Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship?

Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence; however, little is known about the mechanisms of risk between these two public health concerns among this population of women. To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment. In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention strategies. This study is based, in part, on the first author's dissertation. A previous version of this paper was presented at the Society for Social Work and Research Annual Conference held in January 2005 in New Orleans, Louisiana. The following grants provided funding for this study: R01DA11027 and 3T32MH014623-22S1.     

Skills training for treatment of spouse abusers: An outcome study

The present study evaluated a 15-week cognitive-behavioral skills training program for male spouse abusers. Results showed dramatic decreases in occurrence of violent behaviors after treatment, and up to 1-year follow-up in subjects (n =32)completing the intervention. Furthermore, compared to program dropouts (n =36),completers showed a lower rate of physical violence recividism over the 1-year follow-up period. However, there was evidence of continued psychological abuse among completers in some cases (as corroborated independently by the victim/partner). Changes measured by psychometric assessment indicated decreased dysphoria. No change in basic personality, characterized primarily by disorder, was found. The latter findings was interpreted to partly account for continued psychological abuse. Implications for refining programs to address psychological abuse and to develop mechanisms to reduce attrition are discussed.     

The Relationship of Abuse to Women’s Health Status and Health Habits

The present study examined the relationship between exposure to abuse and women’s health status and health behaviors in a sample of rural women. One hundred forty-eight women visiting a community health care center completed survey packets that included measures that assessed: exposure to abuse, impairment associated with exposure to abuse, physical and mental health problems, health behaviors, and the extent of health care usage. Results indicated that exposure to abuse was positively and significantly related to the adoption of a negative psychological perspective, which in turn was negatively correlated with physical and mental health, as well as with the practice of healthy behaviors. Results also showed that women exposed to abuse engage in less healthy behaviors and utilize more health care resources than do women with no such exposure. Implications for improving the assessment and treatment of abuse in health care settings are discussed. This article is based on a thesis completed by the first author with the same title as this report.     

UNPACKING THE RELATIONSHIP BETWEEN ADOLESCENT EMPLOYMENT AND ANTISOCIAL BEHAVIOR: A MATCHED SAMPLES COMPARISON*

A large body of research has consistently found that intensive employment during the school year is associated with heightened antisocial behavior. These findings have been influential in prompting policy recommendations to establish stricter limits on the number of hours that students can work during the school year. We reexamine the linkage between first‐time work at age 16 during the school year and problem behaviors. Our analysis uses group‐based trajectory modeling to stratify youths based on their developmental history of crime and substance abuse. This stratification serves to control for preexisting differences between workers and nonworkers and permits us to examine whether the effect of work on problem behaviors depends on the developmental history of those behaviors. Contrary to most prior research we find no overall effect of working on either criminal behavior or substance abuse. However, we do find some indication that work may have a salutary effect on these behaviors for some individuals who had followed trajectories of heightened criminal activity or substance abuse prior to their working for the first time.     

Matching consequences to behavior: implications of failing to distinguish between noncompliance and nonresponsivity

Neither punitive nor therapeutic approaches alone are effective at addressing the dual public health and public safety concerns associated with managing criminal behavior perpetrated by people who have psychiatric and substance use disorders. The optimal solution may instead require the integration of both criminal justice supervision and treatment. Using problem-solving courts (PSCs) as a model, we focus on one dimension of this integrated approach, distinguishing between behavior that stems from willful noncompliance with supervision and behavior that results from nonresponsivity to treatment. First, we discuss the public health and public safety consequences of using singular approaches to address the criminal behavior of this population. We then present lessons learned from PSCs that distinguish between noncompliant and nonresponsive behaviors in making treatment and supervision decisions. Finally, we consider how the concepts of nonresponsivity and noncompliance may be extended, via policy, to probation and parole settings as well as mental health and substance abuse treatment services outside the criminal justice setting in order to enhance public health and safety.     

Distress Tolerance and Intimate Partner Violence among Men in Substance Use Treatment

Intimate partner violence (IPV) is overrepresented among men in substance use treatment. Individuals who relapse following substance use treatment report greater IPV perpetration relative to individuals who remain remitted. In addition, distress tolerance has been shown to be an important treatment target in substance use treatment, with distress tolerance predicting relapse following treatment. However, we are unaware of any research that has examined the relationship between distress tolerance and IPV among men in substance use treatment, which may hold important treatment implications. The current study therefore examined this relationship in a sample of men in substance use treatment (N = 138). Results demonstrated that distress tolerance was negatively associated with physical and psychological IPV perpetration. After controlling for age and substance use and problems, distress tolerance remained associated with psychological, but not physical, IPV perpetration. These findings suggest that distress tolerance may be an important component of treatments for IPV, particularly for psychological aggression. Substance use treatment programs that target distress tolerance may concurrently reduce the risk for relapse to substance use and IPV perpetration.     

Healing Families: An Outcome Evaluation of a Community Family Court

In this paper, a model community family court program that seeks to break the intergenerational cycle of crime and substance abuse by treating families holistically will be presented. This model court seeks to reduce crime and provide safe and permanent homes for children of substance‐abusing parents. In this community family court, the prototypical problem‐solving court has been both focused and expanded. The community family court provides a focused response designed to address the unique combination of problems facing families on a family‐by‐family basis. At the same time, supervision and treatment services have been expanded to include every family member and all open court cases including criminal charges, juvenile delinquency, dependency, and civil cases. An overview of the court's evolution and discussion of integrated services designed to provide a wraparound style intervention will be highlighted as key contributors to the largely positive results of this community family court's evaluation.     

Social support and one-year outcomes for women participating in prison-based substance abuse treatment programming

In recent decades, the number of women under criminal justice supervision has increased considerably, many of whom are serving time for drug offenses. Furthermore, women in prison are more likely than their non-institutionalized counterparts to suffer from a substance abuse disorder. While there is a growing body of research concerning women offenders’ drug abuse and treatment needs, few studies have examined the substance abuse treatment outcomes of women in the criminal justice system. Using data from Outcome Evaluation of the Forever Free Substance Abuse Treatment Program, this study compared women’s self-reported drug use twelve months after participation in high-intensity (n = 101) and low-intensity (n = 81) prison-based substance abuse treatment programming (N = 182). Women who perceived high levels of emotional social support were less likely to report substance use at 12-month follow-up. Furthermore, perceptions of emotional social support and treatment intensity interacted in their association with relapse, such that the protective effect of social support was strongest for women who participated in high-intensity programming. The results of the analyses highlight the importance of perceived social support for women with substance abuse disorders who are transitioning from prison-based substance abuse treatment programming to the community.     

Screening of Women in Jail for Health Risks and Needs

Abstract

In order to address the relative lack of services for women who come into contact with the criminal justice system, there is a need to develop quick and easily administered screening tools. This pilot study was conducted with 110 women in two urban county jails in Ohio. The purpose of the project was to develop and pilot a quick multidimensional screening instrument for women in jail to identify risk and rehabilitative needs. The project resulted in a 15-item screening tool which can be used in urban crowded jail settings to identify women at risk for health, substance abuse, mental health, family, employment or housing risks.     

Coordinated Community Intervention for Domestic Abusers: Intervention System Involvement and Criminal Recidivism

This study examined prosecution and post-prosecution elements of a coordinated community intervention approach to male perpetrators of adult domestic violence. In a sample of 235 cases, recidivism was assessed from official criminal justice data during a 12- to 18-month period after cases were initially handled by the Baltimore, Maryland State's Attorney's Domestic Violence Unit. Court orders for domestic violence counseling were associated with significantly lower criminal recidivism for battery or violation of a civil order of protection. Lower criminal recidivism was also associated with the cumulative effects of successful prosecution, probation monitoring, receiving a court order to counseling, attending counseling intake, and completion of counseling. Individuals with greater involvement in this intervention system had lower recidivism rates, even though offenders with more extensive abuse histories experienced more intervention. Results provide qualified support for coordinated community intervention for domestic violence perpetrators.     

Childhood Violence and Adult Partner Maltreatment: The Roles of Coping Style and Psychological Distress

The study investigates the impact of psychological well-being, coping style, and maltreatment types on adult partner maltreatment patterns. A large sample of undergraduates completed assessments measuring history of childhood violence exposure, psychological distress, coping, and adult partner maltreatment. The multiply abused group (childhood physical abuse and witnessing family violence) experienced the highest levels of all forms of adult maltreatment, followed by the childhood physical abuse group. As childhood victimization became more severe, the relationship between childhood victimization and adult partner maltreatment became more direct. The current study highlights that individuals exposed to a greater degree of childhood victimization are more vulnerable to adult maltreatment because there are few mediators which may prevent or decrease risk for adult maltreatment. The results suggest that treatment and prevention efforts with victims of interpersonal violence should foster individualized coping skills and address specific psychopathology depending upon the individual??s childhood abuse history.     

Fear of victimization and health

Fear of victimization may have consequences for subjective well-being. I develop and test a model linking fear of victimization to subjective health. I hypothesize that two processes link fear to subjective health-psychological and behavioral. Specifically, I hypothesize that fear of victimization increases psychological distress, and fear decreases outdoor physical activity, especially walking. High levels of psychological distress and low levels of walking, in turn, are associated with poor self-reported health. I find empirical support for the hypothesized processes in a representative national sample of 2031 adults aged 18 to 90 interviewed by telephone in 1990. The negative association between fear and health is explained largely by psychological distress and walking. However, a significant direct effect remains. I conclude with suggestions for future research linking crime and health, focusing on the need for collecting information on community disorganization. Community context is likely the ultimate exogenous variable-the one that sets in motion the destructive cycle of fear, distress, inactivity, and poor health described here.     

Collateral Damage: An Analysis of the Achievements and Unintended Consequences of Batterer Intervention Programs and Discourse

This paper reviews and critiques two prevailing program models for batterer intervention in order to highlight both their valuable achievements and attendant costs and consequences. We analyze these batterer intervention program models at 3 levels. First, we describe the historical development and basic program components of the intervention models. Second, we trace differences in the models to their grounding in different psychological assumptions and theories about behavior change, masculinity, and violence. Third, differences between the models are mapped onto contrasting approaches to the regulation of human deviance in the criminal justice and mental health systems. Based on this analysis, we conclude that further attention to structural and contextual factors, such as class, race, economic stress, and substance abuse in explanations of domestic violence is needed, together with alternative approaches to collaboration between victim advocates and batterer intervention providers.     

Elevated Risk of Arrest for Veteran's Administration Behavioral Health Service Recipients in Four Florida Counties

This paper examines the relative contribution of mental and substance abuse disorders to criminal justice involvement by examining the relative risk of arrest for three groups of adult male recipients of VA behavioral health care services. These groups include men served for both substance abuse and mental health, for only substance abuse, and for only mental health. The relative risk of multiple offences is compared to relative risk of a single offense for each group. Results indicated that relative risk of multiple arrests for the dual diagnosis group is substantially greater than for either of the single diagnosis groups, and greater than the relative risk for recipients of nonbehavioral health services. Relative risk of arrest for recipients of only mental health services is no different than the relative risk for other veterans living in the region under examination.     

Traumatic Event Exposure and Behavioral Health Disorders among Incarcerated Females Self-Referred to Treatment

At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n?=?97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence, other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral health problems within this population and providing effective interventions holds potential promise for preparing incarcerated women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.     

Feasibility of a computerized intervention for offenders with substance use disorders: a research note

Objectives

Despite evidence that treatment is effective in reducing recidivism among inmates with substance use problems, scarce resources mean that few of those in need of treatment actually receive it. Computerized substance abuse interventions could be used to expand access to treatment in prisons without placing an undue burden on resources. The major aim of the study was to compare treatment conditions in terms of their service utilization, skills acquisition, and treatment satisfaction.

Methods

The study recruited men and women with substance use disorders from 10 prisons in 4 states. In an open label clinical trial, 494 subjects were randomly assigned either to the Experimental condition, a computerized drug treatment intervention, the Therapeutic Education System (TES; n?=?249), or to the Control condition, Standard Care (n?=?245). Chi-square tests compared groups on categorical variables and independent samples t tests were used for interval level continuous variables.

Results

Initial evidence demonstrated: (1) comparable group rates of session attendance and high rates of TES module completion for experimental subjects; (2) comparable group gains in the development of coping skills; and (3) a more favorable view of TES than of Standard Care.

Conclusions

Collectively, these results show that a computerized intervention, such as TES, can be implemented successfully in prison. Given the barriers to the delivery of substance abuse treatment typically encountered in correctional settings, computerized interventions have the potential to fill a significant treatment gap and are particularly well suited to inmates with mild to moderate substance use disorders who often are not treated.     

Female Perpetrated Dyadic Psychological Aggression Predicts Relapse in a Treatment Sample of Men with Substance Use Disorders

This study examined whether female-to-male (FTM) psychological aggression predicted men’s relapse of substance use disorder (SUD) 6 months following substance use treatment. Men diagnosed with either a substance abuse or dependence disorder who had recently begun an SUD treatment program participated in the study with their female relationship partners (N = 173). Logistic regression was used to examine the relationship between baseline FTM psychological aggression and SUD relapse when controlling for baseline demographic, dyadic, substance abuse- and treatment-related variables, as well as frequencies of other male- and female-perpetrated aggressive dyadic behaviors. Higher frequencies of severe, but not minor, forms of FTM psychological aggression uniquely predicted an increased risk of relapse at 6 months follow-up. These data add to the developing research program highlighting the negative sequelae of female-perpetrated psychological aggression and also provide an empirical basis for targeting specific dyadic behaviors in the context of SUD treatment and relapse prevention.     

Factors Predicting Relationship Satisfaction,Investment, and Commitment When Women Report High Prevalence of Psychological Abuse

Relationship satisfaction, investment, and commitment in women experiencing extensive psychological abuse were examined to determine predictive factors. Participants were the top quartile of a national sample of women in conflictual relationships (N = 81) experiencing psychological maltreatment. Relationship satisfaction, investment, and commitment were each used as criterion variables with conceptually related factors as the predictors (e.g., reactions to the psychological abuse; mental health indicators; personality variables; perceived harm; problematic relationship schemas; response styles; demographics). These relationship markers were differentially predicted within this group of women. Three independent clusters of women, based on patterns of satisfaction, investment, and commitment scores, were compared regarding physical abuse, reactions to psychological abuse, ratings of perceived harm, endorsement of relationship schemas, psychological distress variables, and personality variables. The cluster of women reporting higher satisfaction, investment, and commitment in these seemingly aversive relationships frequently demonstrated differences from the other two clusters. Implications for clinical applications are discussed.     

The Comparability of Male Violent Substance Abusers in Violence or Substance Abuse Treatment

The abuse of alcohol is strongly associated with violent behavior in general and domestic violence in particular. The present study examined the compara-bility of dual-problem (i.e., substance abuse and conjugal violence) men in substance abuse and violence treatment milieus. Thirty males in substance abuse treatment and 33 men in violence treatment were identified as being dual-problematic and were administered the Addiction Severity Index (ASI) to assess psychosocial and substance abuse status, the Conflict Tactics Scale (CTS) for the frequency and type of abusive behavior, the Symptoms Checklist-90 (SCL-90) for psychological distress, and the 16 Personality Factor (16PF) for personality attributes. When dual-problem men from each milieu were compared on these measures, men in the substance abuse-milieu reported not only significantly more severe substance abuse problems, but also more frequent partner sexual abuse. Few other differences emerged. Thus, while current referral procedures may be appropriate in identifying and directing more severe substance abuse problems to the appropriate treatment setting, violent men with difficulties comparable to those seen in violence treatment may also be found in substance abuse treatment. These findings emphasize the need for: (1) routine objective screening for family violence and substance abuse in these two treatment milieus; (2) informed and up-to-date staff in both settings who are sufficiently prepared for the therapeutic challenges such men may present, and (3) more study of how treatment for dual-problem men may be coordinated by the violence and substance abuse treatment communities to optimize their outcome.