Co-occurring intimate partner violence, mental health, and substance use problems: a scoping review

Figures & data

Fig. 1 Records reviewed.

Table 1 Articles reviewed – IPV, mental health (MH), and substance use (SU)

Author, publication year	Sample size	Sample description/methods	Key findings	Recommendations provided
Cocozza et al., 2005 (39)	2,006 women	SAMHSA: quasi-experimental design with data collected from a convenience sample of women with co-occurring disorders and histories of sexual and/or physical abuse that entered integrated trauma informed treatment programs and comparative service-as-usual programs across the USA	• Treatment improved outcomes in drug use and PTSD symptoms• Integrated counseling significantly related to positive outcomes
Cohen et al., 2013 (40)	288 women	Secondary analysis of a randomized intervention trial comparing Seeking Safety (SS) and Women's Health Education (WHE) with women recruited from 7 community SU treatment centers across the USA	• SS was not superior at reducing IPV risk at 1-year follow-up• Women abstinent at baseline in SS significantly less likely to report IPV at follow-up• SS is likely most effective for reducing future IPV in participants who are abstinent	✓
Domino et al., 2005 (41)	2,006 women	See SAMHSA study above	• Intervention is more cost-effective than treatment as usual
Edwardsen et al., 2011 (42)	73 health care providers (HCP)	Pre/post evaluations of improved knowledge, attitude and efficacy of Veteran HCPs from 4 sites in New York State	• Participants considered IPV a serious issue but felt they did not adequately address it• Increase in HCPs knowledge and efficacy but no changes in attitude• Preferred mode of learning: interactive activities, then lecture, then group work, then films	✓
Herz et al., 2005 (38)	415 health care providers	All IPV/sexual assault program staff, psychologists and psychiatrists, random sample of MH practitioners, all alcohol and drug abuse counselors in Nebraska, USA	• IPV advocates had the most training and felt the most prepared; SU counselors had the least training and felt the least prepared• Respondents felt their training was adequate and there was little need for more training	✓
Larson et al., 2005 (43)	2,729 women	See SAMHSA study above	• High rates of physical health burden• Providers should consider how this may hinder treatment participation	✓
Markhoff et al., 2005 (33)	9 sites	See SAMHSA study above	• Recommendations and best practice guidelines for implementing trauma-informed care in MH and SU services	✓
Markhoff et al., 2005 (34)	1 site	See SAMHSA study above	• A highly collaborative, inclusive, and facilitated change process can:  • effect services-integration within agencies  • strengthen integration within a regional network of agencies  • foster state support for services integration	✓
McHugo et al., 2005 (44)	9 sites	See SAMHSA study above	• High exposure to stressful life events for study participants• Services are more effective when they are gender-specific and trauma-informed
McPherson et al., 2007 (45)	324 women	Longitudinal, community-based study of mothers with severe mental illness recruited from 12 community agencies and 3 psychiatric units in a large Michigan city, USA	• Women with MH and SU problems are more likely to report experiencing IPV
Morrissey et al., 2005 (46)	2,006 women	See SAMHSA study above	• Intervention effects moderated by several person-level variables• Women in high integrated sites had more positive outcomes (despite person-level characteristics)• Integrated counseling appeared most effective in addressing SU and symptoms
Sabri et al., 2013 (49)	543 women	Cross-sectional study of African American (AA) and Caribbean (AC) women recruited from primary care, prenatal or family planning clinics in mainland USA and U.S. Virgin Islands	• Severe physical and psychological abuse associated with high risk of intimate partner femicide (IPF)• Positive association between comorbid PTSD and depression and IPF• SU not significantly related to risk of IPF; PTSD was a significant mediator	✓
Savage and Russell, 2005 (47)	644 women	Subset of 2 SAMHSA sites (3 residential SU programs operated by a single multiservice agency in NY, USA and county-administered SU treatment program in California, USA) (see SAMHSA study above)	• Support network characteristics moderate the effects of traumatic stress on trauma symptoms & MH (modest support)• Women should be cautious relying on existing social support networks to help them heal
Savage et al., 2007 (48)	1,965 women	Subset of 6 SAMHSA sites (primarily SU treatment programs) (see SAMHSA study above)	• Trauma severity significantly related to trauma distress but modest impact on MH and SU problems	✓

Table 2 Articles reviewed – IPV and MH

Author, publication year	Sample size	Sample description	Key findings	Recommendations provided
Crespo and Arinero, 2010 (50)	53 women	Randomized control trial with participants seeking IPV services from several organizations in Madrid, Spain	• Both conditions reported significant improvements in PTSD symptomatology, depression and anxiety	✓
Hegarty et al., 2013 (51)	324 women (272) and doctors (52)	Cluster randomized control trial with family doctors and their patients from clinics in Victoria, Australia	• No improvement on women's quality of life, safety planning and behavior or global mental health• No differences in anxiety or comfort to discuss fear• Depression symptoms significantly decreased in intervention• Women in intervention asked more often about safety and children	✓
Howard et al., 2010 (52)	Unclear number of articles	Literature review on MH responses and interventions for psychiatric patients experiencing IPV		✓ (included articles from our review)
Laing et al., 2012 (53)	27 health care providers	Semi-structured interviews with action research project's working group (IPV and MH practitioners from Sydney, Australia)	• Increased collaboration, built trust, shared sense of purpose, mutual commitment, built personal relationships (more imp for IPV than MH workers), developed institutional empathy• Believed collaboration resulted in better client outcomes• Developed a service agreement btw IPV and MH agencies• Created new IPV-MH outreach worker position in IPV agency	✓
Miller et al., 2014 (54)	111 women	Randomized control trial of women recruited from general community and VAW shelters in urban and rural Midwestern USA and Southern Ontario, Canada	• IPV victimization rates decreased for all mothers but significantly more for those in the intervention	✓
Nicolaidis et al., 2013 (55)	59 women	Pilot study evaluating a community-based intervention with pre/post intervention design with African American participants recruited from IPV services and word of mouth in Portland, Oregon, USA	• Significant improvements in views about depression as well as depression severity, self-efficacy and self-management• Increase in self-esteem and decrease in stress• Modest dose response relationship i.e. those who participated least had least positive outcomes• Outcomes not due to use of formal services or drug therapies for depression	✓
Sabri et al., 2013 (56)	431 women	See Sabri et al., 2013 above	• More severe IPV associated with greater likelihood of MH problems, specifically PTSD and depression• AA women with severe physical and psychological IPV and high risk for IPF significantly more likely to have co-occurring PTSD and depression• Women with severe IPV who need MH care may be most at risk for underserved MH needs	✓

Table 3 Articles reviewed – IPV and SU

Author, publication year	Sample size	Sample description	Key findings	Recommendations provided
Bennett and O'Brien, 2007 (57)	255 women	Non-random sample of women seeking services from 1 of 6 agencies	• Coordinated/integrated services associated with:  • greater self-efficacy in coping with and feeling less vulnerable to the effects of IPV  • greater perceived vulnerability to IPV  • decreased SU
Bennett and O'Brien, 2010 (58)	128 women	See Bennett and O'Brien, 2007 above	• Care pathway does not have a substantial effect on outcomes where services are integrated/coordinated• Women entering through IPV agencies had less positive SU outcomes at follow-up than those entering through SU doors• Women entering through SU door have more complications than women entering through IPV door• Suggests screening at intake only for IPV & SU is inadequate to capture long-term effects of IPV on SU recovery	✓
Brackley et al., 2010 (59)	n/a	Narrative review	• Reviews TIPS 25 recommendations	✓
Fowler, 2007 (60)	102 women	New intakes and current VAW shelter residents	• Incidence of SU 5–18% higher than noted in the file• Supports the need for shelter-based SU assessment & intervention
Galvani, 2006 (61)	13 health care providers	Key informants drawn from a sample of professionals developing IPV & SU practices in England	• Safety is primary consideration• Treat the whole woman (not just her substance user)• Appears SU providers fail to recognize & address IPV leaving women & children at risk	✓
Gilbert et al., 2006 (62)	34 women	Randomized controlled trial of adult women enrolled in an outpatient Methadone Maintenance Treatment Program who reported recent IPV and illicit drug use	• Intervention effective in:   • reducing IPV & SU among women on methadone   • positive secondary outcomes (mental health distress& HIV)• Intervention is both needed and feasible	✓ (with modification)
Gutierres and Van Puymbroeck, 2006 (63)	22 articles	Literature review	• Complex relationship between trauma and SU• Childhood violence creates a vulnerability to SU• Childhood abuse and SU are independent but related risk factors for future adult violence victimization• IPV and sexual assault in adulthood contribute to increased SU which leads to increased victimization• SU treatment should address trauma and be designed specifically for women	✓
Humphreys et al., 2005 (64)	48 health care providers	Literature review/semi-structured key informant interviews with professionals working in IPV or SU policy or practice	• Silos exist for many reasons (i.e. single issue focus, concerns about causality, complex needs, lack of knowledge and training, and fragmentation at government levels)• Working together is more effective than working alone
Lipsky and Caetano, 2008 (65)	3,050 women and men	Sample drawn from 2002 National Survey on Drug Use and Health (cross sectional survey conducted annually in the USA)	• Individuals who experience IPV are more likely to access alcohol treatment services• Highlights potential to identify IPV in SU settings and provide referral and intervention services
Macy and Goodbourn, 2012 (66)	15 articles	Systematic literature review +Google/Google Scholar search and backward search of all documents	• Promote successful collaborations (coordination, integration, linkage) btw IPV & SU treatment services, providers & researchers• Interagency collaboration requires provider, director, agency and policy level strategies• Challenges to collaboration include insufficient training, differences in service and treatment philosophies, limited financial resources, fragmented policies	✓ (included 3 articles from our review)
Macy et al., 2013 (67)	15 women	Exploratory qualitative study with women from SU treatment agency in Southwestern USA	• Address the ways that co-occurring IPV & SU manifest in women's lives• Children motivate women to seek help but women are reluctant to disclose IPV or SU for fear of losing their children	✓
Martin et al., 2008 (68)	71 health care providers	Survey sent to all 84 IPV programs in North Carolina, USA	• Many women utilizing shelters have SU problems however not all shelters/staff are properly equipped to deal with SU problems	✓
Panchanadeswaran et al., 2008 (69)	416 women	Face-to-face, structured interviews with randomly selected woman from 14 Methadone Maintenance Treatment Programs in NYC, USA	• Lower levels of perceived social support were significantly associated with physical aggression, sexual assaults and injurious attacks• Highest levels of perceived social support were from significant others and lowest levels from friends• Significantly lower levels of perceived social support for drug-abusing women in the context of IPV	✓
Schumacher and Holt, 2012 (70)	Unclear number of articles	Literature review	• SA is common in women accessing IPV shelters; IPV shelter policies may bar women with active SA• Preliminary evidence suggests that addressing both problems through parallel or integrated treatment may benefit women who access IPV shelters	✓ (excluded recommendations from articles in our review)

Table 4 Recommendations extracted

Recommendation	Article
Integrate/coordinate/link services; use service agreements	34, 38, 48, 52, 53, 56, 58, 59, 66, 67, 68, 70
Consider IPV, MH & SU in IPV, MH & SU practice settings	34, 38, 40, 49, 56, 58, 63, 66, 67, 68, 70
Tailor services to individual including gender specific and culturally appropriate services	38, 49, 51, 55, 56, 59, 66, 67
Provide trauma-informed services, including assessment and treatment	33, 38, 48, 49, 56, 58, 67
Understand complex relationships among IPV, MH & SU (provider and client)	34, 49, 50, 56, 66, 67
Empower the consumer; emphasize strengths, self-esteem, resiliency	34, 48, 49, 63
Employ social cognitive theories/empowerment theories/psychoeducational interventions/transtheoretical model of behavioral change/motivational interviewing/cognitive behavioral program	50, 54, 62, 70
Consider multiple issues (retention, completion, relapse, practice issues, outreach, crisis intervention, physical disabilities, health problems, etc.)	34, 40, 61
Create safe, confidential & non-judgmental environment; use community spaces	34, 68; 55
Consider safety issues including lethality	49, 59, 67
Provide practical aid	50, 55, 69
Provide advocacy services	54, 55, 67
Provide peer-led services	34, 55
Standardize staff training; provide widespread training	38; 59
Strengthen women's social support networks	54, 69
Develop trust with women	55, 59
Address feelings of powerlessness, helplessness & guilt	63, 67
Use interactive and didactic curriculum elements	42
Develop shared sense of purpose, build relationships that promote trust, inclusive leadership, developing institutional empathy, specialist positions	53
Create a MH position in VAW agencies/VAW position in SU agency/etc.	53
Provide ongoing client-centered assessment and referral	58
Provide info about IPV/MH/SU in waiting rooms, etc.	59
Provide access/engagement	61
Use sensitivity in asking about abuse	63
Agency & policy changes are required	66
Training should be a required part of credentialing and licensing	66
Be aware of negative, critical supports	69

Cocozza JJ, Jackson EW, Hennigan K, Morrissey JP, Reed BG, Fallot R, etal. Outcomes for women with co-occurring disorders and trauma: program-level effects. J Subst Abuse Treat. 2005; 58: 43–54.

 Google Scholar

Cohen LR, Field C, Campbell ANC, Hien DA. Intimate partner violence outcomes in women with PTSD and substance use: a secondary analysis of NIDA Clinical Trials Network ‘Women and Trauma’ multi-site study. Addict Behav. 2013; 38: 2325–32.

 Google Scholar

Domino M, Morrissey JP, Nadlicki-Patterson T, Chung S. Service costs for women with co-occurring disorders and trauma. J Subst Abuse Treat. 2005; 28: 135–43.

 Google Scholar

Edwardsen EA, Dichter ME, Walsh P, Cerulli C. Instructional curriculum improves medical staff knowledge and efficacy for patients experiencing intimate partner violence. Mil Med. 2011; 176: 1260–4.

 Google Scholar

Herz DC, Stroshine M, Houser K. Exploring agreement on appropriate responses to domestic violence and sexual trauma across victim advocates, mental health services providers, and substance abuse treatment providers. Women Crim Justice. 2005; 16: 119–44.

 Google Scholar

Larson MJ, Miller L, Becker M, Richardson E, Kammerer N, Thom J, etal. Physical health burdens of women with trauma histories and co-occurring substance abuse and mental disorders. J Behav Health Serv Res. 2005; 32: 128–40.

 Google Scholar

Markhoff LS, Reed BG, Fallot RD, Elliott DE, Bjelajac P. Implementing trauma-informed alcohol and other drug and mental health services for women: lessons learned in a multisite demonstration project. Am J Orthopsychiatry. 2005; 75: 525–39.

 PubMed Web of Science ®Google Scholar

Markhoff LS, Finkelstein N, Kammerer N, Kreiner P, Prost CA. Relational systems change: implementing a model of change in integrating services for women with substance abuse and mental health disorders and histories of trauma. J Behav Health Serv Res. 2005; 32: 227–40.

 PubMed Web of Science ®Google Scholar

McHugo GJ, Kammerer N, Jackson EW, Markoff LS, Gatz M, Larson MJ, etal. Women, co-occurring disorders, and violence study: evaluation design and study population. J Subst Abuse Treat. 2005; 28: 91–107.

 Google Scholar

McPherson MD, Dleva J, Cranford JA. A longitudinal investigation of intimate partner violence among mothers with mental illness. Psychiatr Serv. 2007; 58: 675–80.

 Google Scholar

Morrissey JP, Ellis AR, Gatz M, Amaro H, Reed BG, Savage A, etal. Outcomes for women with co-occurring disorders and trauma: program and person-level effects. J Subst Abuse Treat. 2005; 28: 121–33.

 Google Scholar

Sabri B, Stockman JK, Bertrand DR, Campbell DW, Callwood GB, Campbell JC. Victimization experiences, substance misuse, and mental health problems in relation to risk for lethality among African American and African Caribbean women. J Interpers Violence. 2013; 28: 3223–41.

 Google Scholar

Savage A, Russell LA. Tangled in a web of affiliation: social support networks of dually diagnosed women who are trauma survivors. J Behav Health Serv Res. 2005; 32: 199–214.

 Google Scholar

Savage A, Quiros L, Dodd S-J, Bonavota D. Building trauma informed practice: appreciating the impact of trauma in the lives of women with substance abuse and mental health problems. J Soc Work Pract Addict. 2007; 7: 91–116.

 Google Scholar

Crespo M, Arinero M. Assessment of the efficacy of a psychological treatment for women victims of violence by their intimate male partner. Span J Psychol. 2010; 13: 849–63.

 Google Scholar

Hegarty K, O'Doherty L, Taft A, Chondros P, Brown S, Valpied J, etal. Screening and counselling in the primary setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. Lancet. 2013; 382: 249–58.

 Google Scholar

Howard LM, Trevillion K, Agnew-Davies R. Domestic violence and mental health. Int Rev Psychiatr. 2010; 22: 525–34.

 PubMed Web of Science ®Google Scholar

Laing L, Irwin J, Toivonen C. Across the divide: using research to enhance collaboration between mental health and domestic violence services. Aust Soc Work. 2012; 65: 120–35.

 Web of Science ®Google Scholar

Miller LE, Howell KH, Graham-Bermann SA. The effect of an evidence-based intervention on women's exposure to intimate partner violence. Am J Orthopsych. 2014; 84: 321–28.

 Google Scholar

Nicolaidis C, Wahab S, Trimble J, Mejia A, Mitchell SR, Raymaker D, etal. The interconnections project: development and evaluation of a community-based depression program for African American violence survivors. J Gen Intern Med. 2013; 28: 530–8.

 Google Scholar

Sabri B, Bolyard R, McFadgion AL, Stockman JK, Lucea MB, Callwood GB, etal. Intimate partner violence, depression, PTSD, and use of mental health resources among ethnically diverse Black women. Soc Work Health Care. 2013; 52: 351–69.

 Google Scholar

Bennett L, O'Brien P. Effects of coordinated services for drug-abusing women who are victims of intimate partner violence. Violence Against Women. 2007; 13: 395–411.

 Google Scholar

Bennett L, O'Brien P. The effects of violence acuity and door to service. J Soc Work Pract Addict. 2010; 10: 139–57.

 Google Scholar

Brackley MH, Williams GB, Wei CC. Substance abuse interface with intimate partner violence: what treatment programs need to know. Nurs Clin N Am. 2010; 45: 581–9.

 PubMed Web of Science ®Google Scholar

Fowler D. The extent of substance use problems among women partner abuse survivors residing in a domestic violence shelter. Fam Community Health. 2007; 30(Suppl 1): S106–8.

 Google Scholar

Galvani S. Safety first? The impact of domestic abuse on women's treatment experience. J Subst Use. 2006; 11: 395–407.

 Google Scholar

Gilbert L, El-Bassel N, Manuel J, Wu E, Go H, Golder S, etal. An integrated relapse prevention and relationship safety intervention for women on methadone: testing short-term effects on intimate partner violence and substance use. Violence Vict. 2006; 21: 657–72.

 Google Scholar

Gutierres SE, Van Puymbroeck C. Childhood and adult violence in the lives of women who misuse substances. Aggress Violent Behav. 2006; 11: 497–513.

 Web of Science ®Google Scholar

Humphreys C, Regan L, River D, Thiara RK. Domestic violence and substance use: tackling complexity. Br J Soc Work. 2005; 35: 1303–20.

 Web of Science ®Google Scholar

Lipsky S, Caetano R. Is intimate partner violence associated with the use of alcohol treatment services? Results from the National Survey on Drug Use and Health. J Stud Alcohol Drugs. 2008; 69: 30–8. [PubMed Abstract].

 Google Scholar

Macy RJ, Goodbourn M. Promoting successful collaborations between domestic violence and substance abuse treatment service sectors: a review of the literature. Trauma Violence Abuse. 2012; 13: 234–51.

 Google Scholar

Macy RJ, Renz C, Pelino E. Partner violence and substance abuse are intertwined: women's perceptions of violence-substance connections. Violence Against Women. 2013; 19: 881–902.

 Google Scholar

Martin SL, Moracco KE, Chang JC, Council CL, Dulli LS. Substance abuse issues among women in domestic violence programs: findings from North Carolina. Violence Against Women. 2008; 14: 985–97.

 Google Scholar

Panchanadeswaran S, El-Bassel N, Gilbert L, Wu E, Chang M. An examination of the perceived social support levels of women in methadone maintenance treatment programs who experience various forms of intimate partner violence. Womens Health Issues. 2008; 18: 35–43.

 Google Scholar

Schumacher JA, Holt DJ. Domestic violence shelter residents’ substance abuse treatment needs and options. Aggress Violent Behav. 2012; 17: 188–97.

 Web of Science ®Google Scholar