States Explore the Relationship Between Partner Violence and Substance Use Disorders

September 30, 2021 | Ramya Dronamraju

October is Domestic Violence Awareness Month, a critical moment to address intimate partner violence (IPV) as a major public health threat. CDC defines IPV as physical and/or sexual violence, stalking, or psychological aggression by a current or former partner or spouse.

According to CDC’s National Intimate Partner and Sexual Violence Survey, one-in-three female respondents report experiencing physical violence, while nearly half (47%) report experiencing psychological aggression by an intimate partner. IPV can also include partner-controlled isolation from friends, family and employment; constant surveillance; strict, detailed rules for behavior; and restrictions on access to basic necessities such as food, clothing, and sanitary facilities.

IPV is associated with substance use disorders (SUD) and mental health challenges, and numerous studies indicate that women who are abused are more likely to use or become dependent on substances. Many who face IPV use substances as a method of coping with trauma and abuse, while others are coerced into using by the abusive partner. Consequently, studies show substance use by the perpetrator of violence or the survivor is a factor in up to 60% of IPV incidents.

Women pursuing SUD treatment often face abusive partners who use tactics that undermine and control their treatment and compromise recovery goals. According to the National Center for Domestic Violence, Trauma and Mental Health, as many as two-thirds of women accessing SUD treatment reported partner violence in the last year. Currently, few systems exist to address both IPV and SUDs. Clinics and providers that treat IPV and SUD separately are usually not trained to address both problems, which can make it difficult for survivors to access effective care.

The Impact of COVID-19 On Partner Violence

The COVID-19 pandemic heightened the risk of IPV, SUD, and negative health outcomes. Although national domestic violence data for 2020 has not been released, several cities reported increases in domestic violence-related homicides.

Because of COVID-19, victims may be confined or isolated with an abusive partner who can track their calls and activities. Domestic violence hotlines anticipate that individuals may not be able to call while near their abuser and some hotlines have seen a drop in usage. Other stressors exacerbated by COVID-19—such as job loss and financial insecurity—can affect survivors’ ability to afford housing when they consider leaving. Survivors may also face homelessness. Due to these added barriers, many people experiencing IPV may not have the resources necessary to cope with and address their situations.

For women experiencing IPV and SUDs, the COVID-19 pandemic may disrupt access to syringe services, medications, and other SUD supports. This includes, but is not limited to, fear of attending treatment, suspension of programs, and financial disruption.

State Resources and Policies That Can Help

Programs, policies, and clinics must consider the changing environment and the holistic needs of those experiencing both IPV and SUDs. Some states have introduced policies that address IPV, SUD, or both during the COVID-19 pandemic:

• In 2020, Colorado allocated funding towards sustaining SUD facilities, behavioral health services, and recovery centers. Funding will explicitly be used for “services [that] help support individuals who do not have a current need for full treatment admission but need a few sessions to support positive outcomes…[and increased] availability of naloxone” to prevent death by overdose.
• In 2021, Colorado also enacted legislation that provides funding for victim services programs and purposes for populations disproportionately affected by COVID-19, including those experiencing domestic violence, sexual assault, and violence.
• In the wake of COVID-19 stay at home orders, Arkansas enacted a bill extending domestic violence protection orders to the unreasonable interference with a person’s free will and personal liberty.
• New Jersey legislators recently introduced a bill requiring the Department of Health to develop standards and protocols for COVID-19 testing for all personnel employed by and residents of SUD treatment facilities. This type of legislation would help ensure continuity of care during the pandemic.
• Connecticut lawmakers introduced legislation to use undisbursed funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act for grants to private providers of domestic violence, mental health, suicide prevention, and substance abuse services for individuals experiencing these issues as a result of the pandemic.

Looking Ahead to Other Opportunities

Beyond what states are currently considering and enacting into law, other policy opportunities to address IPV and SUDs include:

• Providing comprehensive support and resources for survivors, including safe access to in-person and telehealth services.
• Adopting a family-centered treatment approach to support access to treatment and recovery for women experiencing IPV and SUD. This framework involves children and other family members in the treatment process and provides family members with community-based supports.
• Ensuring holistic, informed program and policy development by forging partnerships among health departments, behavioral health departments, substance use facilities, and domestic violence programs.

Conclusion

As the Delta variant continues to spread, there are many public health concerns beyond containing the virus ASTHO encourages decision makers and state leaders to create evidence-based programs that will help people who experience IPV and SUD to address their individual situations.

ASTHO will continue to monitor legislation and programs addressing this important topic.