Q & A: Women's shelters, substance use and domestic violence: Cross Currents Summer 2004

CrossCurrents

by Abigail Pugh

Nancy Poole and Dr. Lorraine Greaves are researchers at the British Columbia Centre of Excellence for Women's Health in Vancouver. They are in the process of completing research with women moving through women's shelters in British Columbia who are experiencing substance use problems. The following is based on an interview with Poole and Greaves. They discuss substance use among women who have experienced domestic violence and the role of shelters in helping these women improve their lives.

Is there a link between substance use among women and domestic violence? And what's the cause of the relationship?

There are multiple issues involved in substance use and domestic violence; thus a causal relationship between the two has never been established. But substance use and domestic violence do often co- exist, and take their place among a range of other challenges for women. The substance use field in general talks about "dual diagnoses" and similar terms, but we believe in the need to talk about mental health, addiction and violence issues nested in the context of women's lives rather than looking at co-existing problems two by two.

We have to recognize that violence against women and children is not uncommon. We're interested in how the problems overlap, but not necessarily to find causation. Many women experience mental health issues as well as violence and substance use problems.

How common is domestic violence among women who have substance use problems?

With this study, one of our intentions is to better understand the prevalence of substance use in women who experience domestic violence. Many studies speculate on what the numbers are, but information on prevalence is not available. There is more evidence from work done among women already in treatment for substance use problems. We have rates of violence among women entering treatment, but our study takes another direction: its aim is to illuminate the use of drugs among women who experience violence.

Describe your recent research study.

Our study looked at the level of substance use in women's shelters in British Columbia, and also examined changes in use between the time of arrival at the shelter and three months later. We were involved with 13 shelters from across the province. We looked at women's experiences: the main causes of stress in their lives and the role of drinking and other drug use as a way to cope as they moved from one shelter to another or into new living situations.

We were interested in the response of shelters to substance use. Some were more proactive in their level of intervention than others. We explored the different experiences of women who were in shelters that provide more and with less intervention. We also looked at the women's backgrounds - violence; other stresses; and substance use, including nicotine and alcohol as a means of coping.

Do substance use problems tend toward alcohol or other drugs?

We asked about all drugs including tobacco, but we haven't done that kind of analysis or our research data yet. But multi drug use, including nicotine, is the standard. This isn't surprising given that having multiple other life issues is also standard: violence, high substance use and a host of other problems such as housing, custody, social services and welfare, legal issues and personal issues such as childhood abuse and family of origin issues.

What challenges do women who have experienced domestic violence and substance use problems face in shelters?

There are so many aspects to the situation for many women in a shelter: there is the housing issue - figuring out where she is going next. There is the legal issue around violence and family law. Some of these legal processes are quite protracted. There is also engagement with the welfare and social services systems. Finding employment or training is related to that system, especially in British Columbia, where social services and employment training are tied together.

On top of these issues are other parts of the system that need to be involved - psychosocial or counseling needs, alcohol and drug recovery. Many of these women are reflecting on childhood victimization. Domestic violence is usually not about a single incident, but a pattern over time. These complex issues come to a head when a woman is in a shelter situation.

The woman is often frustrated because it takes a lot of energy to raise all these different issues at once. There is a definite need to address alcohol and other drug issues, but the system is not set up to address all the issues simultaneously. For example, a woman says she has to go to training but has no money for transport and no childcare. So she's facing a host of other issues, not just ones related to substance use.

How well are shelters addressing domestic violence and substance use among women?

Shelters have a wide range of policies about substance use on the part of women coming for help, ranging from prohibition to active intervention. Some shelters say to women, "You can't come here if you have a substance use problem," but the women may come anyway and may just choose to be silent about the problem. The ability and willingness of these women to discuss their drug issues openly is based on the policy of the shelter.

In our study, three of the 13 shelters had a significant level of intervention for women with substance use problems and all provided some level of response. There was a range of services they offered: counsellors trained and empowered to discuss substance use, drug and alcohol counsellors coming into the shelter, support groups in the shelter and proactive referrals to other resources.

What are the implications of your work for treating women who have experienced domestic violence and who have substance use problems?

The study findings will help us suggest how the system can respond to the realities of the lives of women with substance use, violence and a host of other service needs and supports. We hope to develop recommendations for better engaging with women who face violence and substance use problems.

Preliminary analysis of the qualitative information from the study has shown us that women are spending huge amounts of time trying to access different parts of the system. The time they spend looking for appropriate help almost becomes a full-time job. The system isn't co-ordinated, so at this point, it can't deal with all the aspects of recovery. Women enter one part of the system, for example, a shelter, but these women need various types of intervention according to their multiple issues.

We are approaching this study with enormous respect for the women using and offering these services. Our findings won't be framed only in terms of problems faced by women, but on how to provide woman-centred responses to substance use and domestic violence. The system certainly needs to be better co-ordinated and integrated.

We are not just talking about screening for substance use or domestic violence among those looking for help for one or the other, but also responding: what might responses look like given the profile of the woman we're looking at?

Editor's note: Please consult the Research Update section in future issues of CrossCurrents for a summary of the research findings, which will be released later this summer.

 

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