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Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

Working with domestic abusers in alcohol treatment

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Encouraging lessons learnt from a pilot integrated domestic violence programme for men in substance misuse treatment run jointly by Cranstoun and DVIP.

The Men and Masculinities Programme

Cranstoun and the Domestic Violence Intervention Project (DVIP) just (1 February 2017) published a practice briefing on a pilot programme which integrated the accredited DVIP Domestic Violence Perpetrator Programme (DVPP) and Cranstoun’s structured substance use day programme.

Background

The association between substance use and increased risk of domestic violence perpetration and victimisation is well established. There is a general awareness that women who are victims of domestic violence are at risk of substance misuse and that chronic
and severe alcohol and drug use negatively impact on parenting capacity and outcomes for children.

However, current service provision addresses these issues in isolation and little is known about men seeking help for their substance misuse who also use violent and controlling behaviour in their intimate relationships.

Challenges of integrating two treatment programmes

Whilst the aims, objectives and module content of DVIP and Cranstoun’s programmes were comparable, there were significant differences in their working styles, practices and skill sets.

DVPPs are structured 26-week interventions taking place weekly at the same time and on the same day. They require commitment and continued engagement and take place within an environment which is both challenging and supporting. They are delivered alongside a linked support service for partners of men on the group.

Cranstoun’s substance use day programmes are shorter and more flexible to respond to the needs of the user group. Service-users often have chaotic and transient lifestyles and need an intervention which is relatively tolerant of inconsistent attendance and relapse.

Additionally, men attending substance use treatment are often easily stressed and aversive to intervention. Men participating in a DVPP tend to be more emotionally resilient and able to withstand challenge and direction. They are also known to present a risk of harm to partners and children, making safeguarding and risk management an essential element of DVPPs.

Programme design

DVIP and Cranstoun jointly developed a safety focussed, 60+ hours day programme designed to support the aims and objectives of a substance use treatment programme. It combined the two working styles by using emotionally challenging and more general self-talk and CBT material. The intervention was accompanied by a woman’s support service in line with the national DVPP accreditation standard. The programme targeted men showing stability and abstinence in their substance use and the ability to attend regularly and respond well to the emotional content of the programme.

Outcomes

The practice briefing highlights a number of successful outcomes although it should be borne in mind that these outcomes are based on two full programmes with a total of 30 men:

  • 87% of men commenced treatment;
  • 77% men completed over 30 hours of structured domestic violence prevention work;
  • Men on the programme reduced their drug/alcohol use by 29% and reported a 40% improvement in their quality of life;
  • The combined intervention appeared not to impinge on the aims of the substance misuse treatment;
  • Active contact was established with 53% of ex/current partners; and
  • Only one of the women engaging disclosed an incident of domestic violence while her partner was on the programme.

Conclusions

The key conclusions were:

  • The two agencies report a positive experience of designing and running these pilot programmes. Workers from the two disciplines were able to work together productive and resolve differences in their treatment styles and priorities.
  • Workers discovered that contrary to expectations, men attending a substance misuse project will disclose significant amounts of violence and abuse in their relationships, if they are asked about this and offered the chance of a programme to help them change.
  • All the men on the programme were assessed to have demonstrated to varying degrees some sense of remorse, shame and guilt about their behaviour as they were able to acknowledge it during the programme.
  • Staff in the wider substance use treatment programme fed back that the men who participated significantly in “Men and Masculinities” showed increased levels of emotional awareness, and maintained their motivation around other aspects of the programme.

Recommendations

The briefing concludes with the following recommendations:

  • The fact that a high proportion of the men we assessed had used persistent and severe violence and abuse in their relationships highlights the need for combined substance abuse and domestic violence interventions.
  • The high take-up and retention rates, in a population which is not mandated or pressured to attend, gives hope that substance use agencies could be a good setting for domestic violence intervention work.
  • DV programmes may have something to learn from the high levels of advocacy and support work that substance abuse agencies provide, which may lay the groundwork for very vulnerable and treatment-resistant men to engage in challenging work around their behaviour in relationships.
  • Other domestic violence and substance misuse agencies combine their skills and understanding to deliver joint work. Further groups should have sufficient resourcing to enable them to closely monitor treatment outcomes.
  • Such integrated programmes should also be conducted alongside a partner support service, delivered by dedicated and appropriately experienced staff, which would allow for a more comprehensive case management process to take place alongside service delivery. This would enhance the risk management aspect of the work, as well as increase the safety of those women and potentially children affected by the violence and abuse.

 

 

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1 thought on “Working with domestic abusers in alcohol treatment”

  1. The problem with this analysis is that when the abuser is on a program with a spouse/ partner there is very little confrontation or push back. The encouragement is a natural response by someone committed in a co dependent relationship. Once the more dry abuser feels threatened by independence or stress again the abuse returns. It may not be physical, it changes often to a new form of bullying. The substances magnify but are not the root cause. The partner in co-dependence often is a contributor to substance use as it acts as a buffer and allows some time for their own freedoms. I cant imagine a partner confessing that she is still being abused while the family is being helped and while for the first time her husband seems a little better. She has been told it was her fault and if there is a “slip” she will feel responsible. Also the self absorbed nature of the abuser often allows for them to thrive in these programs –there is a pride issue. Remember this is always a secret type of person who is able to do what he does through manipulations. Unless this person is observed in an organic a way and not clinically I would hesitate to tell any female that they are now in a safe relationship no matter what these outcomes suggest. It is a not enough to feel remorse and shame –there has to be new awareness of how much they cant control it and there needs to be backup plans and safe guards. Some changes of roles is needed and women should not allow their spouse live a life without any submission or connection. I don’t believe the substance is a cause but serves as a symptom of the root in this systemic poison.

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