Addressing ‘the great divide’: mountains of complexity between AOD and DFV Professor Cathy Humphreys The University of Melbourne SANDAS Symposium, ‘ Conversations on Complexity’ 28th September, 2016
Overview • A problem with evidence (or lack of) • Making sense of the ‘great divide’ • The issues for children living with DFV and AOD
Prevalence Alcohol is involved in 50% of all DV and 73% of physical partner assaults with 2/3 of DV involving alcohol resulted in injuries Where injuries were sustained they were more serious and more numerous compared to non-alcohol related DV Laslett, 2010 Alcohol consumed in 44% of partner homicides over 6 year period Dearden 2006 High numbers of homicides were Indigenous (16) and 87% alcohol consumed Virueda 2010 Victims more likely to have alcohol problems Loxton, 2006, Quinliven 2001
LITERATURE REVIEW • Survivors of domestic violence show rates of substance misuse 2 to 9 times the rate of those not living with domestic violence • The rate of domestic violence reported by women using heroin or crack are significantly higher than for other substances. • The link between the misuse of alcohol and drugs by perpetrators of domestic violence shows a consistent pattern of between 35% - 70% depending upon the research sample. (Humphreys, Regan, River, Thiara, 2005)
Measurement an issue • Who is being asked determines the extent of the link. Study in alcohol rehab centre (Gondolf and Foster 1991). • Clinical reports showed 20% DV • Men’s self report showed 52% DV • Partner report showed 82% DV
Evidence gathering since 1974 The evidence of the link between FV and Alcohol is old. 15 studies showed alcohol significant in 60- 70% of DV cases (Collins, 1981) 52 studies of DV showed alcohol use 1 of 4 consistent risk factors ( Hotaling and Sugarman 1986) The critical question is ‘why the gap between interventions for AOD and FV?’
CONTRIBUTIONS TO THE ‘SILO’ MENTALITY • The concerns about ‘causality’ • A ‘cultural clash’ between services • The politics of a ‘single issue’ focus • The problems of resourcing projects which address dual or complex needs • Lack of evidence • Lack of knowledge and training across sectors • Fragmentation at government level
The old chestnut of causality ‘AOD use does not cause FV’ ‘Fixing the alcohol problem won’t necessarily ‘fix’ the FV’ ‘Fixing the FV doesn’t necessarily fix the drug and alcohol problem’ BUT
Compelling cross-over issues • Evidence of increase in severity of violence with AOD is unequivocal (Graham et al 2011; Laslett, 2010) • Evidence of woman’s AOD recovery entwined with the ability to escape violence (Swan, 2001) • Alcohol and drug use becomes a tactic of abuse (Room, 1980)
Single issue focus denies complexity • Service systems have developed around single issues • Specialisation has focused on single issues and not complexity • How would we ensure joint service provision?
Lack of evidence • Joint interventions not well developed or well evaluated (Wilson, Graham, Taft, 2014) • Some promising evidence on brief alcohol intervention in MBC programs though change was not sustained • 11 studies showed clinically significant reduction in drinking and IPV but did not fit the systematic review design criteria • Problems with small numbers, attrition, evaluation design • MBC programs are notoriously difficult to evaluate
Women’s DFV Sector • Very few examples in Australia of the Women’s DFV sector addressing the joint problem of AOD and DFV. • The STELLA project in the UK has developed resources http://www.avaproject.org.uk/our- projects/stella-project.aspx • Holistic practices of women’s drug and alcohol workers addressed all forms of violence against women including DFV
Men’s groupwork programs • Practices developed to send men to AOD programs prior to entry to MBC. Sometimes formal MOUs with the AOD organisations • Motivational interviewing re AOD issues prior to entry to MBC • Communicare MBC program the only one in Australia actively addressing AOD and DFV. (de-funded)
A problem of philosophy • Communicare experience: MBC workers more effective on training to the dual issues than AOD workers. • AOD ‘soft’ on responsibility and accountability in comparison to MBC. • Problems with addiction as illness, co- dependency perspectives, engagement at all cost
Substance Abuse and Aggression program • DVIP partnering with Islington • http://www.dvip.org/assets/files/downloa ds/Substance%20use%20%20aggressi on%20programme.pdf • DVIP inputting into a drug and alcohol program; eligibility dependent upon involvement in alcohol treatment • Linked women’s support program • 2 individual assessment sessions + 16 week program
Program parameters • Any man who acknowledges that his behaviour towards a partner or ex- partner has been abusive or violent at times; who wants to think about how this relates to his substance use; who is keen to try and change some of the things that have gone wrong in his relationships with his partner and children, and stop those things happening again.
Children and FDV and Substance using mothers and fathers • Children impacted by substance misuse or FDV show similar problems • Only a limited number of ways in which children can show their distress • Fathering to date has not been a primary MBC focus. The shift to adult services addressing clients as parents is now in focus
Children living with partner abuse: presenting symptoms • Bedwetting and sleeping disorders • Anxiety, stress, depression,withdrawal • Aggressive behaviour and language • Problems at school • Chronic somatic problems and frequent presentation to doctors • Drug and alcohol abuse, education problems, suicidal ideation in adolescence
Scottish literature review: AoD and DV (Barnish, 2004) • Combination of both factors increased the negative impact in all areas: • the child’s development , • their experiences in adolescence, relationships; adolescent pathology • parenting abilities as adults, • perpetrating child abuse, • developing substance problems, • perpetrating or suffering domestic • violence in adulthood.
Challenges and Risks • Funding and length of programs • Worker training • Overcoming ‘cultural’ differences • Overcoming the ‘comfort of silos’
Benefits and facilitating factors • People’s lives and problems interconnect • The service system can silo or solidify those connections • Severity of DFV and the recovery from AOD problems are evidence based. Ignoring the AOD/DFV relationship ignores the ways in which problems entwine. • Are we part of the problem or part of the solution?
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