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Battered – and boozed

July 22, 2004 in Children, Education and training, Substance misuse, Workforce

Joanna Pearl is a service development officer for
Hounslow social services, leading on departmental transport, and
quality assurance in learning difficulty services. As a social
worker she developed an interest in working with people with
dementia. She volunteers for a domestic violence helpline and is a
workplace mediator.   

After several assaults by her male partner, Lizzie approaches a
refuge with her children. But when she discloses heavy alcohol use
to cope with domestic violence, she is refused a place and
eventually admitted to a residential detox service. It feels like a
male environment and she is afraid to disclose the violence in case
her children are taken away – a threat made by her partner. She has
become isolated by her partner’s behaviour and her own drinking.
Her children miss their home. Her partner finds her and promises to
stop his own drinking; she returns to an increasingly unsafe home
situation.

Lizzie is a fictional woman but her experiences are based on real
ones. It is an unfortunate fact of life that substance use and
domestic violence often go hand in hand, and the link may be
getting stronger. Alcohol Concern quotes Home Office figures from
2000 in which 44 per cent of domestic violence victims said their
attacker was under the influence of alcohol, compared with 33 per
cent in 1998. A US study in 1994 showed that up to 42 per cent of
women in domestic violence refuges used alcohol or other
drugs1.

Initially it may seem that the needs of substance misusers and
domestic violence victims are worlds apart. Domestic violence
services tend to adopt a feminist model, seeing the abuse as about
male power and control over women. Drug and alcohol services, on
the other hand, may adopt a more traditional medical model, viewing
substance misuse as a treatable disease.

But many workers see more similarities than differences. The Stella
Project, a partnership between the Greater London Alcohol and Drug
Alliance and the Greater London Domestic Violence Project, aims to
support organisations to work effectively with women affected by
both. It was born out of concerns expressed by many agencies about
the need for improving cross-sector thinking, networking and
action.

Domestic violence and drug and alcohol services often serve the
same women and deal with some very similar issues. These include
feelings of isolation, guilt, shame, low self-esteem; experience of
trauma; initial denial of the problem; reluctance to seek out
support for fear of losing children; and wishful thinking (“If I
ignore the problem, it might go away”).

Victims’ ability to make logical decisions may also be impaired, or
they may have their efforts at abstinence or escape from violence
sabotaged by their partner as a mechanism of control. Substance use
may even be encouraged or forced. Several returns to the substance
or relationship are common before lasting changes are made.

There is clearly a need for services which deal with both issues at
the same time. Marai Larasi, director of the Nia Project (formerly
Hackney Women’s Aid), asks: “If a substance misuse agency ignores a
woman’s safety, she may never get sober. If we ignore her use of
drugs or alcohol as domestic violence providers, she may never be
safe. Can we really afford to keep taking that risk?”

What services and support could help women like Lizzie? And do they
exist already? Larasi says that, for consistent good practice, we
need to sort the basics out first. She believes this means:

  • Training for the two sectors about each other.
  • Asking women about domestic violence and substance use wherever
    they present (cross-screening) to identify appropriate support
    rather than turn women away.
  • Integrated services, flexibility and creative options, such as
    support for women who choose to stay at home.
  • Research at a strategic and policy level to plan constructive
    agency responses, rather than knee-jerk reactions such as removing
    children.
  • Women-specific spaces and services in the substance use
    sector.

Women present to a range of services, including agencies who do
not specialise in domestic violence or substance use. As a result,
a wide range of professionals may need training and support to work
with them, whether the user is perpetrator or victim.

Research by the London Borough of Tower Hamlets’ Making the Links
project found that individuals experiencing both issues were
approaching housing, health, criminal justice, young people’s and
sex workers’ services.2 Report author Holly Taylor has
created a central point for professionals and planned a
multi-agency training pilot in the borough.

And Michelle Clarke, a specialist officer for the Drug and Alcohol
Service London, runs monthly workshops for professionals such as
midwives, doctors and day nursery workers, who may visit a woman at
home before she has approached services for help.

Clarke emphasises the difficulties women who use substances face in
accessing refuges. Women are likely to be refused if they disclose
substance use, and may have to accept temporary council
accommodation in a B&B or hostel out of the area – away from
support networks and unlikely to offer the confidentiality or
support of a refuge.

Taylor points out that this can lead to repeated loss of housing
because of rent arrears, or a return to the perpetrator: “Services
report that these women may become trapped in a cycle of chaos,
exacerbated substance use and homelessness.” Difficulties can be
multiplied for women who have no recourse to public funds because
of their immigration status.

Good practice may mean making drug and alcohol services safer
places for women experiencing domestic violence, or making refuge
services more responsive to women with drug or alcohol problems.
The former might be a stay in residential detox or rehabilitation
with flexible support from a body such as like Drug and Alcohol
Service London, so that the substance misuse service becomes a
place of safety.

The Nia Project offers the latter – a refuge where women are not
automatically excluded if they disclose alcohol or drug use, or
forced to stop drinking as a condition of entry. The Nia Project
uses a holistic assessment process: refuge workers are trained to
feel more comfortable with questioning women’s use of alcohol,
explaining that it is to identify the best service for the woman
rather than to discriminate. This has increased numbers of women
who disclose.

Women can drink without condemnation in the Nia Project’s refuges,
but they must keep to the rules of behaviour. Similarly, they are
free to return to an abusive partner, but are involved in
transparent decision-making about detrimental effects of that
return on their children and potential child protection
issues.

But Larasi talks of her dream of truly linking domestic violence
and substance use services. She is running a one-year partnership
project to open a specialist refuge for women experiencing domestic
violence and substance use. Its evaluation could champion a
good-practice model.

For women like Lizzie, innovative work is bridging the gap between
sectors. Its efficacy will be proved when they can access
integrated services without judgement and rejection.

Abstract

This article analyses the links between domestic violence and
substance use. It argues that women can be failed or rejected by
services lacking integrated knowledge of domestic violence and
substance use and their links, and that professionals need training
and support to offer safe and effective services.

References

1
Separate Issues Shared
Solutions, the Stella Project, 2003 

2 Holly Taylor, Domestic
Violence and Substance Misuse – Making the Links: An Evaluation of
Service Provision in Tower Hamlets, 2003

Further information

Contact the author   

Joanna Pearl can be contacted at  Joanna.pearl@hounslow.gov.uk

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