Issues in the Linkage of Alcohol and Domestic Violence Services: Introduction

Abstract. It is well established that alcohol is a risk factor for male against female domestic violence. Some evidence also suggests that some women victims of domestic violence develop substance abuse problems in response to their victimization. Although interpretations vary regarding the exact nature of the relationship of substance abuse and domestic violence offending and victimization, there is evidence that linking substance abuse and domestic violence services could have a positive impact on batterer cessation and victim support services. Currently, however, service linkage for the two problems is rare. There are major barriers to linkage of substance abuse and domestic violence services, including philosophical differences of treatment perspective between program types and structural impediments that make linkage difficult. The chapter discusses the barriers to linkage, examines potentially useful linkage models, and suggests the next steps to examine the feasibility of linking services for the two problems.
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Violence within the family is an ancient problem, but one that was largely viewed as a private problem until the past 20 or 25 years. Particularly important to the increased visibility of domestic violence was the first nationally representative survey of violence in the American family conducted in the mid-1970s.

The survey found that 16% of those surveyed reported some kind of violence between spouses in the year of the survey, while 28% reported marital violence at some time during the marriage.¹ This survey and numerous subsequent national and less comprehensive studies have focused attention on the family violence problem and have provided data to study its characteristics.

The reduction of violence against women by their male partners is a priority health objective for the United States² and was a major focus of the 1994 federal crime legislation. Violence against women is believed to affect approximately 4 million women annually in the United States.³ Violence against women is considered to be the leading cause of nonfatal injury for women, and an estimated 1 million women each year seek emergency treatment for injuries sustained during battering.⁴

This figure probably underestimates the number of women with battering-related treatment needs because battering goes largely undiagnosed as a potential cause of women's injuries or health problems.^5–9 National victimization data indicate that only 56% of incidents where women are attacked by an intimate are reported to police.¹⁰ Research also indicates that sustained exposure to violence leads to the development of chronic and acute health problems, including chronic pain,^8,9,11–13 miscarriage,^14,15 irritable bowel syndrome,16 depression and anxiety,^17–20 and suicide. Too often, battering culminates in homicide. In addition, and of significant importance, battered women are at higher risk for inappropriate use of prescription drugs, illicit drugs, and alcohol. In fact, battering is recognized as a major risk factor for substance abuse and mental illness among women in the United States.