Substance Abuse Coercion

What is Intimate Partner Violence (IPV)?

Substance Abuse Coercion

Intimate Partner Violence is a mostly hidden epidemic. In the U.S., more than one in three women (36.4%, or 43.6 million) will experience some type of sexual violence, physical violence, or stalking by an intimate partner during their lifetime. A similar number of women will experience psychological aggression by an intimate partner in their lifetimes. Substance abuse coercion is one form of IPV.

According to the 2015 National Intimate Partner and Sexual Violence Survey, similar rates have been reported for men who experience intimate partner violence. However, women are more likely to be targets of rape or attempted rape.1 Intimate partner violence is a significant public health issue and human rights issue, but what exactly is intimate partner violence and how is it different than other forms of sexual or physical violence?

Defining IPV
Intimate partner violence is “an ongoing pattern of power and control in romantic relationships that is enforced by the use of abusive tactics, such as intimidation, threats, physical or sexual violence, isolation, economic abuse, stalking, psychological abuse, and coercion related to mental health and substance use.” The defining factor of IPV is that the violence occurs between two partners who are in a romantic relationship, rather than occurring between a stranger and a random victim.

What is Coercion?
Coercion in the context of IPV is the “use of force or manipulation to control an intimate partner’s thoughts, actions, and behaviors through violence, intimidation, threats, degradation, isolation, or surveillance.” Coercion can be present through financial, psychological, physical, sexual, reproductive, and other forms of abuse. One of the specific forms of coercion that will be discussed in this article is substance abuse coercion, which is abuse that uses substances as a tool of manipulation, whether that is forcing someone to abuse substances, or withholding substances from them.

What is Substance Abuse Coercion?

Substance abuse coercion is a form of intimate partner violence that involves the use of abusive tactics relating to substance abuse to control and manipulate a victim. Substance abuse coercion involves issues like:

Substance Abuse Coercion Issues
Forcing the victim to use alcohol or drugs, by which the abuser holds control over the victim while making the victim dependent on them.
Threatening to report their substance abuse to authorities to punish them, manipulate them, or force them to lose custody of their children.
Preventing a victim from getting addiction treatment as a form of maintaining control over them. The control over the victim’s sobriety can lead the victim to untreated substance abuse disorders that can result in overdose and death.
Forcing a victim into withdrawal by withholding substances from them.

While other forms of IPV such as sexual violence or stalking have been heavily researched, substance abuse coercion has not received as much attention as it has only recently emerged as a form of IPV.

What Are the Abuser’s Tactics?

While there are various tactics of substance abuse coercion and every individual case will differ, here are some of the tactics used by abusers that have been reported by individuals who have experienced substance abuse coercion as a form of intimate partner violence:

Abuser’s Tactics
•Being forced or pressured to use alcohol or other substances, or to take more than the victim wanted to.
•A partner or ex-partner threatening to report an individual’s alcohol or substance use to the authorities in an attempt to keep them from getting custody of their children, a job, benefits, or a protective order.
•Being afraid to call the police or alert authorities during episodes of abuse because the victim’s partner says that the police will not believe them and that they will be arrested for being under the influence of alcohol or drugs.
•A partner preventing or discouraging an individual from accessing treatment for their substance abuse (e.g., not allowing them to attend AA meetings or seek treatment options).
•A partner withholding methods of transportation or financial resources that the victim might need to get treatment for substance abuse.
•A partner keeping substances in the house even while the victim is seeking treatment and trying to refrain from drug use to try to encourage them to use again.
•A partner sexually assaulting the victim while they are under the influence of alcohol or substances and might be passed out or unconscious.
•A partner using alcohol or substances as a way to justify sexually-abusive behavior.
•A partner lying or manipulating the victim by saying that they were too inebriated to remember what happened.

What Does the Research Show About Substance Abuse Coercion?

Research on substance abuse coercion is quite limited; however, the National Center on Domestic Violence, Trauma & Mental Health conducted a survey in 2014 with people who called into their hotline and had experienced intimate partner violence. Male responses weren’t used because there were not enough calls. From the 9,359 females who called into the hotline, 3,065 of them agreed to participate. It should be noted, however, that many people might not even realize that they are being subject to substance abuse coercion, or may not be willing to admit that they use or abuse substances, even if coerced. This indicates that, while the data will show that substance abuse coercion is a problem, it doesn’t accurately show the size of the problem.

Age Ranges for the Survey
Out of the 3,065 people that were surveyed, 2,525 provided information about their age. They were as follows:

3,056 Surveyed, 3,018 Provided Age Information

Respondents' Ethnicity
Out of the 3,065 people that were surveyed, 2,487 provided information about their race or ethnicity. The ethnic makeup of the group is as follows:
3,056 Surveyed, 3,025 Provided Race Or Ethnicity Information

5 Questions to Identify Substance Abuse Coercion

The survey had five questions for the respondents to see if they experienced substance use coercion. These are the five questions that were asked (with a potential sixth follow up question) and the results of the survey. The first three questions are coercion tactics, and the last two are behaviors that relate to substance abuse coercion.

Key Takeaways from the Survey

The respondents’ answers provided much-needed information about substance abuse coercion. The answers that were provided in the survey offer information about substance abuse coercion experienced by the females had who participated in the survey.

Conclusions from the Survey
The results of the survey show that substance use coercion is a problem that affects many people who experience IPV. It can cause individuals to feel manipulated, trapped, and isolated and is a public health issue that needs to be addressed adequately. Individuals suffering from IPV as well as substance use coercion require immense support from family, friends, health care workers, the legal system, and society at large.

Abuse Tactics That Were Linked Together
Researchers who conducted the survey also analyzed the relationship between coercive tactics. Because abuse typically does not happen in one singular fashion and an abuser may use many different tactics, its essential to look at the relationship between the coercive tactics that were used.
47.7% of respondents who said that their partner had forced or pressured them into using alcohol or other substances also reported being afraid to call the police for help because their partner told them they wouldn’t be believed or that they would be arrested for their substance use.
•60.1% of respondents who reported trying to get help for their substance abuse in the past years also reported that their partners tried to prevent or discourage them from seeking help. •66.5% of respondents who said that their partner had forced or pressured them into using alcohol or other substances also reported that their partner threatened to report their alcohol and substance use to authorities. •69.7 percent of respondents who reported using alcohol or substance to cope with physical or psychological pain caused by their partners abuse also reported being afraid to call the police for help due to threats made by their partner.
•82% of respondents who reported that they were too afraid to call the police for help because their partner told them they wouldn’t be believed or that they would be arrested for their substance use also reported that their partner had threatened to call the authorities on them. •92.4% of respondents who reported trying to get help for their substance abuse in the past years also reported that their partner threatened to report their substance abuse to authorities. •94% percent of respondents who reported that their partner prevented or discouraged them from seeking substance abuse treatment also reported that their partner had threatened to report their substance use to authorities.

Other Signs of Substance Abuse Coercion

Although only five questions that were asked in this survey, other questions can be asked to identify someone who might be experiencing substance use coercion. The National Center on Domestic Violence, Trauma & Mental Health has created A Toolkit for Screening, Assessment, and Brief Counseling in Primary Care and Behavioral Health Settings, which includes additional relevant questions to identify substance use coercion.

These include:
•How does your partner treat you when they are using alcohol or substances?
•How does your partner treat you when you are sober or not using?
•Does your partner use their substance use to justify abuse?
•Is your partner only kind when they are using but abusive and unsupportive when they are sober or vice versa?
•Has your partner ever tried to prevent you from accessing treatment or medication?
•Do you have concerns that your partner might try to make you leave treatment?
•Do you have concerns about your partner stealing, using, or selling their medications?

Adapting the CAGE Substance Abuse Questionnaire
An adaption of the questions used in the CAGE questionnaire on alcohol patterns can also be used:

•Have you ever felt like you ought to cut down on your drinking or drug use? Have you ever tried to cut down on your drinking or drug use? Has your partner ever tried to stop you from cutting down on your drinking or drug use?
•Have you ever been annoyed by someone criticizing your drinking or drug use? Have you ever been made to feel afraid by someone’s criticizing your drinking or drug use? Has your partner used your drinking or drug use as a way to threaten you?
•Have you ever felt guilty about your drinking or drug use? Have you ever felt coerced into drinking, using drugs, or engaging in illegal activities or other behaviors you weren’t okay with or that compromised your integrity, and then felt guilty about it?
•Have you ever had an eye-opener first thing in the morning because drinking or using drugs felt like the only way you could survive or get through the day, steady your nerves, or relieve a hangover? •Have you had an eye-opener first thing in the morning because you were forced to drink or use drugs right away?

Implications for Healthcare Professionals

Many women who are seeking treatment in health, mental health, and substance abuse settings have experienced IPV, yet they are not often asked about their experiences of abuse. In substance abuse treatment, it is not yet a common practice to ask women about experiencing intimate partner violence or substance abuse coercion. In fact, many people may not know that substance abuse coercion exists at all. It makes sense that intimate partner violence and substance abuse could be linked, yet this link is not always made. Understanding these issues can help healthcare workers to assist patients in getting the help and treatment that they need. It can help survivors to work through both the abuse they have experienced and their substance abuse issues. Because both can be linked, treating abuse issues and substance abuse disorders separately might not be as beneficial as considering them and treating them together. Because talking about substance abuse coercion can be difficult, it is worthwhile for healthcare providers to ask about substance use coercion during an IPV assessment and as part of a conversation about substance use history.5 It would also be beneficial to ask about the relationship between substance use and substance use coercion, and about how the patient’s partner responds to their substance use or lack thereof.
Implications for the Legal System
Having an understanding of substance abuse coercion can help law enforcement professionals, lawyers, and judges to better understand issues involving mental health concerns, substance abuse, and child custody cases. When someone is at risk of losing their children due to the abuse and manipulation that they are experiencing at the hands of their abuser, it is vital for the authorities making decisions about the children to be aware of the context behind a victim’s substance abuse. Substance abuse isn’t always the way it looks. Many people hold stereotypes against people who abuse substances; however, they might not be aware that that person is being coerced into using and often has no choice. Understanding the context behind someone’s substance abuse is crucial for police officers and authorities to whom a victim might be reaching out for help. When a person asks for help but also presents with substance use issues, it can be easy for authorities to blame the victim for their drug use. This makes it even more difficult for people to break free from substance use coercion and IPV, and to successfully seek treatment.
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Help for Survivors of Substance Use Coercion

The results of the survey, as well as the survey process itself, served to validate the feelings and experiences of survivors of substance abuse coercion and IPV. Many of the women who participated in the phone survey said that no one had ever asked them about substance use coercion as being a part of intimate partner violence. Many of the women felt alone in their experience and appreciated having their experiences recognized and talked about. Discussing the coercion tactics with women helped them to feel empowered and as if people would be more likely to believe them if they were to share their experience.

This survey also helps to reduce the stigma associated with substance use coercion. It is easy to pass judgments about people who abuse substances without knowing the reason that they are using. Understanding how some people might be forced to use alcohol or substances against their own will might help people to be more understanding and compassionate of people who use substances and who experience IPV.

The survey can also help to form policies and programs surrounding substance use coercion and including that in treatment plans. Establishing policies and programs with substance use coercion in mind will allow people to come forward with their experiences without feeling judged or isolated. Experiencing intimate partner violence on its own is traumatic enough, let alone having to deal with that kind of violence while also experience substance use coercion.

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