safety alert

If you are in danger, please use a safer computer, call 911 or your local hotline or call the National Domestic Violence Hotline: 1-800-799-SAFE (7233 voice), 1-800-787-3224 (tty). There is always a computer trail, but you can click ESCAPE to leave the site quickly.

Initial Intervention and Follow-Up

Described below are different categories that reflect an individual’s use of substances. An advocate’s response and follow-up should be determined by each individual woman’s experience with substance use.

No Significant Problem with Substance Abuse

Once an initial screening occurs, an advocate may determine a woman has no significant problem with substance use. Should this be the case, information about safety should be provided. Alcohol and drugs affect the brain and the body whether addiction is present or not. This information should be included along with basic information about how substance use can compromise safety. Sometimes a woman herself may not be using or misusing substances but her safety may be compromised by another’s use. Discussions about safety should explore risks associated with partner use as well.

Follow-up is advised to determine whether a woman’s needs change over time. Additional options, referrals and support must be offered if, over time, an advocate becomes aware of potential difficulties stemming from the program participant’s, or another person’s, use, misuse or addiction. Follow-up may address concerns stemming from changes in observed behavior, noticeable signs of substance use or concerns about drug-seeking behavior (e.g., over-use of over-the-counter or prescription medications).

It is also helpful to be alert. Notice if the client has:

The odor of alcohol on her breath
Red eyes, pin-point or dilated pupils
Track marks on arms, hands or feet
Inflamed or eroded nasal septum

Cues which, if not directly indicative of addiction, at least indicate substance misuse may be occurring, include:

Rapid speech
Difficulty tracking conversation
Scratching and picking at arms or face during a visit
Lethargy
Nodding
Cigarette burns (which may also be indicative of domestic violence)
Prescription drug-seeking behavior

Significant Problem with Substance Abuse

Substance abuse is a destructive pattern of use of drugs including alcohol, which leads to clinically significant (social, occupational, medical) impairment or distress. Often the substance use continues in spite of significant life problems related to that use. Following an initial screening, an advocate may identify a woman has an increased safety risk stemming from her, or another’s, significant problem with substance misuse or abuse. Sometimes a significant problem with substance abuse is not identified at an initial contact but is revealed later. Whenever substance abuse is identified, information about safety should be provided and concern should be expressed. Options should include reviewing safer alternatives to substance use, providing linkage to counseling and on-site support systems, as well as community-based referrals. Discussions about safety should explore risks associated with partner substance abuse as well.

Substance-abusing women should be asked to consider refraining from substance use while they are using services. Follow-up should include checking to see if abstinence is causing any unexpected challenges or difficulties. Should a woman feel out of control, preoccupied by use, edgy or compelled to use, addiction may be indicated and withdrawal symptoms may appear.

Chemical Dependence

Substance use and misuse are behaviors. Research supports several theories related to causal etiologies of substance abuse and addiction, including behavioral, medical and other models. According to the disease model, chemical dependence, unlike domestic violence, is not a behavior. It is considered a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal.

When a person begins to exhibit symptoms of tolerance (the need for significantly larger amounts of substance to achieve intoxication) and withdrawal (adverse reactions after a reduction of substance), it is likely that the person has progressed from abuse to dependence and addiction. While diversity of thought exists pertaining to addiction, it is critical to learn to recognize and identify women with this condition and provide appropriate intervention.

Battered Women in Recovery from Chemical Dependence

Following an initial screening, an advocate may learn a woman is in recovery from addiction to alcohol or other substances. Whenever past substance abuse is identified, information about safety should be provided and concern should be expressed about risks to sobriety associated with domestic violence and stress. These concerns may be greater for women with less time in recovery, but warranted for any woman addressing both issues regardless of amount of time in recovery.

Basic safety and sobriety tips should be provided, as well as information about risks associated with partner substance use. Options should include reviewing current support systems, providing linkage to counseling and on-site support systems, as well as community-based referrals. Follow-up is indicated periodically to determine whether increased support is wanted. Chemical dependence is a disease marked by periodic relapse. Should obvious signs of renewed preoccupation with substances or substance use occur, address them immediately. Discuss safety options including support groups and treatment with an open, supportive and non-judgmental attitude.

Battered Women Currently Active in their Addiction

Expressing care and concern rather than being critical is most useful when helping chemically dependent battered women address addiction and its impact on their safety. Be gentle. Always include messages linking safety and sobriety and address the benefits of stopping use any time.

Addiction is characterized by continuous or periodic impaired control over drinking alcohol or using other drugs, preoccupation with drugs or alcohol, use of drugs or alcohol despite adverse consequences and distortions in thinking (most notably denial). Therefore, this problem impacts sufferers whether they are actively using or not.

Addiction is marked by physiological and central nervous system changes that lead to the development of tolerance, loss of control, continued use in spite of adverse consequences and withdrawal symptoms. Women are often unable to discontinue use without assistance.

Should this be the case, advocates will need to help women assess whether the immediate risks from a batterer outweigh those stemming from their current substance abuse and addiction. Ultimately this is not a question of whether safety or sobriety should take place first. Safety and sobriety are both important, since one is less likely without the other. Rather, the question is: What does the woman you are advocating for want to address today?

Discuss strategies to support behavior change such as 12-step programs, chemical dependency/domestic violence support groups and treatment options. If possible, suggest a referral for a more in-depth chemical dependency assessment and make the appointment together if the client is interested. Get a release of information and maintain communication with the chemical dependency treatment provider to support her progress. Be sure to follow up and provide emotional support.

print this page

email this page

back to previous page