies were collated and organised under three main themes: (i) harmful alcohol-related actions by men (e.g. violence, sexual coercion, economic abuse), (ii) impact on women (e.g. physical and mental health harm, relationship functioning, social harm), and (iii) how partner alcohol use was framed by women in the studies.

CONCLUSION

Men's drinking results in a multitude of direct, indirect and hidden harms to women that are cumulative, intersecting and entrench women's disempowerment. An explicit gendered lens is needed in prevention efforts to target men's drinking and the impact on women, to improve health and social outcomes for women worldwide.

Different Scripts, Different Casts: A Crime Script Analysis Indicating Intimate Partner Violence Is Not All the Same

Crime script analysis was used to analyze intimate partner violence diversity by identifying variables significantly associated with different script tracks. Qualitative thematic analysis using official police administrative data from Queensland, Australia, was used to develop an intimate partner violence protoscript (n = 40), followed by quantitative hierarchical cluster analysis and cross-tabulations to examine diversity within scripts. Four diverse script tracks were identified: "escalating jealousy," "persistently possessive," "controlling victim agency," and "enduring argument." Intimate partner diversity exists with divisions based on statistically significant variables. Implications for situational crime prevention and the use of mixed methods for strengthening crime script analysis are discussed.

The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence

The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence is not well understood. To address this we conducted a systematic review and meta-synthesis of qualitative studies. Our search strategy included electronic searches of 18 databases and grey literature, citation tracking and reference list screening. Studies were eligible if they presented qualitative data from racially and/or ethnically minoritised women or girls, who had experienced sexual violence at any age and described their experiences of receiving treatment from statutory mental health and/or substance use services. Studies were analysed using meta-ethnography. Fourteen papers based on 12 individual studies were included. Analysis developed three main themes: (1) understanding minoritised women holistically, (2) processing the trauma and beginning the healing and (3) the need for social connectedness and empowering relationships. For minoritised women to benefit from treatment, mental health and substance use services need to challenge the dynamics of the multiple traumas minoritised women experience. Knowledge and understanding of the racial trauma minoritised women experience is limited and many are subjected to further harm from racist practices occurring in some treatment services. Offering culturally safe, trauma-informed care which promotes anti-racist practices may help improve mental health and substance use service responses to minoritised women who have experienced sexual violence.

Thematic Synthesis of the Experiences of Intimate Partner Violence Among Mothers Who Use Substances

OBJECTIVE

To integrate the findings of qualitative research to describe the experiences of intimate partner violence (IPV) among mothers who use substances.

DATA SOURCES

A systematic search of the literature was conducted using the databases of the American Psychological Association PsycINFO, CINAHL, and PubMed along with a manual search of Google Scholar.

STUDY SELECTION

The Joanne Briggs Institute critical appraisal checklist for qualitative research criteria was used to assess the studies for selection. Inclusion criteria comprised (a) qualitative research, (b) available in English, (c) published in peer-reviewed journals, (d) inclusive of descriptions of IPV experienced by mothers who use substances, (e) conducted in the United States, and (f) published between January 2013 and October 2023.

DATA EXTRACTION

The researchers highlighted and extracted data from studies that met the inclusion criteria. Data describing IPV among mothers who use substances were extracted.

DATA SYNTHESIS

A thematic synthesis was used to integrate the findings using three stages and included (a) free line-by-line coding of the findings of the primary studies, (b) the development of the free codes into associated areas to construct descriptive subthemes, and (c) the development of overarching analytic themes.

CONCLUSION

Findings from 11 qualitative studies were synthesized. Four descriptive subthemes emerged to delineate the experiences of IPV in mothers who use substances: Experience of Various Types of IPV, Lack of Structures to Identify and Address IPV, Coping With Violence by Taking Substances, and Substance Use Influences Behaviors of IPV. Nurses who work with mothers who use substances should be knowledgeable about local resources for IPV, complete ongoing educational training for IPV screening, and be familiar with recommended guidelines for the routine assessment of IPV.

What are the impacts of alcohol supply reduction measures on police-recorded adult domestic and family violence in the Northern Territory of Australia?

BACKGROUND

During 2017-18, the Northern Territory (NT) introduced a Banned Drinker Register (BDR) and Minimum Unit Price (MUP) NT-wide; Police Auxiliary Liquor Inspectors (PALIs) in three regional towns; and restrictions on daily purchases/opening hours (DPOH) in one regional town. The BDR is an individual-level alcohol ban; MUP is a pricing policy; and PALIs enforce bans on restricted areas at takeaway outlets. This study examines the impact of these policies on adult domestic and family violence (DFV).

METHODS

We examined DFV assaults and breaches of violence orders from January 2014 - February 2020 using interrupted time series models for NT, Greater Darwin, Katherine, Tennant Creek, and Alice Springs. To account for increasing numbers of individuals on the BDR we tested two timepoints (Sept 2017, March 2018).

FINDINGS

Following DPOH, assaults (78 %) and alcohol-involved assaults (92 %) decreased in Tennant Creek. After PALIs, assaults (79 %) in Tennant Creek, and breaches (39 %) and alcohol-involved breaches (58 %) in Katherine decreased. After MUP, assaults (11 %), alcohol-involved assaults (21 %) and alcohol-involved breaches (21%) decreased NT wide. After MUP/PALIs in Alice Springs, alcohol-involved assaults (33 %), breaches (42 %), and alcohol-involved breaches (57 %) decreased. BDR (Sept 2017) found increases in assaults (44 %) and alcohol-involved assaults (39 %) in Katherine and assaults (10%) and alcohol-involved assaults NT-wide (17 %). There were increases of 21 %-45 % in breaches NT-wide, in Darwin, Katherine, and Alice Springs. Following March 2018 found increases in assaults (33 %) and alcohol-involved assaults (48 %) in Katherine. There were increases - from 20 % to 56 % - in breaches in NT-wide, Katherine, and Alice Springs.

CONCLUSION

PALIs and DPOH were associated with some reductions in DFV; the BDR was associated with some increases. The upward trend commences prior to the BDR, so it is also plausible that the BDR had no effect on DFV outcomes. Although MUP was associated with reductions in the NT-wide model, there were no changes in sites without cooccurring PALIs.

How Health Professionals Identify and Respond to Perpetrators of Domestic and Family Violence in a Hospital Setting: A Scoping Review

There is heightened awareness that a whole-of-systems approach to perpetrator responses is key to addressing domestic and family violence (DFV). This paper reports on the findings from a scoping review which mapped the international literature on how health professionals identify and respond to perpetrators of DFV within a hospital setting. A comprehensive scoping review methodology was used. The search, spanning January 2010 to January 2022, yielded 12,380 publications from four databases. Eligibility for inclusion included peer-reviewed literature with any reference to inpatient hospital health professionals identifying or responding to perpetrators of DFV. Fourteen articles were included in the final review. The review presents the literature categorized by levels of prevention, from primary, secondary, through to tertiary preventive interventions. An additional category "other practices" is added to capture practices which did not fit into existing levels. Despite glimpses into how health professionals can identify, and respond to perpetrators of DFV, the current knowledge base is sparse. The review did not identify any mandated or formal procedures for identifying and/screening or responding to perpetration of abuse in hospitals. Rather, responses to perpetrators are inconsistent and rely on the motivation, skill, and self-efficacy of health professionals rather than an embedded practice that is driven and informed by hospital policy or procedures. The literature paints a picture of missed opportunities for meaningful work with perpetrators of DFV in a hospital setting and highlights a disjuncture between policy and practice.

Adapting the ADVANCE group program for digitally-supported delivery to reduce intimate partner violence by men in substance use treatment: a feasibility study

Introduction

COVID-19 restrictions created barriers to "business as usual" in healthcare but also opened the door to innovation driven by necessity. This manuscript (1) describes how ADVANCE, an in-person group perpetrator program to reduce intimate partner violence (IPV) against female (ex)partners by men in substance use treatment, was adapted for digitally-supported delivery (ADVANCE-D), and (2) explores the feasibility and acceptability of delivering ADVANCE-D to men receiving substance use treatment.

Methods

Firstly, the person-based approach and mHealth development framework were used to iteratively adapt ADVANCE for digitally-supported delivery including conceptualization, formative research, and pre-testing. Then, a non-randomized feasibility study was conducted to assess male participants' eligibility, recruitment, and attendance rates and uptake of support offered to their (ex)partners. Exploratory analyses on reductions in IPV perpetration (assessed using the Abusive Behavior Inventory; ABI) and victimization (using the revised ABI; ABI-R) at the end of the program were performed. Longitudinal qualitative interviews with participants, their (ex)partners, and staff provided an understanding of the program's implementation, acceptability, and outcomes.

Results

The adapted ADVANCE-D program includes one goal-setting session, seven online groups, 12 self-directed website sessions, and 12 coaching calls. ADVANCE-D includes enhanced risk management and support for (ex)partners. Forty-five participants who had perpetrated IPV in the past 12 months were recruited, forty of whom were offered ADVANCE-D, attending 11.4 (SD 9.1) sessions on average. Twenty-one (ex)partners were recruited, 13 of whom accepted specialist support. Reductions in some IPV perpetration and victimization outcome measures were reported by the 25 participants and 11 (ex)partners interviewed pre and post-program, respectively. Twenty-two participants, 11 (ex)partners, 12 facilitators, and 7 integrated support service workers were interviewed at least once about their experiences of participation. Overall, the program content was well-received. Some participants and facilitators believed digital sessions offered increased accessibility.

Conclusion

The digitally-supported delivery of ADVANCE-D was feasible and acceptable. Remote delivery has applicability post-pandemic, providing greater flexibility and access. Given the small sample size and study design, we do not know if reductions in IPV were due to ADVANCE-D, time, participant factors, or chance. More research is needed before conclusions can be made about the efficacy of ADVANCE-D.

The Use of Chemical Control Within Coercive Controlling Intimate Partner Violence and Abuse

This paper explores the use of chemical control by perpetrators as part of coercive controlling intimate partner violence and abuse, defined as the nonconsenting use of prescribed and nonprescribed medication (including vaccines), and/or other substances to coerce or control, reducing the victim-survivor's capacity for independence, freedom, and health. Based on testimonies of 37 victims-survivors and nine domestic abuse practitioners in the UK we identify varying tactics used to chemically coerce and control, deepening our understanding about the continually changing forms of domestic violence and abuse and enhancing the potential for a more robust response through better informed policy and practice.

Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

Computer-based intervention for residents of domestic violence shelters with substance use: A randomized pilot study

BACKGROUND

Intimate Partner Violence (IPV) is a significant public health problem often associated with serious mental health and physical health implications. Substance use disorders (SUDs) are one of the most common comorbidities among women with IPV, increasing risk of subsequent IPV.

METHODS

The current study examined the feasibility, acceptability, and preliminary effectiveness of a brief computerized intervention to reduce alcohol and drug use among women with IPV. Fifty women with recent IPV and alcohol and drug use risk were recruited from domestic violence shelters and randomized to the experimental computerized intervention or to an attention and time control condition. The primary outcome was percent heavy drinking or drug using days in 3 month increments over the 6 months after leaving the shelter. Receipt of substance use services and IPV severity were evaluated as secondary outcomes.

RESULTS

The computerized intervention was feasible and acceptable, with high (n = 20, 80%) completion rates, engagement with the intervention, and satisfaction scores. As expected in this pilot trial, there were no significant differences between conditions in percent heavy drinking/drug using days or receipt of substance use services and large individual differences in outcomes. For example, receipt of substance use services decreased by a mean of 0.05 times/day from the baseline to the 6-month time period in the control condition (range -1.00 to +0.55) and increased by a mean of 0.06 times/day in the intervention condition (range -0.13 to +0.89). There were large decreases in IPV severity over time in both conditions, but directions of differences favored the control condition for IPV severity.

CONCLUSION

A computerized intervention to reduce the risk of alcohol/drug use and subsequent IPV is feasible and acceptable among residents of a domestic violence shelter. A fully powered trial is needed to conclusively evaluate outcomes.

Participants in Court-mandated Intervention Programs for Intimate Partner Violence Perpetrators with Substance Use Problems: A Systematic Review of Specific Risk Factors

Men with alcohol and/or other drug use problems (ADUPs) court-mandated to attend intervention programs for intimate partner violence (IPV) perpetrators have been identified as a high-risk, highly resistant group of IPV perpetrators, as they present lower treatment adherence and higher dropout and recidivism rates. Previous research suggests that IPV perpetrators with ADUPs may require tailored interventions to address their specific risk factors. The present systematic review was conducted using PRISMA guidelines to identify the specific risk factors in men with and without ADUPs on entry to court-mandated perpetrator programs. The following databases were searched from inception to November 2021: Web of Science, PsycINFO, and Scopus. There was a screening of 3,995 records, and 29 quantitative studies were included in the review. Risk factors present in males court-mandated to perpetrator programs were grouped into four categories: sociodemographic risk factors, personality disorders and psychological adjustment, social-relational risk factors, and risk factors related to attitudes towards women. Results indicated that the main risk factors in IPV perpetrators with ADUPs, compared to those without, were higher clinical symptomatology (e.g., anger and impulsivity), personality disorders, poorer executive functions, having experienced more stressful life events, higher exposure to childhood trauma, lower intimate social support, and higher responsibility attributed to the offenders' personal context. These results contribute to a deeper understanding of the complex phenomenon of IPV and ADUPs, and could help to inform key targets for perpetrator programs that may improve the well-being of their (ex)partners and increase the effectiveness of intervention programs for IPV perpetrators.

Partner Gender and Binegativity Uniquely Impact Relationship Quality among Bisexual Men

Romantic relationships both buffer and exacerbate adverse health outcomes among bisexual individuals, so understanding determinants of their functioning may be key to correcting health inequities affecting this population. Binegativity (i.e., prejudiced attitudes about bisexuality) expressed from one's intimate partner has the potential to be uniquely impactful for bisexuals, but it is presently unknown how this experience might impact the quality (and therefore potential health promotive effects) of their romantic relationships. In addition, gender of one's current romantic partner may shape experiences of binegativity and relationship quality in important ways. The purpose of this report was to examine how binegativity from intimate partners impacts relationship functioning (i.e., relationship satisfaction and intimate partner aggression) among bisexual men (N = 113), and how the gender of one's partner might moderate this effect. Results suggested that binegativity is detrimentally associated with relationship satisfaction, and that bisexual men in relationships with women report more frequent intimate partner aggression. Furthermore, partner gender and binegativity showed novel interactive associations with intimate partner aggression, such that bisexual men in relationships with women tended to perpetrate less intimate partner aggression when experiencing more binegativity. These results are discussed with regard to future avenues for research into the health promotive benefits of relationships for bisexual individuals.

Influences and patterns of intimate partner violence among married Akha and Lahu women in northern Thailand

BACKGROUND

Intimate partner violence (IPV) is a major global public health problem. Women are the principal victims of IPV, and some special populations have been particularly impacted. The Akha and Lahu women are vulnerable populations for IPV due to the modernization and changes of their culture and norms. This study aimed to understand premarriage factors related to IPV, including associated factors, influencers, patterns and impacts, in Akha and Lahu women in Thailand.

METHODS

A qualitative method was used to gather information among Akha and Lahu women who had experienced IPV in the previous year and were fluent in Thai. Women who had experienced IPV in the previous year and lived in the border area of Thailand and Myanmar were invited to provide information. A thematic analysis was used to extract information from the participants and develop findings.

RESULTS

A total of fifty-two married women were recruited into the study: 46.2% were Akha and 53.8% were Lahu. Those married Akha and Lahu women younger than 39 years found their partner through social media, had conditions before getting married, had high self-confidence, and tended to marry people from different tribes. While those aged 40 years and over met their husbands in village activities, were highly compliant with the norms of their culture, and married men from the same tribe. Three factors were detected as associated factors of IPV: cultural differences between partners from different tribes, substance use, and personality. Differences in age between partners, living in poor family economic status, and poor education were also detected as influencers of IPV. Four patterns of IPV were observed among Akha and Lahu married women: neglect, emotional abuse, verbal abuse, and physical abuse. Several patterns of the impacts were presented: children were neglected, especially in the preparation of daily food, having stress, having poor family relationships, and having children with unsuccessful lives in terms of education and getting a good job. Almost all married Akha and Lahu women had no particular expectations in their lives.

CONCLUSION

Akha and Lahu women face IPV problems with several key influences and impacts. Effective implementations are required to monitor and reduce the problem in the Akha and Lahu families, especially where the women are younger than 40 years old and married to men from different tribes.

Association Between Cannabis and Violence in Community-Dwelling Patients With Severe Mental Disorders: A Cross-sectional Study Using Machine Learning

The objective of this cross-sectional study was to identify cannabis-related features and other characteristics predictive of violence using a data-driven approach in patients with severe mental disorders (SMDs). A Least Absolute Shrinkage and Selection Operator regularization regression model was used on the database consisting of 97 patients with SMD who completed questionnaires measuring substance use and violence. Cannabis use, particularly related to patients' decision to consume or time spent using, was a key predictor associated with violence. Other patterns of substance use and personality traits were identified as strong predictors. Regular patterns of cannabis use and interpersonal issues related to cannabis/stimulant abuse were inversely correlated to violence. This study identified the effect of several predictors correlated to violence in patients with SMD using a regularization regression model. Findings open the door to better identify the profiles of patients that may be more susceptible to perpetrate violent behaviors.

Substance Use and Violence Victimization Among Women: A Review of Relevant Literature

A review of the recent scientific literature on the relationship between substance use and violence victimization among women in the United States is presented. Systematic review methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. In total, 15 studies were identified that met inclusion criteria. There is substantial evidence suggesting substance use (e.g., severity of use, types of substances used) is associated with women's violent victimization histories. Evidence suggests that women are uniquely situated in illicit drug markets and other illicit economies in a manner that increases their risk for violent victimization. The strengths and shortcomings of current theoretical explanations of substance use and violence victimization are discussed, as well as considerations for future research and interventions.

Qualitative description of outreach and engagement in perinatal substance treatment in Finland

BACKGROUND

Women with perinatal substance problems experience a multitude of barriers to care. They have specific early intervention needs, they endure societal stigma, and both substances and mental health issues influence the way they navigate within support and treatment systems. Early interventions for women with perinatal substance problems are underresearched contexts. The aim of the study is to describe building relationships and engagement within an outreach and low threshold service encounter tailored for pregnant women with SUD (substance use disorder).

METHODS

The data consist of online written narratives from 11 workers involved in the program and feedback from 504 families in the recovery process comprising 228 open-ended answers. The data were analyzed with a thematic analysis.

RESULTS

The programs are characterized by flexibility and the implementation of inclusive ways to approach families. The themes for enhancing relationships and engagement within outreach and low threshold programs are Acceptance and attitude: a sensitive approach of approval; flexibility within strictness to allow for diversity and individuality; availability and space to ensure a trustful atmosphere; negotiating via doing to build connections; and everyday life changes: imagining recovery. The themes represent the need of being available, focusing on the worker's attitudes and building connections by doing together, and visioning recovery together.

CONCLUSIONS

The study results can add to the understanding of SUD outreach and low threshold work during pregnancy. The elements described in this study need further theoretical development, research and critical assessment. Building relationships during pregnancy were characterized by connecting within everyday life situations and supporting the development of an attachment relationship between the baby and the parents. To promote recovery, a comprehensive approach in which substance-related issues and mental health conditions are interconnected can be favored. Engaging early on during pregnancy might enhance success during future rehabilitation.

A Prospective Analysis of the Interrelationship between Physical Intimate Partner Violence and Alcohol Use: A Post-Hoc Analysis of Young Women Involved in the Stepping Stones and Creating Futures Trial in South Africa

Prospective studies assessing women's experience of intimate partner violence (IPV) and alcohol use have shown mixed results and all are from high-income countries. Using longitudinal data from young women in South Africa we assess whether changes in physical IPV impact alcohol use, and whether changes in alcohol use impact physical IPV experience. Post-hoc analysis of women aged 18-30 living in informal settlements in eThekwini Municipality, South Africa, involved in the Stepping Stones and Creating Futures trial, between September 2015 and October 2019, with data collected at baseline (n = 677) and endline at 24 months (n = 545, 80.5% retention). At both timepoints, women were asked about their past year physical IPV experience and alcohol use. We estimated changes in physical IPV over time and whether this was associated with harmful alcohol use at endline. We then estimated changes in alcohol use over time, and whether this was associated with experience of past year physical IPV at endline. Women who experienced an increase in physical IPV over the study period were more likely to report harmful drinking at 24 months (aOR2.45, 95% CI 1.21-4.97). Similarly, women reporting increased alcohol use over time were more likely to report past year physical IPV at 24 months (aOR2.04, 95% CI 1.21-3.46). Among young women living in urban poverty those who experienced increasing physical violence from intimate partners were more likely to report increased and problematic alcohol use. Similarly, women reporting increasing alcohol use over 24 months were more likely to report physical IPV. However, there was no evidence that decreased alcohol use led to reductions in IPV, or that reduced IPV experience led to decreased alcohol use. Future research and interventions need to consider the reciprocal risks of physical IPV and alcohol use, with a focus on joint underlying drivers.

"When I Take Drugs, I Don't Care": Insights into the Operational Dynamics of Male Violent Offenders in a Correctional Centre

This study investigated the operational dynamics of male violent offenders incarcerated in Abakaliki custodial center, Nigeria. A cross-sectional survey research design was adopted and purposive technique used to recruit 260 inmates charged with violent offenses. The data generated from structured questionnaire were analyzed using Predictive Analytic Software (PAS), with ordinary least regression, descriptive statistics and spearman rank order correlation techniques, employed in testing the variables explored. Findings revealed that this population use drugs to enhance criminal performance through being brutal; instilling fear in victims to secure their total compliance and submission; and suppressing regret for their criminal acts. Heroin, followed by, cocaine, cannabis, tramadol, and multiple drug use, were commonly used drugs in the population surveyed, with their offenses ranging from cultism, armed robbery, murder and burglary to kidnapping and assault and battery. Gaining insights into the changing operational knowledge, procedures and dynamics of violent offenders will (re)direct policy approach and action that are capable of increasing public and custodial safety. It will also orient and direct practical prison reforms for successful rehabilitation and reintegration of released inmates into the free world.

A recreational group intervention based on Relational Cultural Theory for women experiencing substance use disorders in Australia: A protocol

Gender differences exist in the progression, initiation and maintenance of substance use disorders (SUDs). Women encounter unique barriers to accessing treatment for their SUDs and commonly report higher perceptions of stigma around their substance use. Currently, there is a paucity of women-specific treatment options that address their perception of stigma and shame regarding SUDs. The Women of the West (WOW) programme is a pilot study that explores the subjective acceptability and feasibility of participating in a recreational and relational skill development group for women with SUDs. The pilot study adopts qualitative research methods including focus groups and interviews with ten participants who self-identify as women experiencing SUDs and two programme facilitators. The programme's primary aim is to promote participants' relational skills with peers in an enjoyable, and therapeutic environment. It is anticipated as participants develop their relational skills with peers, their sense of stigma regarding their SUDs and social isolation will decrease. Ultimately this can promote their long-term recovery from SUDs and overall well-being. Findings from this study will provide direction for future programme development and treatment services seeking to promote better outcomes for women with SUDs.

The feasibility of delivering the ADVANCE digital intervention to reduce intimate partner abuse by men receiving substance use treatment: protocol for a non-randomised multi-centre feasibility study and embedded process evaluation

BACKGROUND

Compared to men in the general population, men in substance use treatment are more likely to perpetrate intimate partner abuse (IPA). The ADVANCE group intervention for men in substance use treatment is tailored to address substance use and IPA in an integrated way. In a feasibility trial pre-COVID, men who received the ADVANCE intervention via face-to-face group delivery showed reductions in IPA perpetration. Due to COVID-19, ADVANCE was adapted for remote digital delivery.

METHODS/DESIGN

This mixed-methods non-randomised feasibility study, with a nested process evaluation, will explore the feasibility and acceptability of delivering the ADVANCE digital intervention to men in substance use treatment who have perpetrated IPA towards a female partner in the past year. Sixty men will be recruited from seven substance use treatment services in Great Britain. The ADVANCE digital intervention comprises a preparatory one-to-one session with a facilitator to set goals, develop a personal safety plan, and increase motivation and a preparatory online group to prepare men for taking part in the intervention. The core intervention comprises six fortnightly online group sessions and 12 weekly self-directed website sessions to recap and practise skills learned in the online group sessions. Each website session is followed by a one-to-one video/phone coaching session with a facilitator. Men will also receive their usual substance use treatment. Men's female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Outcome measures for men and women will be sought post intervention (approximately 4 months post male baseline interview). Feasibility parameters to be estimated include eligibility, suitability, consent, recruitment, attendance, retention and follow-up rates. In-depth interviews or focus groups will explore the intervention's acceptability to participants, facilitators and ISS workers. A secondary focus of the study will estimate pre-post-differences in outcome measures covering substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts and quality of life.

DISCUSSION

Findings will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE digital intervention for reducing IPA.

TRIAL REGISTRATION

The feasibility study was prospectively registered: ISRCTN66619273 .

Family focused interventions that address parental domestic violence and abuse, mental ill-health, and substance misuse in combination: A systematic review

Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) are three public health issues that tend to cluster within families, risking negative impacts for both parents and children. Despite this, service provision for these issues has been historically siloed, increasing the barriers families face to accessing support. Our review aimed to identify family focused interventions that have combined impacts on parental DVA, MH, and/or SU. We searched 10 databases (MEDLINE, PsycINFO, Embase, CINAHL, Education Research Information Centre, Sociological Abstracts, Applied Social Sciences Index & Abstracts, ProQuest Dissertations and Theses Global, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials) from inception to July 2021 for randomised controlled trials examining the effectiveness of family focused, psychosocial, preventive interventions targeting parents/carers at risk of, or experiencing, DVA, MH, and/or SU. Studies were included if they measured impacts on two or more of these issues. The Cochrane Risk of Bias Tool 2 was used to quality appraise studies, which were synthesised narratively, grouped in relation to the combination of DVA, MH, and/or SU outcomes measured. Harvest plots were used to illustrate the findings. Thirty-seven unique studies were identified for inclusion. Of these, none had a combined positive impact on all three outcomes and only one study demonstrated a combined positive impact on two outcomes. We also found studies that had combined adverse, mixed, or singular impacts. Most studies were based in the U.S., targeted mothers, and were rated as 'some concerns' or 'high risk' of bias. The results highlight the distinct lack of evidence for, and no 'best bet', family focused interventions targeting these often-clustered risks. This may, in part, be due to the ways interventions are currently conceptualised or designed to influence the relationships between DVA, MH, and/or SU. Trial registration: PROSPERO registration: CRD42020210350.

Would restricting firearm purchases due to alcohol- and drug-related misdemeanor offenses reduce firearm homicide and suicide? An agent-based simulation

Background

Substance-related interactions with the criminal justice system are a potential touchpoint to identify people at risk for firearm violence. We used an agent-based model to simulate the change in firearm violence after disqualifying people from owning a firearm given prior alcohol- and drug-related misdemeanors.

Methods

We created a population of 800,000 agents reflecting a 15% sample of the adult New York City population.

Results

Disqualification from purchasing firearms for 5 years after an alcohol-related misdemeanor conviction reduced population-level rates of firearm homicide by 1.0% [95% CI 0.4–1.6%] and suicide by 3.0% [95% CI 1.9–4.0%]. Disqualification based on a drug-related misdemeanor conviction reduced homicide by 1.6% [95% CI 1.1–2.2%] and suicide by 4.6% [95% CI 3.4–5.8%]. Reductions were generally 2 to 8 times larger for agents meeting the disqualification criteria.

Conclusions

Denying firearm access based on a history of drug and alcohol misdemeanors may reduce firearm violence among the high-risk group. Enactment of substance use-related firearms denial criteria needs to be balanced against concerns about introducing new sources of disenfranchisement among already vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-022-00381-x.

Combining Group-based Interventions for Intimate Partner Violence Perpetrators With Comorbid Substance Use: An Australian Study of Cross-sector Practitioner Views

The connection between intimate partner violence (IPV) perpetration and problematic alcohol and/ or other drug (AOD) use has been well established in public health, social work and criminology research. Despite the overwhelming evidence of the correlation between these two problem behaviors, service systems addressing these issues have historically done so in siloed approaches to practice. AOD interventions have frequently been criticized for a lack of IPV focused assessment and practice. Similarly, specialist IPV interventions generally do not address clients' underlying risk factors, including problematic AOD use, through holistic intervention approaches. Suggestions to combine IPV and AOD focused interventions for men who use violence are often met with skepticism, raising questions around which sector could deliver a combined intervention approach and how different ideological standpoints in client work can and should be integrated into a combined framework. In this article, we examine the views of key stakeholders (n = 10) involved in the funding, development and/ or delivery of different service responses to men who use IPV in an Australian jurisdiction. Drawing on qualitative interview and focus group data, we explore their views around combined, group-based interventions, including the perceived need for such intervention models along with sector readiness and key considerations critical in informing the combining of IPV and AOD focused perpetrator interventions. Stakeholder findings identify the need for holistic responses to perpetrators of IPV with comorbid problematic AOD use. Further, findings provide guidance for funding bodies and community service providers considering combined, group-based interventions for perpetrators of IPV with comorbid problematic AOD use.

The Sociocultural Dimensions of Gender-Based Violence in Afro-Mexican Communities in the Coastal Region of Oaxaca, Mexico

In Mexico, as part of the historical and political context, race heavily influences a person’s opportunities. Moreover, the data refer to a scenario of normalized gender-based violence caused by sociocultural practices, the lack of application of the laws, and structural discrimination. Given this precedent, the purpose of this study is to analyze the social and physical dimensions of gender-based violence in an Afro-Mexican community in the south of Mexico. The techniques used to gather data for this study consist of a variety of styles of interviews with a group of Afro-Mexican women from the Costa Chica of Oaxaca, who are survivors of gender-based violence, and participant observation obtained through conducting ethnographic fieldwork in Oaxaca. The social phenomena of emigration and alcohol and drug consumption, in combination with the cultural dimensions of the machista practices in this region of Mexico, are the material and immaterial spaces where GBV is produced and reproduced daily. An intersectional perspective of the context can be helpful when collecting data for effective and well-grounded public policies and intervention projects established on a feminist and women-centered perspective.

Participatory practice guideline development at the intersections of domestic and family violence, mental distress and/or parental substance use

Purpose

It is well established that the service system has a poor history of responding holistically to address the needs of children and families living with co-occurring complexities such as domestic violence, parental mental health and/or substance use. The purpose of this conceptual paper is to primarily describe the developmental process used to create guidelines to inform practice at the intersections of domestic violence, mental health and alcohol and other drug services, ensuring that the tactics of coercive control are visible in contexts of complexity.

Design/methodology/approach

The guidelines were developed through undertaking a literature review, followed by a practice-led research approach with practitioners from 33 organisations across three Australian states, Safe & Together consultants and researchers. Communities of practice composed of practitioners providing interventions to children and families were central to the approach. Data that informed the development of the guidelines included a literature review, ethnographic notes, qualitative interviews, quantitative surveys and reflections.

Findings

Practice-led research engaged practitioners in the development of guidelines to promote an integrated response to working with families experiencing domestic violence, substance use and mental health issues. The integrated approach drew from the Safe & Together model, emphasising partnering with women survivors, pivoting to the perpetrator, focusing on children’s safety and well-being, promoting worker safety, collaborating across agencies and influencing organisational change. The process demonstrated the usefulness of this integrated approach, using practitioner-based examples.

Originality/value

Successful iterative processes to develop the guidelines were undertaken to support cultural change towards holistic and collaborative work across multiple sectors and organisations.

Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders

OBJECTIVES

Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health.

METHODS

We did a cross-sectional evaluation of sexual and reproductive health behaviors and outcomes among women with substance use disorders, who were enrolled in one of two concurrent clinical trials of pre-exposure prophylaxis for HIV prevention. Descriptive analyses and bivariate logistic regression were used to assess factors driving contraceptive use, and other essential sexual and reproductive health services utilization and outcomes.

RESULTS

Among 226 women, 173 (76.5%) were of reproductive age. Most women had histories of unintended pregnancy (79.2%) or miscarriage (45.1%) and high HIV risk behaviors (53.5%). Most (61%) participants did not use any form of contraception at the time of assessment, although few (15%) reported pregnancy intentions. In bivariate models, ongoing criminal justice involvement was associated with 2.22 higher odds of not using contraception (95% confidence interval = 1.09-4.53; p = 0.03) and hazardous drinking was protective against not using contraception (odds ratio = 0.33, 95% confidence interval = 0.13-0.81; p = 0.02). Contraception use was not significantly associated with any other individual characteristics or need factors.

CONCLUSIONS

This is the first study that identifies the unmet sexual and reproductive health needs of women with substance use disorders who are engaging with pre-exposure prophylaxis. We found that women accessed some health services but not in a way that holistically addresses the full scope of their needs. Integrated sexual and reproductive care should align women's expressed sexual and reproductive health intentions with their behaviors and outcomes, by addressing social determinants of health.

Interpersonal Trauma Among Women and Men Receiving Buprenorphine in Outpatient Treatment for Opioid Use Disorder

People with opioid use disorder (OUD) are vulnerable to negative health outcomes related to substance use and psychosocial issues, such as interpersonal trauma (IPT). Participants receiving buprenorphine completed a cross-sectional survey (July-September 2019). OUD outcomes were prospectively abstracted over a 28-week timeframe. More than a third reported recent IPT (40% women, 36% men). Sexual violence was more common among women than men (p = .02). For women only, IPT was associated with substance use during follow-up (β = 20.72, 95% CI: 4.24, 37.21). It is important for public health strategies in the opioid crisis to address IPT using sex- and gender-informed approaches.

Interventions to Reduce Intimate Partner Violence Perpetration by Men Who Use Substances: A Systematic Review and Meta-Analysis of Efficacy

INTRODUCTION

Despite the high prevalence of intimate partner violence (IPV) perpetration by men who use substances, limited evidence exists about how best to reduce IPV among this group.

METHOD

A systematic narrative review with meta-analysis determined the effectiveness of interventions to reduce IPV by men who use substances. Inclusion criteria were randomized and nonrandomized controlled trials; adult heterosexual male IPV perpetrators where at least 60% of participants were alcohol and/or drug users; the intervention targeted IPV with or without targeting substance use (SU); outcomes included perpetrator and/or victim reports of IPV, SU, or both. Methodological quality was assessed.

RESULTS

Nine trials (n = 1,014 men) were identified. Interventions were grouped into (1) integrated IPV and SU interventions (n = 5), (2) IPV interventions with adjunct SU interventions (n = 2), and (3) stand-alone IPV interventions (n = 2). Cognitive behavioral and motivational interviewing therapies were the most common approaches. Data from individual trials showed a reduction in SU outcomes in the short term (≤3months; n = 2 trials) and IPV perpetration at different time points (n = 3 trials) for interventions compared with treatment as usual (TAU). Meta-analysis with integrated IPV and SU interventions showed no difference in SU (n = 3 trials) or IPV outcomes (n = 4 trials) versus SU TAU.

CONCLUSIONS

Little evidence exists for effective interventions for male IPV perpetrators who use substances. Outcomes in integrated interventions were not superior to TAU in meta-analysis. Future trials should consider the nature of the relationship between IPV and SU in intervention design, duration of intervention, and type and timing of outcome measures. .

What Role Does Substance Use Play in Intimate Partner Violence? A Narrative Analysis of In-Depth Interviews With Men in Substance Use Treatment and Their Current or Former Female Partner

Few studies have examined intimate partner violence (IPV) in relationships where one or both partners are in treatment for substance use, from the perspectives of both members of a couple. This study used thematic and narrative analysis of the accounts of 14 men recruited from substance use services and 14 women who were their current or former intimate partners. Separate researchers interviewed men and women from the same dyad pair. The psychopharmacological effects of substance use (including intoxication, craving, and withdrawal) were rarely the only explanation offered for IPV. Violence was reported to be primed and entangled with sexual jealousy, with perceptions of female impropriety and with women's opposition to male authority. Both partners reported adversities and psychological vulnerabilities that they considered relevant to conflict and abuse. Male participants were more likely to describe IPV as uncharacteristic isolated events that arose from specific disputes-either aggravated by intoxication or withdrawal or about substance use and its resourcing-whereas women described enduring patterns of abusive behavior often linked to intoxication, craving, withdrawal, and to disputes linked to raising funds for substances. In relationships where both partners used substances, men described the need to protect their partners from addiction and from unscrupulous others while women described highly controlling behavior. In relationships where women were not dependent substance users, they reported the combined effects of psychological and financial abuse often linked to recurring patterns of substance use and relapse. These findings highlight the challenges faced by practitioners working with male perpetrators who use substances as well as the need of those working with women who have been abused to engage with the ways in which hesitance to leave male abusers can be complicated by shared drug dependency.

Using the Behaviour Change Wheel to design an intervention for partner abusive men in drug and alcohol treatment

Background

We aimed to establish what core elements were required in a group therapy programme for men who disclose perpetrating intimate partner abuse in a substance use setting and develop, and test the feasibility of delivering an intervention in this setting.

Methods

We describe the theoretical development and feasibility testing of an integrated substance use and intimate partner abuse intervention (‘ADVANCE’) for delivery in substance use services. We employed a comprehensive eight-stage process to guide this development applying the ‘COM-B’ (‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’) model for intervention design which specifies the following: (1) define the problem, (2) select the target behaviour, (3) specify the target behaviour, (4) identify what needs to change, (5) identify intervention functions, (6) identify policy categories, (7) select behaviour change techniques, and (8) design a mode of delivery. The development was informed by primary research conducted by the authors, consulting with organisation steering groups and by those with personal experiences. The identified targets for intervention and mode and method of delivery were then refined over 4 intervention development meetings, using the nominal group technique with the ADVANCE experts, then further refined following consultation with service user groups and wider expert groups via a learning alliance meetings.

Results

Our final intervention, the ADVANCE intervention consisted of a group intervention comprising of up to four pre-group individual interviews, followed by 12 × 2-h group sessions supported by integrated safety work for victim/survivors, and risk and safety support and integrity support for the professionals. The main targets for change were personal goal planning, self-regulation, and attitudes and beliefs supporting intimate partner abuse. The intervention was regarded as very acceptable to both staff and clients in substance use services, with group attendees reported positive behaviour changes and development of new skills.

Conclusion

We have demonstrated the ability to employ a structured eight-step process to develop an integrated intervention to address substance use-related intimate partner abuse that is acceptable to staff and clients in substance use services. This led to a feasibility study (ISRCTN 79435190) involving 104 men and 30 staff at three different locations across the UK was conducted to assess the feasibility and acceptability of the intervention and to refine the content and approach to delivery (BMC Public Health, 21: 980, 2021).

The Role of Illicit Drug Use in Family and Domestic Violence in Australia

Drug use has been shown to interact in complex ways with the occurrence and prevalence of family and domestic violence (FDV), with illicit drug use being associated with an increased risk for FDV. The current study aims to extend upon the literature by investigating the role of illicit drugs in intimate partner violence (IPV), family violence (FV), and other violence (violence between people other than partners or family) within a representative Australian sample (n = 5,118). Participants were recruited through an online survey panel and completed an online self-report survey assessing the role of alcohol and other drugs on violence, with a specific focus on FDV. Binary logistic regression showed that respondents who reported having used any illicit drug in the past 12 months (with or without alcohol use) had over three times the odds of experiencing any violence in the past 12 months (OR = 3.18, 95% confidence interval (CI) = [2.25, 4.48]) compared with those not using illicit drugs. Furthermore, drug involvement in FDV (IPV or FV) was significantly more likely than other violent incident types (OR = 1.65, 95% CI = [1.25, 2.19]). For the most recent FDV incident, age group was the only significant demographic predictor of drug involvement at this incident; younger age groups were over twice as likely to report drug involvement than those over 65 years of age. Drug involvement at the most recent FDV incident was also associated with over twice the odds of injury (OR = 2.38, 95% CI = [1.67, 3.38]) and significantly greater negative life impact. The findings that drug use increases both the risk for and impact of FDV indicate the need for policy that advocates for interventions addressing both drug use and violence in combination.

ADVANCE integrated group intervention to address both substance use and intimate partner abuse perpetration by men in substance use treatment: a feasibility randomised controlled trial

BACKGROUND

Substance use is a risk factor for intimate partner abuse (IPA) perpetration. Delivering perpetrator interventions concurrently with substance use treatment shows promise.

METHODS

The feasibility of conducting an efficacy and cost-effectiveness trial of the ADVANCE 16-week intervention to reduce IPA by men in substance use treatment was explored. A multicentre, parallel group individually randomised controlled feasibility trial and formative evaluation was conducted. Over three temporal cycles, 104 men who had perpetrated IPA towards a female (ex) partner in the past year were randomly allocated to receive the ADVANCE intervention + substance use treatment as usual (TAU) (n = 54) or TAU only (n = 50) and assessed 16-weeks post-randomisation. Participants' (ex) partners were offered support and 27 provided outcome data. Thirty-one staff and 12 men who attended the intervention participated in focus groups or interviews that were analysed using the framework approach. Pre-specified criteria assessed the feasibility of progression to a definitive trial: 1) ≥ 60% of eligible male participants recruited; 2) intervention acceptable to staff and male participants; 3) ≥ 70% of participants followed-up and 4) levels of substance use and 5) IPA perpetrated by men in the intervention arm did not increase from average baseline level at 16-weeks post-randomisation.

RESULTS

70.7% (104/147) of eligible men were recruited. The formative evaluation confirmed the intervention's acceptability. Therapeutic alliance and session satisfaction were rated highly. The overall median rate of intervention session attendance (of 14 compulsory sessions) was 28.6% (range 14.3-64.3% by the third cycle). 49.0% (51/104) of men and 63.0% (17/27) of their (ex) partners were followed-up 16-weeks post-randomisation. This increased to 100% of men and women by cycle three. At follow-up, neither substance use nor IPA perpetration had worsened for men in the intervention arm.

CONCLUSIONS

It was feasible to deliver the ADVANCE intervention in substance use treatment services, although it proved difficult to collect data from female (ex)partners. While some progression criteria were met, others were not, although improvements were demonstrated by the third cycle. Lessons learned will be implemented into the study design for a definitive trial of the ADVANCE intervention.

TRIAL REGISTRATION

ISRCTN79435190 prospectively registered 22nd May 2018.

Parental status and characteristics of women in substance use treatment services: Analysis of electronic patient records

BACKGROUND

Many women receiving substance use treatment services are mothers. Despite this, research has not proved whether substance use treatment services are addressing the specific needs of mothers. This study explored differences in sociodemographic, psychological, patterns of substance use, and treatment characteristics between mothers and women without children, and between mothers whose children were in alternative care.

METHOD

The study extracted data from electronic patient records (EPRs) of women who attended South London and Maudsley (SLaM) National Health Services (NHS) Foundation Trust addiction services between 2013 and 2020 (N = 4370).

RESULTS

The study identified 1730 participants (39.6%) as mothers, of whom 1340 (77.4%) had dependent children. The average number of births was 1.83 (SD = 1.0). Of the participants, 54.3% of mothers did not disclose whether their dependent child(ren) was under their care and 37.5% of mothers indicated that at least one of their child(ren) was in alternative care. Alcohol was the most reported type of substance used in the past 28 days. Mothers also highly reported suicide attempts and hospitalization due to mental health problems. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine in the past 28 days and experience lifetime domestic violence victimizations. Mothers were also less likely to have alcohol-related problems, experience overdose, and social isolation than women without children.

CONCLUSION

The study highlights the need for substance use services to invest in approaches to improve mothers' disclosure of parenting and childcare issues. It also demonstrates that EPRs can identify key characteristics of mothers.

The Challenges of Conducting Qualitative Research on "couples" in Abusive Intimate Partner Relationships Involving Substance Use

Undertaking qualitative dyad or couple interviews involving intimate partner abuse and substance use presents considerable ethical, safeguarding, and theoretical challenges throughout the research process from recruitment to conducting interviews and analysis. These challenges and how they were managed are outlined using the experience from a qualitative study of 14 heterosexual "couples" that explored the complex interplay between intimate partner abuse and substance use. Managing these challenges for participants, their families, and researchers included the use of safeguarding protocols and procedures to manage risk and the provision of clinical support for experienced researchers. Researchers often felt drawn into the conflicts and complex dynamics of opposing accounts from the male and females' relationship which could be emotionally and methodologically taxing. Researchers discussing their analysis and felt experiences with each other provided a reflexive space to manage emotions and stay close to the theoretical underpinnings.

Tales of gender-based oppression and violence: Risks and vulnerabilities of women who inject drugs (WWID) in Dhaka, Bangladesh

BACKGROUND

Women who inject drugs (WWID) experience various complexities, risks and vulnerabilities attributed to unequal gendered power differentials. This article has aimed to explore the unequal gendered power dynamics that influence HIV risks and vulnerabilities among WWID in Dhaka, Bangladesh.

METHODS

This paper is based on an ethnographic study conducted from April 2018 to December 2019 in Dhaka, Bangladesh. This component of the study constituted 2500 h of extensive field observations, 15 in-depth interviews and five focus groups exclusively with WWID. We also interviewed 15 key-informants including programme managers, an academician and harm reduction service providers. Data were thematically analysed in relation to the four bases of gendered power theorised by gender scholars Pratto and Walker which include force, resource control, asymmetrical obligations and consensual ideologies.

RESULTS

The first base, "force", highlighted situations where WWID were compelled into risky injecting and sexual behaviours to avoid violent ramifications or losing their safety nets with intimate partners. The second base, "resource control", depicted unequal access to commodities where men exercised their dominance over money and drugs. The third base, "social obligations", depicted the propensity of WWID to obey their partners and clients, thus precipitating their risky behaviours. The fourth base, consensual ideologies, were linked to weakened negotiation powers of WWID, thus increasing their propensity to risky injecting and sexual behaviours alongside poly-drug use. Despite several instances of gender-based violence and oppression, WWID have fallen victim to gender-blind interventions, as demonstrated by study observations and anecdotes.

CONCLUSION

Gender-based violence and oppression were depicted as prominent driving forces exacerbating WWID's HIV risks and vulnerabilities. If these issues are overlooked, the HIV burden will continue permeating among WWID. Thus, stakeholders need to look beyond the lens of conventional harm reduction modalities and synergize evidence-based gendered dynamics to formulate a gender-responsive comprehensive service package for WWID.

"Violence and love and drugs…it all goes hand in hand": A mixed methods analysis of the substance abuse, violence, and HIV/AIDS syndemic among women who use methamphetamine

Background: The synergistic epidemics of substance use, violence, and HIV/AIDS, also known as the SAVA syndemic, disproportionately affects vulnerable women in the United States. Methamphetamine use is closely linked with physical and sexual violence, including intimate partner violence (IPV), which heightens women's vulnerability to HIV. This mixed methods study examined the prevalence and correlates of violence among women who use methamphetamine, (n = 209) enrolled in an HIV intervention study in San Diego, California. Methods: At baseline, 209 women completed an interviewer-administered computer-assisted survey. A sub set of women who reported lifetime IPV (n = 18) also participated in qualitative interviews to contextualize our understanding of patterns of violence over time. Results: In the overall cohort, reports of lifetime (66.0%) and past 2-month (19.6%) IPV were prevalent. Moreover, women reported lifetime physical only (27.3%), sexual only (6.2%), or both forms of violence (50.7%) by multiple perpetrators. Factors independently associated with lifetime IPV were having unprotected sex with a steady partner (odds ratio [OR]: 2.50, 95% confidence interval [CI]: 1.04, 6.00) and being high on methamphetamine during unprotected sex with a steady partner (OR: 2.56, 95% CI: 1.30, 5.09) within the past 2 months. Our qualitative narratives illuminated how IPV in women's steady relationships often reflects a culmination of violent victimization throughout their lifetime which is further exacerbated by methamphetamine use and sexual risk through gendered power dynamics. Conclusions: HIV prevention interventions should address the SAVA syndemic in a holistic manner, including the role of methamphetamine use in the context of women's abusive steady relationships.

Using arrest and prescription data to examine the relationship between intimate partner violence and opioid prescriptions in the United States, 2006-2012

BACKGROUND

Research has established a strong and positive correlation between substance use and intimate partner violence due to a complex interplay of individual, situational, and contextual factors. This study seeks to further explore this relationship in the context of the recent opioid crisis in which millions of Americans have been diagnosed with an opioid use disorder. Specifically, we analyze how opioid prescriptions relate to intimate partner violence within and between counties over time throughout the rise of the opioid crisis.

METHODS

This study employs an integrated dataset that merges crime data from the Federal Bureau of Investigation, demographic data from the American Community Survey, and prescription opioid pill counts from the Drug Enforcement Administration to study the relationship between opioid pills prescribed per person and levels of intimate partner violence arrests from 2006-2012. Fixed-effects and mixed-effects techniques are both used.

RESULTS

Increases in opioid pill distribution volume within-counties over time are related to increases in intimate partner violence arrest volume (p ≤ .001). Additionally, counties which have higher amounts of opioid pills in circulation tend to experience higher levels of arrests for intimate partner violence than counties with fewer pills (p ≤ .001).

CONCLUSIONS

Policymakers who are dealing with the effects of the opioid crisis should consider the relationship between opioids and intimate partner violence when attempting to address either of these issues. Based on the results of this study, addressing opioid dependence and mitigating the extent of the crisis may also reduce intimate partner violence.

A qualitative examination of alcohol use and IPV among Nepali couples in a violence prevention intervention

Intimate partner violence (IPV) impacts the physical and mental health of one in three women globally, with equally high rates in rural Nepal. The risk of physical violence, stalking, harassment, and homicide between intimate partners increases when alcohol is used by the perpetrator. This study evaluates the impact of Change Starts at Home, a nine-month intervention to prevent IPV in which 360 married couples in the Terai region of Nepal listened to a serial radio drama and engaged in Listening Group Discussions. A sub-sample of 18 couples were selected for individual in-depth interviews that were taken at the end of the intervention and 16 months later. Participants strongly and consistently associated alcohol use with IPV against women in their own and others' relationships. Husbands and wives agreed that men sustained reductions in alcohol use, conflict, and perpetration of IPV, attributed to improvements in communication, conflict resolution, and a reduction in alcohol expenditure following the intervention. The results of this study suggest that integrating programming on alcohol reduction within IPV prevention interventions in the Terai region of Nepal has benefits on couple functioning, alcohol consumption, and IPV perpetration.

A study protocol to assess the feasibility of conducting an evaluation trial of the ADVANCE integrated intervention to address both substance use and intimate partner abuse perpetration to men in substance use treatment

BACKGROUND

Strong evidence exists that substance use is a contributory risk factor for intimate partner abuse (IPA) perpetration. Men in substance use treatment are more likely to perpetrate IPA than men from the general population. Despite this, referral pathways are lacking for this group. This trial will assess the feasibility of conducting an evaluation trial of a tailored integrated intervention to address substance use and IPA perpetration to men in substance use treatment.

METHODS/DESIGN

ADVANCE is a multicentre, parallel-group individually randomised controlled feasibility trial, with a nested formative evaluation, comparing an integrated intervention to reduce IPA + substance use treatment as usual (TAU) to TAU only. One hundred and eight men who have perpetrated IPA in the past 12 months from community substance use treatment in London, the West Midlands, and the South West will be recruited. ADVANCE is a manualised intervention comprising 2-4 individual sessions (2 compulsory) with a keyworker to set goals, develop a personal safety plan and increase motivation and readiness, followed by a 12-session weekly group intervention delivered in substance use services. Men will be randomly allocated (ratio 1:1) to receive the ADVANCE intervention + TAU or TAU only. Men's female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Regular case management meetings between substance use and ISS will manage risk. Outcome measures will be obtained at the end of the intervention (approximately 4 months post-randomisation) for all male and female participants. The main objective of this feasibility trial is to estimate parameters required for planning a definitive trial including rates of consent, recruitment, and follow-up by site and group allocation. Nested formative evaluation including focus groups and in-depth interviews will explore the intervention's acceptability to participants, group facilitators, keyworkers and ISS workers. Secondary outcomes include substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts, and quality of life.

DISCUSSION

Findings from this feasibility trial will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE intervention for reducing IPA and improving the well-being of female (ex)partners.

TRIAL REGISTRATION

ISRCTN79435190.

Is intimate partner violence more common in pregnant women with severe mental illness? A retrospective study

OBJECTIVE

To examine the risk of past and current experiences of intimate partner violence (IPV) in women with severe mental illness (SMI) in pregnancy.

METHODS

We examined past and current experiences of IPV in women with SMI in pregnancy. The data of 304 women with SMI including schizophrenia and related psychotic disorders and Bipolar Disorder meeting International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) criteria were extracted from hospital records at King Edward Memorial Hospital, Western Australia. Comparisons were made between our study data and the Australian population data reported by the Australian Bureau of Statistics, which included data on pregnant women in Western Australia. Additional measures included reported demographics, substance use and pregnancy variables.

RESULTS

Around 48% of pregnant women with SMI had experienced IPV and were three times the risk when compared with the general pregnant population in Australia. There was no difference in rates of IPV in those women with psychotic disorders when compared with bipolar disorder. Furthermore, the rates of smoking and illicit substance use were significantly higher in pregnant women with SMI who experienced IPV compared with those who have not experienced IPV.

CONCLUSION

These findings suggest women with SMI in pregnancy are at significantly higher risk of having experienced or experiencing IPV. In addition, IPV in pregnant women with SMI may increase the risk of smoking and illicit substance use. Together this suggests that maternity and mental health services should ensure there are both screening and support pathways for IPV that are developed and evaluated specifically for pregnant women with SMI.

[…] you feel there’s nowhere left to go: the barriers to support among women who experience substance use and domestic abuse in the UK

Purpose

Domestic abuse victimisation is a common experience among women with problematic substance use, but support provision for both issues is siloed within the UK. Research on the topic focuses on practitioner responses, dominating women’s voices within research, policy and practice. As such, knowledge about women’s experiences of help-seeking is missing. This study therefore aims to fill a gap in knowledge by exploring the lived experiences of supporting seeking among women impacted by domestic abuse and substance use.

Design/methodology/approach

Semi-structured interviews were conducted with 12 women who had a history of co-occurring problematic substance use and domestic abuse. Influenced by interpretive phenomenological analysis and feminist research praxis, the study explored how women with dual needs navigated support and help seeking and the barriers they faced.

Findings

The women reported the biggest barrier was the disconnect between substance use and domestic abuse support, including a gap in the communication of information. This resulted in them having to choose which of their needs to seek support for. None of the women received support for their combined experiences, and most of the women never received support for their domestic abuse experiences alone.

Originality/value

This is the first piece of research from the UK to explore, in-depth, women’s journey through support for their co-occurring substance use and domestic abuse victimisation. Previous research has not consulted with women to understand how they navigate the complex support systems available. This paper is, therefore, important, because it demonstrates the journeys to services these women take and the barriers they have to overcome.

Factors associated with the severity of IPV perpetrated by substance using men towards current partner

Purpose

The purpose of this paper is to examine frequency and correlates of intimate partner violence (IPV) severity perpetrated by heterosexual men receiving treatment for substance use towards a current partner in the past 12 months.

Design/methodology/approach

A secondary analysis of a self-reported questionnaire (n=162) completed by men receiving treatment for substance use in England and Brazil was conducted. Types of IPV perpetration (emotional, physical and/or sexual IPV) and frequency of occurrence were assessed. A five level ordinal variable for IPV perpetration severity was created: no IPV, minor; moderate, low severe and high severe. Psychological and cultural correlates of perpetration severity were explored using ordinal logistic regression.

Findings

Approximately four in ten men reported perpetrating IPV towards their partner in the past 12 months, one in ten reported perpetrating severe IPV (including hitting with something, kicking or beating, choking or burning, threatening with/using a weapon, sexual IPV and frequent emotional IPV) during this period. A number of correlates of perpetration severity were identified: experiencing childhood physical abuse, witnessing IPV in childhood, perpetrating IPV in previous relationships, committing violence towards another man, controlling behaviours, technology-facilitated abuse, depressive symptoms, having a substance using partner, receiving treatment for illicit drug use, hazardous drinking and poly-drug use.

Research limitations/implications

Despite the small sample size, small to large positive associations were observed between reporting IPV perpetration and several factors. These factors could be targeted to improve identification and assessment of IPV among men receiving treatment for substance use.

Originality/value

A strength of this study methodology is the use of a specific 12 months time frame for the perpetration of IPV towards current partner. The categorisation of levels of IPV perpetration based on types and frequency of violence occurrence was an additional valuable contribution of this study.

Long-Term Drug Misuse Increases the Risk of Cognitive Dysfunctions in Intimate Partner Violence Perpetrators: Key Intervention Targets for Reducing Dropout and Reoffending

Intimate partner violence against women (IPVAW) is a major public health problem, with an important mortality rate in women across the world. In this regard, it has been well-established that drug misuse explains (at least in part) an increased risk of IPVAW perpetration. Even though alcohol is the most widely studied drug underlying IPVAW, other drugs, such as cannabis and cocaine also seem to be significant indicators of this type of violence. Nonetheless, little is known about mediators, such as cognitive domains that facilitate proneness to violence after drug consumption. Therefore, the primary objective of the present study was to compare drug misuse patterns and cognitive performance in a carefully selected sample of IPVAW perpetrators (n = 63) and a group of non-violent men (control group; n = 39). Second, we also aimed to study the association between different patterns of drug misuse and cognitive performance and several facets of IPVAW perpetration (i.e., severity of injuries and type of aggression). Our results revealed that IPVAW perpetrators showed considerably higher levels of sustained drug misuse (alcohol, cannabis, cocaine, and heroin) for years and worse cognitive performance than controls. Moreover, the highest drug misuse sustained over time was related to the worst cognitive performance and the highest IPVAW severity. Finally, alcohol and cocaine seemed to be related to IPVAW and risk of reoffending. Whereas, cannabis, heroin, and MDMA were related to the existence of a previous criminal record (delinquency without violence). Hence, research in this field would help to develop coadjutant treatments and intervention packages to reduce drug misuse in the initial stages, which in turn would reduce cognitive impairments in IPVAW perpetrators. These expected improvements might produce an increase in treatment adherence and a decrease in the risk of future IPVAW reoffending.