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Domestic Abuse & Addiction: A Vicious Cycle

Substance abuse and domestic abuse: two important issues with a lot in common. Both are responsible for causing tremendous damage to the lives of countless people throughout the U.S. and beyond. Both cross all social, economic, political, racial, and cultural boundaries. Both exact a heavy financial toll on individuals, families, and entire communities.

Another important factor common to substance abuse and domestic abuse: they are inextricably linked to one another. Here are just a few notable facts:

So, while not every domestic abuser or victim has a co-occurring substance abuse problem, and not every substance abuser is a domestic violence offender or victim, the connection between substance abuse and domestic abuse is powerful and undeniable.

There’s one more significant factor that substance abuse and domestic abuse have in common, and it may be the most important: both can be treated successfully.

The purpose of this guide is to provide a practical discussion of co-occurring substance abuse and domestic abuse: their causes, consequences, signs and symptoms, and what can be done to defeat them. If substance abuse and domestic violence are a part of your life, or the life of someone you love, read on to learn what you can do to help.

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Substance abuse and domestic abuse: two important issues with a lot in common. Both are responsible for causing tremendous damage to the lives of countless people throughout the U.S. and beyond. Both cross all social, economic, political, racial, and cultural boundaries. Both exact a heavy financial toll on individuals, families, and entire communities.

Another important factor common to substance abuse and domestic abuse: they are inextricably linked to one another. Here are just a few notable facts:

So, while not every domestic abuser or victim has a co-occurring substance abuse problem, and not every substance abuser is a domestic violence offender or victim, the connection between substance abuse and domestic abuse is powerful and undeniable.

There’s one more significant factor that substance abuse and domestic abuse have in common, and it may be the most important: both can be treated successfully.

The purpose of this guide is to provide a practical discussion of co-occurring substance abuse and domestic abuse: their causes, consequences, signs and symptoms, and what can be done to defeat them. If substance abuse and domestic violence are a part of your life, or the life of someone you love, read on to learn what you can do to help.

For anonymous, confidential help anytime, call the National Domestic Violence Hotline at

1-800-799-SAFE (7233) or 1-800-787-3224 (TTY).

What Is Substance Abuse?

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According to the World Health Organization, “Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.” For the last several years, doctors have begun using the term “substance abuse disorder” in the diagnosis of the misuse of a variety of substance types, most commonly:

  • Alcohol
  • Tobacco
  • Cannabis: marijuana, hashish, etc.
  • Stimulants: cocaine, amphetamines, methamphetamine, etc.
  • Hallucinogens: LSD, MDMA, peyote, psilocybin, mushrooms, etc.
  • Opioids: heroin, codeine, fentanyl, hydrocodone, oxycodone, methadone, etc.

There are plenty of others. And, as evidenced by the above list, substance abuse is not limited to the use of illicit drugs. In fact, the abuse of prescribed medications in the United States has reached epidemic proportions. Consider the following: The Centers for Disease Control and Prevention (CDC) reports that the amount of prescription opioids sold in the U.S. has nearly quadrupled since 1999. During that same period, the number of deaths from prescription opioids – including methadone, hydrocodone, and oxycodone – has also quadrupled.

Signs & Symptoms of Drug or Alcohol Abuse

Substance abuse can have devastating consequences for the abuser, both physically and psychologically, such as:

  • Cardiovascular damage
  • Weakened immune system
  • Liver damage
  • Seizures, stroke, brain damage
  • Addiction
  • Paranoia
  • Hallucinations
  • Loss of self-control
  • Coordination problems
  • Impaired judgment
  • Concentration and memory lapses
  • Mood swings
  • Death

The effects of substance abuse, however, reach far beyond the actual abuser, wreaking havoc on the health and well-being of family members, friends, and even total strangers. The repercussions experienced by immediate family members can be particularly acute, often including financial instability, child abuse and neglect – and domestic abuse.

What Is Domestic Abuse?

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Domestic abuse is a term that is often used interchangeably with a number of others, including “spousal abuse,” “domestic violence,” and “intimate partner abuse.” For the sake of this article, domestic abuse will be defined using the U.S. Department of Justice’s definition of domestic violence: “… a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner.”
Domestic abuse takes many forms, including:

  • Physical Abuse
  • Sexual Abuse
  • Psychological and Emotional Abuse
  • Economic Abuse
  • Involves any intentional act resulting in physical injury or trauma through bodily contact. May include grabbing, hitting, punching, biting, slapping, hair pulling, and shoving, as well as acts of physical restraint, forcing the victim to consume drugs or alcohol, or denial of medical care.

  • Unwanted sexual activity perpetrated through the use of force, threats, or taking advantage of someone unable to give consent. In the domestic setting, may include among other things, marital rape, forcing sex following physical violence, demeaning sexual treatment, and attacks on the victim’s body.

  • Involves the use of fear and intimidation (bullying, threats of physical harm, name calling, unrelenting criticism, stalking, etc.) to cause damage to someone’s character, self-esteem, or self-worth, resulting in depression, anxiety, post-traumatic stress disorder, and/or other form of psychological trauma.

  • In the domestic environment, economic abuse refers to one partner limiting the access to financial resources to the other. May include denying access to cash, credit cards, or bank accounts, or forcing the victim to miss school or work.

Risk Factors for Domestic Abuse

While there are no specific causes that directly lead to it, there are a number of factors that may point to a greater risk of the occurrence of domestic violence. These factors can apply to either the perpetrator or the victim, or to both. They include:

  • Substance abuse, particularly alcohol
  • Unemployment or underemployment
  • Poverty
  • Poor education, such as failing to graduate from high school
  • Unplanned pregnancy or becoming a parent at an early age
  • Under 30 years of age
  • Prior involvement in an abusive relationship
  • History of abuse of pets or other animals

One of the strongest predictors of domestic abuse is the exposure to abuse in the abuser’s or victim’s childhood home. This exposure can take the form of actual abuse to the child of any kind (physical, sexual, emotional, psychological), or witnessing the abuse by one parent to the other, or to someone else. Abusers may include the child in the participation of the abuse in a number of ways, such as by blaming the violence on the child, turning the child against the victimized parent, or forcing the child to monitor the victim’s activities.

Note: It’s important to remember that the risk factors listed above only point to a greater possibility of domestic violence, and that an individual possessing one or more of these factors is not necessarily destined to become a domestic abuser or abuse victim.

Warning Signs of Domestic Abuse: What to Look For

For someone who has never experienced domestic abuse personally, the signs of violence – or the potential for violence – can be surprisingly hard to spot, particularly in the early stages of a relationship. This is true regardless of whether the victim is a family member, friend, co-worker – or even the victim him or herself. Here are some of the most common warning signs of domestic abuse to look for:

There are a variety of physical injuries that raise red flags to health care providers to the possible occurrence of domestic violence. They include:

  • Bite marks
  • Broken or fractured bones
  • Broken or loose teeth
  • Burns, particularly cigarette burns
  • Contusions (bruises)
  • Facial marks or trauma
  • Genital or rectal damage
  • Hematomas
  • Lacerations
  • Rope burns
  • Ruptured eardrum
  • Sprains or strains to knees, ankles, feet, elbows or wrists
  • Strangulation marks
  • Welts or impressions in the skin in the shape of a hand, fist, or physical article such as a belt buckle

Be particularly on the lookout for physical injuries more severe than can be explained away by the victim. It’s important to understand that victims of domestic violence are often extremely hesitant to admit to the occurrence of abuse, and frequently lie about the cause of physical injuries or make excuses for a partner’s actions.

Ongoing Physical Symptoms

Victims may also be symptomatic for a number of chronic medical issues resulting from ongoing stress caused by domestic abuse. Those issues include:

  • Back pain
  • Chest pain
  • GI problems
  • Headaches
  • Neck pain
  • Numbness and/or tingling, especially in hands or feet
  • Pelvic pain, genital pain, painful intercourse, urinary tract infection
  • Sleeplessness or restlessness

Treatment for Co-Occurring Substance Abuse and Domestic Abuse

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Regardless of any causal link, the sheer number of patients with co-occurring substance abuse and domestic violence issues presenting for treatment compels treatment programs to address the two issues concurrently. This has not always been the case. The need to treat co-occurring substance abuse and domestic violence problems simultaneously was brought about by the realization that, according to this study, “failure to address domestic violence issues among substance abusers interferes with treatment effectiveness and contributes to relapse.”

No two treatment programs are alike, each taking its own unique approach to caring for its patients. Nevertheless, most programs for the treatment of co-occurring substance abuse and domestic violence share a common set of protocols that begin with screening for domestic violence (including childhood physical abuse and sexual abuse) among substance abuse patients, and for substance abuse among domestic abusers and their victims. Screening is typically followed by a medical detox, further patient assessment, and the creation of an individualized treatment course of action that includes:

Psychotherapy

A process involving interactive talk therapy between the patient and therapist. One-on-one therapy commonly rests at the core of psychotherapy treatment, but group sessions may be included.

Medication

Treatment often includes the administration of medications to reduce substance cravings.

Holistic Therapies

Such as yoga, massage therapy, hypnotherapy, exercise, meditation, nutritional therapy, and others.

Family Counseling

Education and counseling is typically offered to provide family members and others with the knowledge and coping skills necessary to protect themselves and provide essential support for the patient. In most cases, family counseling does not directly include the domestic abuser patient.

Aftercare and Long-Term Recovery

Prior to completing inpatient or primary outpatient treatment, an individualized aftercare plan is developed to help facilitate long-term recovery success. Plans typically include provisions for continued psychotherapy, medication (if needed), and participation in peer group and/or 12-step programs.

Inpatient treatment is preferred, but outpatient programs may be available for patients unable to afford the cost or time required for inpatient care.

Rehab Considerations for Victims of Domestic Violence

For the domestic abuse victim with co-occurring substance abuse issues, the foremost concern is patient safety. Inpatient programs should have a comprehensive security plan in place. Outpatient programs should offer patients a personalized safety plan that includes safe housing and emergency support options.

Along with safety concerns, treatment programs commonly include therapies that support and validate the domestic victim patient’s story, strengthen personal empowerment, and develop problem-solving, decision-making, and life-planning skills.

Rehab Considerations for the Domestic Abuser

Safety is of paramount concern for the domestic abuser patient, in this case concerning the prevention of new incidents of violence. The key to treatment, then, is to address the patient’s violent tendencies through specifically-related therapies. The importance of obtaining a complete assessment that includes a thorough history of the patient’s prior abuse cannot be overstated.

The abuser patient is often reluctant to honestly share his or her story, so providing a therapeutic, non-judgmental environment is crucial. Since childhood abuse is often at the root of the patient’s later violent behavior, he or she must confront those past incidents of abuse and come to appreciate their impact on his/her life. The patient must also be made to understand and accept the responsibility for his or her violent and abusive acts. The development of anger management and other related coping skills are additionally emphasized.

Q&A With Addiction & Domestic Abuse Experts Heather MacLaren and Megan Wilson

About Heather MacLaren, LPC, R-DMT, GLCMA, ICDVP

Heather is a registered-dance/movement therapist and trauma specialist at Timberline Knolls, working with adolescent and adult women struggling with co-occurring disorders and trauma recovery. Her prior experience includes counseling survivors of domestic violence and their children in the Chicago area. Heather has presented her research on using dance/movement therapy with survivors of domestic violence at national and regional conferences, and is passionate about continuing the conversation on how to best support survivors’ safety and healing.

About Megan Wilson, BS, CADC

Megan facilitates psycho-educational group therapy, completes substance use assessments, and takes on the leadership role of the Addictions Specialist Team at Timberline Knolls. She additionally meets with residents on an individual basis to support a better understanding and application of 12-step. Megan received her Bachelor of Science Degree in psychology from Illinois State University. She began at Timberline Knolls in 2013 as a Behavior Health Specialist.

  • Q. Is there a connection between substance abuse and domestic violence? If so, what is it?

    Yes, substance abuse is commonly seen in abusive relationships. Many survivors find ways to avoid or numb the pain of their experiences by turning to substances, which may be a maladaptive coping mechanism. They may also be coerced or forced into using substances by their abuser.

    With the generational cycle of domestic violence, an abuser may have been a victim or witness of domestic violence as a child. They may also use substances as a coping skill, which could have deterred them from seeking support and therapy for their trauma. This suppression of their trauma can lead to acting out behaviors and the continuation of the domestic abuse cycle towards their partner or family.

    Substance use increases the likelihood of impulsive behaviors and the level of severity of abuse in perpetrators while impairing the judgment and thought processes needed for survivors to plan for their own safety.

  • Q. Is substance abuse a trigger for domestic abuse? Is domestic abuse a trigger for substance abuse?

    Substance abuse can trigger domestic abuse, and vice versa. Abusing substances can lead to increased emotions, such as exacerbation of fear or insecurities, which may be displayed as anger towards others. The feelings of guilt afterwards may then lead the abuser to return back to substance use in a vicious cycle.
    Substance use, however, is never an excuse for manipulative, coercive, controlling, or violent behavior.

    This could then trigger the survivor to abuse substances as a maladaptive coping skill. The physical and emotional isolation experienced by the survivor may also contribute to increased substance use.

    Ultimately, substance abuse and domestic violence are related, yet distinct issues.

  • Q. Are there particular substances whose abuse is more closely associated with domestic violence than others?

    Alcohol is a commonly misused substance that is related to domestic violence, with over half of reported domestic violence cases involving drinking. However, any substances may be used by the abuser or survivor.

  • Q. Is the co-occurrence of substance abuse and domestic violence common among domestic abusers? How about domestic abuse victims?

    Yes. The National Institute of Drug Use reported that 90% of women in substance use treatment had experienced severe domestic violence from a partner in their lifetime (Miller, 1994). Additionally, nearly 75% of wives of alcoholics have been threatened (AMA, 1994).

  • Q. How does treatment differ for patients (abusers, victims) with co-occurring substance abuse and domestic violence issues as compared to those without domestic violence issues?

    Treatment for survivors of domestic violence with co-occurring substance abuse includes a focus on safety and validation. Physical safety is addressed by creating a safety plan with the survivor, and is also addressed in co-occurring treatment by building positive coping skills and personal resources to support the survivor in finding a sense of safety within themselves. This can be achieved through the use of yoga, meditation, and embodied and creative arts therapies.

    Emotional safety is established through compassionate and validating relationships in which the survivor’s experience is heard and honored. Safety of the survivor through a supportive relationship provides a foundation from which to build resilience to address the underlying thoughts of the substance abuse. Treatment for perpetrators also includes emotional safety, to encourage honest reflection on their experiences without the fear of judgment.

    Treatment for both survivors and perpetrators examines how the patient’s behaviors in the past have helped them cope with their experiences. Treatment may also support patients in developing healthier relationship skills. This provides the basis for their development of healthier ways to cope with their experiences, the ability to feel and express emotions relating to their past, and ultimately towards healing.

  • Q. If you were contacted by someone about co-occurring substance abuse and domestic violence (abuser, victim, or family member or friend), what would be your first piece of advice to him or her?

    I would ask if the survivor is open to receiving services and what support they need in that moment. Rather than advice, the domestic violence community views survivors as the experts of their lives. They know best what the safe and viable options are as they take steps towards safety and health. Oftentimes, what outsiders perceive as a positive step – such as moving out of the home or relocating – can actually increase the risk of violence occurring in the relationship.

    I would have an open, honest conversation with the survivor, providing validation and support while also expressing my concerns for their safety. Securing safety for those involved is a top priority, so it is important to ensure a safety plan is made with the survivor. This includes identifying various ways they feel they can take steps to maintain or increase safety and build support around themselves and their families. Safety plans can include steps like making copies of identifications and prescriptions to keep at a different location, packing an emergency bag, or having an identified support person periodically check on them.

    If they are open, I would also provide them resources to crisis hotlines, support groups, counseling, legal counsel, and/or substance abuse treatment. There are many great resources that can further survivors’ access to support and safety when they are ready to take the next step, whatever that may be.

Q. Is there a connection between substance abuse and domestic violence? If so, what is it?

Yes, substance abuse is commonly seen in abusive relationships. Many survivors find ways to avoid or numb the pain of their experiences by turning to substances, which may be a maladaptive coping mechanism. They may also be coerced or forced into using substances by their abuser.
[...]

With the generational cycle of domestic violence, an abuser may have been a victim or witness of domestic violence as a child. They may also use substances as a coping skill, which could have deterred them from seeking support and therapy for their trauma. This suppression of their trauma can lead to acting out behaviors and the continuation of the domestic abuse cycle towards their partner or family.Substance use increases the likelihood of impulsive behaviors and the level of severity of abuse in perpetrators while impairing the judgment and thought processes needed for survivors to plan for their own safety.

Find More

Q. Is substance abuse a trigger for domestic abuse? Is domestic abuse a trigger for substance abuse?

Substance abuse can trigger domestic abuse, and vice versa. Abusing substances can lead to increased emotions, such as exacerbation of fear or insecurities, which may be displayed as anger towards others. The feelings of guilt afterwards may then lead the abuser to return back to substance use in a vicious cycle.
Substance use, however, is never an excuse for manipulative, coercive, controlling, or violent behavior.
[...]

This could then trigger the survivor to abuse substances as a maladaptive coping skill. The physical and emotional isolation experienced by the survivor may also contribute to increased substance use.Ultimately, substance abuse and domestic violence are related, yet distinct issues.

Find More

Q. Are there particular substances whose abuse is more closely associated with domestic violence than others?

Alcohol is a commonly misused substance that is related to domestic violence, with over half of reported domestic violence cases involving drinking.[...]

However, any substances may be used by the abuser or survivor.

Find More

Q. Is the co-occurrence of substance abuse and domestic violence common among domestic abusers? How about domestic abuse victims?

Yes. The National Institute of Drug Use reported that 90% of women in substance use treatment had experienced severe domestic violence from a partner in their lifetime (Miller, 1994). [...]

Additionally, nearly 75% of wives of alcoholics have been threatened (AMA, 1994).

Find More

Q. How does treatment differ for patients (abusers, victims) with co-occurring substance abuse and domestic violence issues as compared to those without domestic violence issues?

Treatment for survivors of domestic violence with co-occurring substance abuse includes a focus on safety and validation. Physical safety is addressed by creating a safety plan with the survivor, and is also addressed in co-occurring treatment by building positive coping skills and personal resources to support the survivor in finding a sense of safety within themselves. This can be achieved through the use of yoga, meditation, and embodied and creative arts therapies.[...]

Emotional safety is established through compassionate and validating relationships in which the survivor’s experience is heard and honored. Safety of the survivor through a supportive relationship provides a foundation from which to build resilience to address the underlying thoughts of the substance abuse. Treatment for perpetrators also includes emotional safety, to encourage honest reflection on their experiences without the fear of judgment.
Treatment for both survivors and perpetrators examines how the patient’s behaviors in the past have helped them cope with their experiences. Treatment may also support patients in developing healthier relationship skills. This provides the basis for their development of healthier ways to cope with their experiences, the ability to feel and express emotions relating to their past, and ultimately towards healing.

Find More

Q. If you were contacted by someone about co-occurring substance abuse and domestic violence (abuser, victim, or family member or friend), what would be your first piece of advice to him or her?

I would ask if the survivor is open to receiving services and what support they need in that moment. Rather than advice, the domestic violence community views survivors as the experts of their lives. They know best what the safe and viable options are as they take steps towards safety and health. Oftentimes, what outsiders perceive as a positive step – such as moving out of the home or relocating – can actually increase the risk of violence occurring in the relationship.
[...]

I would have an open, honest conversation with the survivor, providing validation and support while also expressing my concerns for their safety. Securing safety for those involved is a top priority, so it is important to ensure a safety plan is made with the survivor. This includes identifying various ways they feel they can take steps to maintain or increase safety and build support around themselves and their families. Safety plans can include steps like making copies of identifications and prescriptions to keep at a different location, packing an emergency bag, or having an identified support person periodically check on them.
If they are open, I would also provide them resources to crisis hotlines, support groups, counseling, legal counsel, and/or substance abuse treatment. There are many great resources that can further survivors’ access to support and safety when they are ready to take the next step, whatever that may be.

Find More

For anonymous, confidential help anytime, call the National Domestic Violence Hotline at

1-800-799-SAFE (7233) or 1-800-787-3224 (TTY).