Comorbid substance use diagnoses and partner violence among offenders receiving pharmacotherapy for opioid dependence

Identifying best practices for substance-related intimate partner violence screening and referral: a narrative review

Introduction

Substance use is strongly associated with intimate partner violence (IPV) and is a modifiable risk factor for IPV. However, lack of comprehensive screening and referral for co-occurring IPV and substance use, along with their psychiatric sequalae, limits the identification and implementation of effective interventions for substance-related IPV. This narrative review (1) investigates the literature on screening and referral practices for IPV, and if these include screening for substance use or other psychiatric comorbidities, (2) provides recommendations for current best practices, and (3) suggests future directions for research and practice aimed at identifying and reducing substance-related IPV.

Methods

A narrative literature review examined studies investigating IPV screening and referral programs in clinics. Selected studies were reviewed for: (1) effectiveness, (2) barriers to implementation and sustainability, and (3) responsivity to psychiatric comorbidity, including substance use and substance use disorders (SUD).

Results

Findings suggest that effective IPV screening and referral programs have been developed, but disparities in IPV screening exist and many programs only screen for IPV victimization. Barriers to the implementation and sustainability of IPV screening programs include lack of ongoing provider training, funding or institutional support, and direct connection to referral services. Further, many IPV screening programs lack assessment of and referral for comorbid psychiatric conditions, including substance use, and tend not to be routinely implemented in SUD clinics.

Discussion

Additional systematic work is needed to develop universal and comprehensive screening and referral programs for substance-related IPV and address issues of long-term sustainability, particularly within SUD treatment settings.

Intimate Partner Violence and Couple Conflict Behaviors: The Moderating Effect of Drug Use Problem Severity

Intimate partner violence (IPV) is a maladaptive conflict behavior, and IPV is both a precipitant and consequence of drug use problems among couples. It is unknown how drug use problem severity modulates the association between IPV and observed conflict behaviors. As part of a larger clinical trial, a sample of 30 different-sex substance-misusing couples completed self-report questionnaires and participated in a laboratory conflict resolution task. The current exploratory study tested whether drug use severity moderated the association between IPV perpetration and positive and negative conflict resolution behaviors, respectively, while controlling for IPV victimization. The results suggest that among men, drug use severity moderates the association between psychological IPV perpetration and negative conflict behaviors. Men who report more severe IPV display more negative behaviors when their drug use problems are more severe. Among women, drug use severity moderated the effect between psychological IPV perpetration and negative conflict behaviors among women, such that women with lower drug use problem severity displayed more negative conflict behaviors when psychological IPV perpetration was more versus less severe. Drug use severity also moderated the association between physical IPV perpetration and negative and positive conflict behaviors among women. That is, women who reported more severe physical IPV displayed more negative and fewer positive behaviors when their drug use problems were more severe. Results have preliminary implications for targeting conflict resolution strategies differentially in men and women with drug use and a history of IPV perpetration. Future studies should replicate the current findings in larger, more representative samples, and examine the role specific drugs have on the association between IPV and conflict behaviors.

Dispositional Mindfulness and Aggression Among Adults in Residential Treatment for Opioid Use Disorder: Preliminary Findings From an Applied Setting

Individuals with opioid use disorder (OUD) evidenced high levels of aggression both before and after the onset of opioid misuse. Continued aggression after abstinence suggested that abstinence alone may be inadequate. The present study investigated dispositional mindfulness in relation to aggressive attitudes, and verbal and physical aggression, by reviewing medical records of 163 adults in residential treatment for OUD. Results of hierarchical regression analyses, controlling for age and alcohol/drug use and problems, revealed a negative relationship between dispositional mindfulness and both aggressive attitudes and verbal aggression. Although dispositional mindfulness negatively related to physical aggression at the bivariate level, only alcohol use and problems related to physical aggression in regression analyses. Mindfulness-based treatments may be a useful avenue for targeting aggression within this population.

The Influences of Drug Abuse on Mother-Infant Interaction Through the Lens of the Biopsychosocial Model of Health and Illness: A Review

Women who abuse illicit drugs often engage in atypical parenting behaviors that interfere with the natural development of mother-infant interaction and attachment. Maternal caregiving deficits leave pronounced adverse consequences in the wake of drug abuse relapse, which often occurs and in early infancy. These are times when the child requires optimal parental care. The contemporary literature documents long-term implications of illicit drug-abuse in parenting on infants. However, factors that drive and sustain the influence of drug abuse on parent-infant outcomes remain elusive. This review adopts a biopsychosocial approach to synthesizing the existing state of knowledge on this issue. Mother-infant interaction is a dynamic socio-relational process that occurs at multiple levels of organization. As such, a biopsychosocial perspective enables us to uncover: (i) roles of specific physiological mechanisms and biological characteristics of atypical parenting in mothers who abuse drugs, (ii) the influence of drugs on maternal psychological state (i.e., beliefs regarding parenting practices, emotional regulation), and (iii) social relationships (i.e., relationships with spouse and other drug abusers) and contextual cues (i.e., triggers) that moderate non-optimal maternal caregiving. A comprehensive review of these key domains provides a nuanced understanding of how these several sources interdependently shape atypical parent-infant interaction amongst drug abusing mothers. Systematic elucidation of major factors underlying drug-abused maternal behaviors facilitates the development of targeted and more effective interventions.

Coping and violence perpetration in a residential substance use disorder treatment sample

Background: Individuals in substance use disorder treatment report high rates of violence against partners and non-partners. There is growing interest in integrated coping-oriented treatment approaches for violence and substance use concerns, yet little is known about the relationship between specific coping responses and perpetration of partner and non-partner violence. Objective: This cross-sectional study evaluated relationships between coping responses and partner and non-partner physical assault perpetration in a substance use disorder treatment sample. Methods: Participants included 343 men (76%) and women (24%) who completed self-report survey measures of coping responses, violence perpetration, and substance use as part of screening for a randomized trial. Negative binomial regression was used to examine relationships between coping strategies and partner and non-partner violence perpetration, when accounting for substance use and demographic factors. Results: About one-third of participants reported partner violence perpetration (30%) and non-partner violence perpetration (34%). Frequency of partner violence and non-partner violence were both associated with more use of avoidant and emotion-focused strategies and less use of problem-focused coping in adjusted models. Discussion: Continued research is warranted to determine whether coping-oriented interventions decrease violence among people in substance use disorder treatment.