More Handouts

Safety and Sobriety Manual
Best Practices in Domestic Violence and Substance Abuse

January 2005

If you have any questions regarding the documents found in the Appendix Resource, please contact Teresa Tudor via email or at 217-558-6192.

Woman Abuse/Substance Abuse: What is the Relationship?

When substance abuse and violence against women happen together, many people get confused about cause and effect. Does alcohol or drug use cause a perpetrator to get violent? Does being a victim of violence cause a woman to develop substance abuse problems? If a woman abuses alcohol or drugs, does this mean she asks for trouble? Here, based on research, are answers to some commonly asked questions.

Does alcohol or drug use cause violent behavior?

Studies show that people who get violent when intoxicated already have attitudes that support violence⁽¹⁾ They believe they have the right to control another person. They believe violence and other abuse are acceptable ways to gain control. A perpetrator may use intoxication to excuse violent or abusive behavior. But substance abuse is no excuse for crimes such as domestic violence or sexual assault.

Will treatment help a perpetrator stop being violent?

If a woman leaves an abusive relationship, her partner may promise to get treatment or attend A.A. meetings. These promises may be a way to manipulate her into returning. Unfortunately, there is no guarantee that substance abuse treatment will stop violence.⁽²⁾ If physical violence stops, other abusive and controlling behavior often replaces it.⁽²⁾ A perpetrator must confront attitudes that support violence.

Does being a victim of violence cause substance abuse?

Not every abused woman uses alcohol or drugs. So there is not a direct cause-and effect relationship. But trauma can increase a woman's risk for substance abuse.⁽¹⁾ Some women may use alcohol or drugs as an anesthetic, to relieve the pain caused by violence.⁽¹⁾ If the pain continues, and the "self-medicating" continues, conditions are perfect for addiction to develop.

If a woman abuses alcohol or drugs, does this mean she asks for trouble?

No woman deserves to be abused in any way, no matter what else is going on. If she is in a relationship, does this mean her partner must overlook substance abuse? No. Her partner has a right to ask that she get counseling or other help. Her partner has a right to end the relationship. But drinking or drug use never justifies violence.

Why is substance abuse risky in a violent situation?

While substance abuse does not cause violence, it can make a violent situation more dangerous. If the perpetrator is intoxicated, there is a greater risk the victim will be injured or killed.⁽³⁾ If the victim is intoxicated, she may find it harder to get safe.⁽²⁾

Women coping with violence and their own substance abuse may find themselves caught up on a merry-go-round. Substance abuse makes it harder to escape a violent situation, or to heal from past abuse.⁽²⁾ Continuing violence or unresolved feelings about abuse make it harder to stay away from alcohol or drugs.⁽²⁾

How does substance abuse interfere with safety?

Substance abuse impairs judgment. This makes safety planning more difficult.⁽²⁾ The victim may avoid calling police for fear of getting arrested or being reported to a child welfare agency.⁽²⁾ She may be denied access to shelters or other services if she is intoxicated.⁽²⁾

How does substance abuse interfere with healing from violence?

If a woman is abusing alcohol or drugs, it is hard to heal the pain caused by violence. Counseling or therapy sessions can bring out strong emotions.⁽¹⁾ Alcohol and drugs cut off these emotions, and the feelings get pushed back down inside.⁽¹⁾ So the work cannot go forward. The healing doesn't happen. The pain continues.

How does violence interfere with recovery from addiction?

A woman may use alcohol or drugs to "stuff' her feelings about the abuse.⁽¹⁾ When she stops drinking alcohol or using drugs, buried emotions may come to the surface. ⁽¹⁾ These feelings of pain, fear or shame can lead to relapse if not addressed.⁽⁴⁾

In an abusive relationship, a woman's recovery may threaten her partner's sense of control. To regain control, her partner may try to undermine her recovery. ⁽¹⁾ Her partner may pressure her to use alcohol or drugs. ⁽¹⁾ Her partner may discourage her from seeing her counselor, completing treatment, or attending meetings. ⁽¹⁾ Her partner may escalate the violence. ⁽¹⁾

How can a woman get off this merry-go-round?

Many women have found they will need to address both the substance abuse and the violence.⁽²⁾ A domestic violence agency can help a woman who is in an abusive relationship. A rape crisis center can help if she has been sexually assaulted or sexually abused. Substance abuse treatment can help if she has problems with alcohol or other drugs. No matter where she goes for help first, her counselor or advocate can make referrals. This way, she can get all the services she needs.

(1) Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment. Substance Abuse Treatment and Domestic Violence, Treatment Improvement Protocol Series 25. Rockville, MD: U.S. Department of Health and Human Services, 1997.

(2) Domestic Violence/Substance Abuse Interdisciplinary Task Force. Safety and Sobriety: Best Practices in Domestic Violence and Substance Abuse. Springfield, IL: Illinois Department of Human Services, 2000.

(3) Bland, Patricia. Strategies for improving women's safety and sobriety. The Source, Reprint 50, 1997.

(4) Simmons, Katherine P., Terry Sack and Geri Miller. Sexual Abuse and Chemical Dependency: Implications for Women in Recovery. Women and Therapy 19 (2), 22. O 2001 by Debi Edmund Springfield, IL

Naming the Problem

Violence against women and girls takes many forms. These include domestic violence, sexual assault and sexual abuse. Substance abuse also takes many forms. The substance could be an illegal drug such as crack or heroin. The substance could also be alcohol or prescription drugs such as tranquilizers, painkillers or sedatives.

Put a check mark next to any of these signs you have experienced. Do any of your answers surprise you? Whether the issue is substance abuse or violence, it can be hard to face the situation. But the first step in addressing a situation is to recognize the situation for what it is.

What is domestic violence?

Domestic violence goes beyond normal disagreements to abuse. One person uses a pattern of abusive behavior to gain power and control over another. The abuse may be physical, sexual, psychological or economic. Examples of abuse range from put downs and name-calling, to pushing and shoving, to severe beatings or murder. Could you be involved in an abusive relationship? Here are some warning signs. Does your partner:

Slap, hit, push, punch or physically hurt you in other ways?
Threaten to harm you or your children?
Say things to you that are hurtful or demeaning?
Discourage you from seeing or speaking to your family or friends?
Prevent you from leaving the house, getting a job or returning to school?
Force you to have sex, or pressure you to perform sexual acts you don't like?
Express anger physically (throw things, hit walls, destroy your belongings)?
Use alcohol or drugs as an excuse for saying hurtful things or abusing you?
Make you feel as if you need to "walk on eggshells?" In other words, are you often afraid of your partner, or afraid to express your true feelings?

What is sexual assault or sexual abuse?

Sexual assault and sexual abuse refer to any sexual contact without your consent. Examples include rape, attempted rape, unwanted touching and child sexual abuse. The abuser could be a stranger, date, friend, lover or even a spouse or relative. Sexual abuse is often involved in domestic violence, and may be one way batterers abuse their partners. Here are some examples of sexual assault and sexual abuse. Has anyone:

Forced you to have sex when you didn't want to?
Forced you to perform sexual acts you didn't like?
Touched you in ways you didn't like after you said no?
Threatened to hurt you if you didn't cooperate?
Behaved in ways that caused you to feel intimidated or afraid?
Forced you to have sex with others, or engage in prostitution?
Had sex with you while you were heavily intoxicated or passed out?

Any sexual behavior between a child and someone who has power over the child is sexual abuse. This is true even if the child agreed to participate. The difference in age and power between a child and an older person makes informed consent impossible. When you were a child, were you ever:

Touched or fondled in a sexual way by an older person?
Asked to touch an older person in a sexual way?
Asked by an older person to look at pornographic movies or magazines?
Asked by an older person to undress or pose in a sexual manner for a photo?
Asked to keep any sexual activity a secret or warned not to tell anybody?

What is substance abuse?

Substance abuse is the continued use of drugs, including alcohol, even when such use causes problems. If a person experiences unusual tolerance or withdrawal, the substance abuse has probably progressed to addiction. Addiction is a chronic disease which is often progressive and fatal. Could you be in trouble with alcohol or other drugs? Here are some warning signs:

Do you often use alcohol or drugs to relieve stress or escape problems?
Do you use prescription drugs more often than directed, or for nonmedical purposes?
Do you need more and more of the substance to get the same effect?
Do you often get drunk or high after promising yourself you wouldn't?
Do you have blackouts (times when you don't remember what happened while you were intoxicated)?
Do you have tremors, shakes or other uncomfortable symptoms when you can't get alcohol or another drug?
Do you often fail to meet responsibilities because of drinking or drug use?
Has your alcohol or drug use caused you to give up activities you enjoy?
Have you had legal problems related to alcohol or drug use?
Does the thought of running out of alcohol or drugs make you nervous?
Does the thought of stopping feel overwhelming or even impossible?

If you answered yes to any of these questions, you are not alone. Tell someone what is going on. Don't keep it a secret. Seek counseling. Try a support group. Please don't be afraid or embarrassed to seek this help and support. Your life is at stake. The sooner you ask for help, the sooner you can get safe, begin to recover, and heal.

Definition and warning signs of domestic violence adapted from "The Problem," National Coalition Against Domestic Violence [On-line].

Definitions of sexual assault/sexual abuse and child sexual abuse, and some indicators, adapted from By the numbers: Sexual violence statistics, Illinois Coalition Against Sexual Assault, Springfield, IL, 2001.

Indicators of sexual assault also adapted from Types and signs of abuse, Wisconsin Coalition Against Sexual Assault [On-line]. Available: http://danenet.wicip.org/dcccrsa/saissues/types.html.

Definition and warning signs of substance abuse or addiction adapted from Diagnostic criteria from DSM-IV, American Psychiatric Association, Washington, DC., 1994; and from the "The Definition of Alcoholism," American Society for Addiction Medicine [On-line]. Available: www.asam.org © 2001 by Debi Edmund Springfield, IL

Safety at Support Group Meetings

Support groups can serve as a valuable supplement to counseling or advocacy. Much of the power in these groups comes from the personal stories. People share their experience, strength and hope with each other. When one person breaks the silence about her experiences, others feel safer breaking their silence. You also hear success stories. You hear what others are doing to cope with problems similar to yours.

Some initial discomfort is normal if you're new to support groups. It is natural to feel nervous in a roomful of strangers. You may have spent years avoiding the issues the group is discussing. If your experience includes violence or abuse, you also may have safety concerns. Here are some tips to help you feel comfortable - and stay safe:

Protect your safety.
Most people in support groups respect confidentiality (anonymity). However, if you are leaving an abuser, don't share information that could put your safety at risk. Do carry your cell phone with you to 12 Step meetings if you have one. Tell your sponsor or someone else at the meeting what is going on.
Find a home group.
This is a group you attend regularly. You get to know other "regulars" and feel more comfortable talking at meetings. Some 12 Step veterans have two or three home groups. If you need to avoid being predictable to an abuser, have a back-up home group. Alternate between one meeting and the other one.
Shop around.
You will probably notice that each support group has a distinct personality, depending on who attends. Larger communities may have dozens of groups holding meetings in a given week. Sample several. Some abused women may feel more comfortable in small, intimate groups.
Recognize the group's limitations.
Support group meetings are not meant to be a substitute for professional help. Use sessions with a counselor or advocate for issues that are beyond the group's scope.
Respect your own boundaries.
Some people may try to sexually exploit others in the group. 12-Steppers call this practice "13th Stepping," and most consider such behavior unethical. You don't have to tolerate it! Also, don't feel compelled to talk about painful abuse issues in groups if this makes you uncomfortable.
Try women-only groups.
Survivors of domestic violence or sexual abuse may have difficulty setting healthy boundaries, especially with men. Many report that women's meetings feel safer than meetings where both men and women are present.

As a "recovering survivor," what if you feel the need to talk about the "other issue?" You can honor your own needs while respecting the group's primary purpose. Explain how sobriety, safety and healing are linked for you. Discuss how violence or past abuse issues make it harder for you to stay clean and sober. Discuss how relapse would make it harder for you to stay safe or heal from violence. Share how you've made safety part of your recovery plan, and recovery part of your safety plan.

Using 12 Step Groups

People recovering from addictions often participate in 12-Step groups such as Alcoholics Anonymous or Narcotics Anonymous. Many find these groups a helpful source of support. If you have experienced violence or abuse, here are some ideas to consider while "working the program." As they say in 12 Step groups, take what you need and leave the rest.

Step One: We admitted that we were powerless over alcohol - that our lives had become unmanageable.

When 12 Step groups discuss powerlessness, it may be helpful to explore how power is defined. Some people view power as the ability to control other people, places and things. "The program" asks you to let go of attempts to have this kind of power. However, power can also be defined as the ability to make choices and act on them. For example, you cannot control the impact of chemicals on your body. But you can choose to seek treatment for an addiction. If you are in an abusive relationship, you cannot control your partner's behavior. But you can choose to seek help getting safe. This step encourages you to break through denial and acknowledge that you are out of control with alcohol or another addiction. Before you can do something about a problem, you must acknowledge that the problem exists.

Step Two: Came to believe that a power greater than ourselves could restore us to sanity.

Some women feel more comfortable with feminine or gender-neutral images of God or "higher power." This may be especially true for women who have been abused by a male parent or partner. 12 Step groups encourage you to interpret this power in a way that is right for you. "When we speak of God, we mean your own conception of God." In fact, "You can, if you wish, make A.A. itself your 'higher power.¹ Here's a very large group of people who have solved their alcohol problem."² This step encourages you to feel hope. There is a way out of your problems. Help is available. Recovery and healing are possible.

Step Three: Made a decision to turn our will and our lives over to the care of God as we understood Him.

For some women, turning over our will to someone else may sound like a demand from an abuser. It may be helpful to remember that there is a difference between turning one's will over to a deity (if that's what your religious or spiritual tradition teaches), and being asked to turn your will over to another human being. It may also be helpful to think of "turning it over" as "letting go," and willingness as being open to new ideas. Giving up an addiction (or a relationship) can feel pretty scary. You are letting go of something familiar without knowing what will replace it. The good news is you don't have to do this alone. This step encourages you to break your isolation by seeking help and accepting the support that is offered.

Step Four: Made a searching and fearless inventory of ourselves.

Keep in mind that Step Four is not an "immoral inventory." A.A. literature points out that "assets can be noted with liabilities."³ Listing your strengths can be especially helpful if your self-esteem has been battered by abuse. A.A. literature suggests that you "consider carefully all personal relationships which bring continuous or recurring trouble. Appraising each situation fairly, can I see where I have been at fault? . . . And if the actions of others are part of the cause, what can I do about that?"⁴ When looking at relationships, remember that you are not responsible for violence or abuse committed against you. However, exploring the impact abuse has had on your life can strengthen your resolve to break free of the abuse and heal from it. This step encourages you to take a realistic look at your life. This allows you to discover your strengths and limitations, and identify your needs.

Step Five: Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

When you choose someone to hear your Fifth Step, A.A. literature cautions you to "take much care."⁵ This care is especially important if your experience involves domestic violence, sexual assault or sexual abuse. Survivors may want to share this part of their experience with a qualified therapist or advocate. This person should understand that responsibility for violence belongs with the perpetrator. This step encourages you to share your past with someone you trust. This can help you let go of the shame that comes with thinking you must keep parts of your life secret

Step Six: Were entirely ready to have God remove these defects of character.

Nobody is perfect, so self-improvement is a worthy goal for everyone. But A.A. literature cautions you to "avoid extreme judgments" and "not exaggerate" your defects.⁶ This precaution is especially important for abused women. An abuser may have whittled away at your self-esteem by encouraging you to feel defective. A person who wants to control you is not the best judge of your character! A.A. literature also reminds you to distinguish between societal expectations and your own values. For example, when the subject is sex, "we find human opinions running to extremes - absurd extremes, perhaps."⁷ This can certainly be said about the messages our society directs toward women. Women also get mixed messages about everything from their roles to how they should look or act. Step Six can be a good place to examine what your own values are. This step encourages you to prepare for change in your usual patterns of behavior. What behaviors do you want to let go of? What patterns do you want to stop repeating?

Step Seven: Humbly asked Him to remove our shortcomings.

A.A. literature says humility is "a word often misunderstood. . . . It amounts to a clear recognition of what and who we really are, followed by a sincere attempt to become what we could be."⁸ We should "be sensible, tactful, considerate and humble without being servile or scraping."⁹ And, "we stand on our feet; we don't crawl before anyone."⁹ Humility does not mean seeing yourself as less important than others. This step encourages you to begin letting go of the unhealthy patterns you identified in Step Six. If some of these patterns stem from your experience of violence or abuse, you may want to seek professional help from a person trained to work with abuse survivors.

Step Eight: Made a list of all persons we had harmed and became willing to make amends to them all.

People in recovery need to acknowledge how their drinking or drug use affected others. But recovery groups also remind you to make amends to yourself as well. One such amend might be to stop blaming yourself for domestic violence, sexual assault or other abuse. You are only responsible for your own behavior, not someone else's. This step encourages you to identify what needs changing in your relationships with others. "Making amends" does not mean you must reconcile with an abuser. "Amend" simply means "to change or modify for the better."¹⁰ With an abusive relationship, this may well mean ending it. According to A.A. literature, "If there be divorce or separation, there should be no undue haste for the couple to get together. . . . Sometimes it is to the best interests of all concerned that a couple remain apart." ¹¹

Step Nine: Made direct amends to such people wherever possible, except when to do so would injure them or others.

If you have left an abusive relationship, it may be best to avoid your partner. This is true even if you believe you did something "wrong." A.A. literature does not say you must contact everyone on your amends list. In some cases, "by the very nature of the situation, we shall never be able to make direct personal contact at all" ¹² If "making amends" to an abuser would put you or your children in danger, stay away! Children often blame themselves for their parents' problems. So this can be a good time to talk with your children about incidents they have witnessed. Explain that they are not responsible for your alcohol or drug use. Nor are they responsible for an abuser's behavior toward you or them. This step encourages us to settle with the past. "When this is done, we are really able to leave it behind us." ¹³

Step Ten: Continued to take personal inventory and when we were wrong promptly admitted it.

When doing an inventory, remember to focus on strengths as well as weaknesses. A.A. literature points out that "inventory-taking is not always done in red ink. It's a poor day indeed when we haven't done something right."¹⁴ This step encourages you to maintain the progress you have made in previous steps. Give yourself credit for things well done.

Step Eleven: Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

This step encourages you to develop emotional balance. For you, this could mean prayer and meditation. It could mean keeping a journal or taking daily walks. It could mean turning to a friend to help you sort out your feelings. Do whatever helps you feel centered and at peace with yourself.

Step Twelve: Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics or addicts, and to practice these principles in all our affairs.

A.A. literature says "helping others is the foundation stone of your recovery."¹⁵ You can do this by sharing your experience, strength and hope with other people like you. When you take back your life from addiction (or abuse), you carry a powerful message! Many recovering alcoholics and addicts believe carrying their message to others helps them to stay clean and sober. Many survivors of violence find that working for social change aids their own healing process. People may call their efforts working for change, service to others, or carrying the message. This step encourages you to discover what you have to offer others and to pass it on!

Note: The views expressed in this handout are the views of the author only. The author makes no claim to speak for alcoholics Anonymous, Narcotics Anonymous or any other 12-step group.

¹ Alcoholics Anonymous, 4th Edition, Alcoholics Anonymous World Services Inc., New York, 2001, p. 47
² Twelve Steps and Twelve Traditions, Alcoholics Anonymous World Services, New York, 1981, p. 27
³ Twelve Steps and Twelve Traditions, p. 52
⁴ Twelve Steps and Twelve Traditions, p. 6
⁵ Twelve Steps and Twelve Traditions, p. 61
⁶ Twelve Steps and Twelve Traditions, p. 82
⁷ Alcoholics Anonymous, p. 68
⁸ Twelve Steps and Twelve Traditions, p. 58
⁹ Alcoholics Anonymous, p. 83

¹⁰ Webster's Ninth New Collegiate Dictionary, Merriam-Webster Inc., Springfield, MA, 1989

¹¹ Alcoholics Anonymous, p. 99

¹² Twelve Steps and Twelve Traditions, p. 83

¹³ Twelve Steps and Twelve Traditions, p. 89

¹⁴ Twelve Steps and Twelve Traditions, p. 93

¹⁵ Alcoholics Anonymous, p. 97

Sorting Out Messages

If you are recovering from an addiction, you may be seeing a substance abuse counselor. If you are dealing with violence or abuse, you may be seeing a women's advocate. If you are seeing a women's advocate and a substance abuse counselor, you may be getting confused! These are some of the messages you may be hearing:

Substance abuse counselor: You have a disease. You need treatment.

Women's advocate: You are a victim of a crime. You need justice.

Substance abuse counselor: Your priority must be sobriety.

Women's advocate: Our priority is your safety.

Substance abuse counselor: You must accept your powerlessness.

Women's advocate: You need to be empowered.

Substance abuse counselor: You need to look for your part in your problems.

Women's advocate: You are not responsible for what happened. The perpetrator must be held accountable.

Substance abuse counselor: You need to change yourself and be of service to others.

Women's advocate: We need to change society.

Can these statements all be true? One way to reconcile the messages is to understand that substance abuse and violence are different problems. When people talk about different problems, they may need different words and different approaches. Here are some examples.

Disease or criminal behavior?

Addiction is a disease. It is not a crime. People do not choose how their bodies will respond to alcohol or drugs. People with addictions deserve treatment and recovery. Violence is a crime. It is not a disease. Perpetrators choose to commit domestic violence, sexual assault and sexual abuse. Their victims deserve justice.

Safety first or sobriety first?

For "recovering survivors," both safety and sobriety must be priorities. Women's advocates have clients develop a safety plan. Substance abuse counselors have clients develop a recovery plan. You can make recovery part of your safety plan, and safety part of your recovery plan.

Powerlessness or empowerment?

You are powerless over the impact of chemicals on your body. You are powerless over another person's behavior. But you can choose to seek help getting safe and sober. When you make personal choices, you become empowered.

Who is responsible?

You are responsible for recovery from addiction. The perpetrator is responsible for violence. You are responsible for your own choices and your own behavior. You are not responsible for another person's choices or behavior.

Social change or service to others?

Service to others is one way to achieve social change. Working for social change can be a way to serve others. When people in 12-Step groups take a meeting to a jail or hospital, they serve others. They also create social change by making recovery available to more people. When abuse survivors make a T-shirt for the Clothesline Project, they help change public attitudes about violence. This serves other victims of violence.

Of course, sometimes the same approach can work for different problems. People with addictions often take a "one day at a time" approach to recovery. This approach can also work well for women leaving a violent relationship or healing from abuse. Both recovering women and abused women can benefit by getting support from others.

When sorting out messages from helping professionals, be creative. Give yourself permission to reconcile the messages in a way that works for you. The most important thing is that you be able to benefit from both kinds of services.

NOTE: Examples of the differing words and approaches used by women's advocates and substance abuse counselors adapted from Domestic Violence and Chemical Dependency: Different Languages, developed by Theresa Zubretsky, New York State Office for the Prevention of Domestic Violence. Available: www.thesafetyzone.org/alcohol/language.html