Half of the men in batterer intervention programs appear to abuse alcohol or drugs, approximately half of the men in treatment for substance abuse batter, between a quarter and half of the women in treatment for substance abuse have been battered, and a substantial portion of the women in IPV programs are substance abusers (Gondolf, 1999, Chermack, Fuller & Blow, 2000; Fals-Stewart & Kennedy, 2005, Fals-Stewart, 2003, Lawson, 1994; Downs, 2001; Ogle & Baer, 2003). Despite these high numbers, the relationship between substance abuse (SA) and intimate partner violence (IPV) is complex and should not be reduced to ideas about one causing the other. Many theoretical perspectives explain the co-occurrence of SA and IPV including: substance use disruption of thinking processes; adverse childhood experiences; power motivation; during the process of obtaining and using substances; and co-occurring situations like hostile personalities, antisocial personality disorder, or poverty; however none of these theories account for all the co-occurrence of SA and IPV to indicate that SA causes IPV. Therefore, we recommend practitioners learn to ask a series of questions rather than adhere to a single theory. The questions are: (1) When did the perpetrator or victim use drugs or alcohol relative to an episode of IPV, what did they use, and how much? (2) What aspects of personality or living conditions might be influencing SA and IPV? (3) What power and control issues are in play in this case? (4) What was the specific situation and setting in which the SA and IPV occurred? (5) What is the family and social history of violence, trauma, and SA in the life of victim and perpetrator that is background to the current situation? And, (6) to what do the victim and perpetrator attribute the IPV and the SA, and how do they believe SA and IPV are linked?
The role that SA plays in men's IPV is much more prominent than the role SA plays in women's victimization. There is little evidence to support the belief that a woman's SA causes her victimization. SA plays a more substantial role in maintaining women in IPV relationships, as SA may impair women's ability to adequately protect themselves. Thus, the lifestyle associated with abuse of illegal drugs may put women even closer to harm's way.
Services provided for co-occurring SA and IPV may be serial, where SA treatment precedes IPV services, parallel or coordinated, where services are provided at the same time by different agencies, or integrated, where services are provided at the same time by the same agency. In the past decade, there was been a trend away from serial and parallel approaches and toward coordinated and integrated services.
Screening for both SA and IPV should be routine in all settings that specialize in either SA or IPV, as well as in settings where we can expect a high prevalence of both SA and IPV, such as health (both physical and mental), child welfare, and public aid agencies. Screening will be useful only if systems are modified to engage and refer those who screen positive and if agencies are in place to assess, educate, or treat the problems referred to them. Ultimately, the success of interventions for co-occurring SA and IPV depend on the investment a society is willing to make. Although rates of IPV and SA are roughly equivalent in the population, our society has viewed SA as the greater problem, while placing less emphasis (in terms of funding) on IPV. A greater awareness of IPV and a more balanced approach to co-occurring IPV and SA will benefit perpetrators, victims, and our society as a whole.