by Gail Gilchrist, Professor of Addictions Healthcare Research, King’s College London & Liz Gilchrist, Professor of Psychological Therapies, University of Edinburgh
This article appears in our latest newsletter (Spring 2024) which can be downloaded here.
Substance use is a strong and consistent risk factor for intimate partner violence (IPV) perpetration.1
Our research found that around 4 in 10 men in substance use treatment had been abusive towards their female current or ex-partner in the past year.2,3 Rates of IPV perpetration by men in treatment for substance use are around 4 times higher than men in the general population.4 Risk factors for IPV
perpetration, including adverse childhood experiences, general violence and mental health problems, are elevated among men who use substances which may account for the higher prevalence.2,3,5
We interviewed men in treatment for substance use and their (ex)-partners to better understand the role of substance use in IPV perpetration,6-8 to inform the development of the ADVANCE-D Programme.9
Men’s substance use was linked with their use of abusive behaviour including when intoxicated, craving, in withdrawal, and when acquiring substances. We found a complex interplay between psycho-pharmacological effects of substances, gendered power relations and controlling behaviours. Intoxication, craving, and withdrawal from substances were rarely the only explanation as IPV perpetration is tied up with sexual jealousy, with perceptions of females behaving improperly and opposing male authority.
Despite the higher prevalence of IPV perpetration, there is a lack of perpetrator programmes targeted to influence the risk the factors most strongly associated with abusive behaviour.10 Incorporating substance abuse or trauma components to perpetrator interventions has shown better results.11 Perpetrator programmes that include motivational strategies increase attendance rates, treatment adherence, motivation for change, and behavioural and attitudinal outcomes.12
To address this gap, we developed The ADVANCE Programme focusing on developing participants’ strengths and developing healthy, non-abusing relationships.9
Two main models to enable change were selected 1) personal goal setting to work with individual SMART goals to build genuine motivation to facilitate change and 2) self regulation to manage disruptive emotions and impulses.
In ADVANCE clients learn to build and practice self-regulation skills to manage themselves. The ADVANCE Programme was originally delivered face-to-face in a group setting.9,13 The Programme was adapted for blended digitally-supported delivery (ADVANCE-Digital (ADVANCED)), combining an individual goal-setting session, 7 online groups, 12 self-complete website sessions led by a digital coach to practice what was learned in the groups and 12 individual coaching calls/sessions from a facilitator.14 Preliminary findings support the feasibility of delivering ADVANCE-D in substance use treatment. Online training and certification have been developed for facilitators.
Funding has been awarded to conduct a multi-centre cluster randomised controlled trial to test whether ADVANCE-D for men who use substances and are serving a community sentence or who are on license for IPV perpetration is superior in reducing IPV perpetration compared to usual criminal justice offender management in the short (4 months), medium (12 months) and longer term (24 months).
- For more information about the ADVANCE-D Programme please visit https://www.kcl.ac.uk/research/advance
References:
1 Cafferky, B. M., Mendez, M., Anderson, J. R., & Stith, S. M. (2018). Substance use and intimate partner violence: A meta-analytic review. Psychology of Violence, 8(1):110–131. https://doi.org/10.1037/vio0000074
2 Gilchrist, G., Radcliffe, P., Noto, A., Flavia, A. (2017) The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: a cross-cultural comparison. Drug and Alcohol Review. 31(1): 34-51. http://onlinelibrary.wiley.com/doi/10.1111/dar.12436/full
3 Canfield, M., Radcliffe, P., Flavia, A., Gilchrist, G. (2020) Factors associated with the severity of intimate partner violence perpetrated by men in treatment for substance use treatment towards current partner in the past 12 months. Advances in Dual Diagnosis. 13(1):32-45 https://www.emerald.com/insight/content/doi/10.1108/ADD-04-2019-0003/full/html?skipTracking=true
4 Saunders KRK, Landau S, Howard LM, Fisher HL, Arseneault L, McLeod GFH, et al. Past-year intimate partner violence perpetration among people with and without depression: an individual participant data (IPD) meta-mediation analysis. Social Psychiatry and Psychiatric Epidemiology, 58(12):1735-1747. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10627935/
5 Expósito-Álvarez, C., Santirso, F.A., Gilchrist, G., Gracia, E., Lila, M. (2023) Participants in Court-mandated Intervention Programs for Intimate Partner Violence Perpetrators with Substance Use Problems: A Systematic Review of Specific Risk Factors. Psychosocial Intervention, 26;32(2):89-108. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294470/
6 Radcliffe, P., Gadd, D., Henderson, J., Love, B., Stephens-Lewis, D., Johnson, A. et al. (2021) What Role does Substance use play in Intimate Partner Violence? Analysis of in-depth interviews with men in substance use treatment and their current or ex-partner. Journal of Interpersonal Violence, 36(21-22):10285-10313 https://doi.org/10.1177/0886260519879259
7 Gadd D, Henderson J, Radcliffe P, Stephens-Lewis D, Johnson A, Gilchrist, G. (2019) The Dynamics of Intimate Partner Violence Perpetrated by Substance Using Men. British Journal of Criminology, 59:5: 1035–1053. https://academic.oup.com/bjc/article/59/5/1035/5486457
8 Gilchrist, E., Johnson, A., Thomson, K., Stephens-Lewis, D., Henderson, J., Gadd, D. et al. (2022) Substance Use and Intimate Partner Abuse (IPA): A Descriptive Model of the Pathways Between Substance Use and IPA Perpetration for Men. Journal of Family Violence. https://doi.org/10.1007/s10896-022-00395-5
9 Gilchrist, E., McMurran, M., Johnson, A., Stephens-Lewis, D., Kirkpatrick, S., Gardner, B. et al. (2021) Using the Behaviour Change Wheel to design an intervention for partner abusive men in drug and alcohol treatment. Pilot and Feasibility Studies. 7, 191 https://doi.org/10.1186/s40814-021-00911-2
10 Lila, M., Gilchrist, G. (2023) Treatment resistant perpetrators of intimate partner violence: Research advances. Psychosocial Intervention, https://doi.org/10.5093/pi2023a10
11 Karakurt, G., Koç, E., Çetinsaya, E. E., Ayluçtarhan, Z., Bolen, S. (2019). Meta-analysis and systematic review for the treatment of perpetrators of intimate partner violence. Neuroscience and Biobehavioral Reviews, 105, 220-230. https://doi.org/10.1016/j.neubiorev.2019.08.006
12 Santirso, F.A., Gilchrist, G., Lila, M., Gracia, E. (2020) Motivational Strategies in Intimate Partner Violence Offender Programs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Psychosocial Intervention. https://doi.org/10.5093/psed2020a13
13 Gilchrist, G., Potts, L., Radcliffe, P., Halliwell, G., Dheensa, S., Henderson, J. et al. (2021) Findings from a feasibility trial of the ADVANCE integrated intervention to address both substance use and intimate partner abuse perpetration by men in substance use treatment. BMC Public Health, 21:980 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11012-3
14 Gilchrist, G., Dheensa, S., Johnson, A., Henderson, J., Radcliffe, P., Dwyer, G. et al. (2024) Adapting the ADVANCE group program for digitally-supported delivery to reduce intimate partner violence by men in substance use treatment: a feasibility study. Frontiers in Psychiatry. 14:1253126. https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1253126/full
Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.
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