ADVANCE Programme – Summary of findings

The ADVANCE team have written a summary of the programme findings:

The ADVANCE study:
ADVANCE is a 60-month programme with 5 workstreams to describe the role of substance use in intimate partner violence (IPV) perpetration by men in substance use treatment and develop and test a perpetrator programme for this group. ADVANCE is led by King’s College London, together with colleagues from the University of Worcester, University of Manchester, University of Bristol, University of York, RESPECT, South London and the Maudsley NHS Foundation Trust and Rochester Institute of Technology.

Background:
• IPV includes physical harm, sexual abuse, psychological harm, controlling behaviour and financial abuse between an intimate couple.1
• In the UK, 8% of women and 4% of men experienced past year IPV2 compared to 57% of women attending substance use treatment.3,4 40% of men receiving substance use treatment have perpetrated past year physical or sexual IPV rates four times higher than men in the general population.5-9
• No single factor explains why some people perpetrate IPV but alcohol, cocaine and methamphetamine are strongly and consistently associated with IPV perpetration.9-11
• Around 23-63% of IPV incidents involve alcohol as a contributing factor,1 “approximately equal to other contributing causes such as gender roles, anger and marital functioning”.11
• Physical violence is also more severe on days when heavy drinking has occurred and when one or both partners have been drinking.12

Our previous research found:
• 77% of men in substance use treatment in England had perpetrated IPV, only 25% had been arrested for it, and even fewer had received support13
• Substance use treatment staff have concerns about role boundaries, competency and confidence in asking service users about IPV perpetration. Staff highlighted a lack of care pathways including perpetrator programmes.14
• A systematic review was conducted to determine the efficacy of interventions to reduce IPV by men who use substances. Limited evidence that IPV interventions targeting substance-using men reduce IPV. Individual trials report short-term improvements in IPV and substance use outcomes. Integrated IPV and substance interventions showed no difference IPV outcomes compared to usual treatment.15

Gaps in knowledge
• There remains an urgent need to explain and address the high prevalence of IPV amongst men receiving substance use treatment and to develop evidenced based, integrated interventions for IPV perpetrators who use substances.
Findings to date from ADVANCE:
Two studies were conducted to explore how substance use featured in survivors’ and perpetrators’ accounts of IPV to inform the development of the ADVANCE intervention to reduce IPV perpetration by men receiving substance use treatment:

1. A systematic review of 26 qualitative studies 16
Whilst perpetrators depicted their violence as typically motivated and moderated, the studies exposed assaults that were uncontrolled and brutal, the repetition of which survivors anticipated. The review found that substance use and IPV were linked in the following complex ways:

Intoxication: Survivors and perpetrators both explained IPV perpetration in terms of a change or disinhibition in self when under the influence of alcohol or stimulant drugs.
Withdrawal: There was an increased risk of IPV perpetration when men were in withdrawal or craving alcohol, heroin and stimulant drugs due to irritability and frustration or because they needed money to obtain substances. Failure or refusal of a partner to procure money for drugs increased the likelihood of violence.
Impact of substance use on relationship: Perpetrators who used substances were more likely to blame their violence on intoxication or their partner’s behaviour. The substance user’s lifestyle further created environments experienced as emotionally unstable and unpredictable. Survivors reported hypervigilance in anticipation of their partner’s abusive behaviours and bore the burden of an unequal share of childcare, domestic duties and economic finances to support the family.
Power and control: Survivors often depicted their partner’s intoxication and withdrawal as part of a wider pattern of behaviour, including controlling tendencies and emotional unpredictability. Male perpetrators’ controlling behaviours were exacerbated by intoxication
Psychological vulnerabilities: Childhood trauma, mental health and emotional instability were further linked to substance use and IPV perpetration.

2. A qualitative study of 14 male IPV perpetrators in substance use treatment in England and their current or former female partners17,18
The majority of men used heroin, crack, cocaine and/or alcohol. Four female partners were current heroin and/or crack users, and two had previously used substances. Eight men reported they had been arrested for IPV and 6 men reported having received a custodial sentence. Eleven men and 8 women disclosed mental health problems. At least three couples reported that their children had been taken into local authority care.

Overall men minimised and/or denied their violence. Some men viewed it as a one-off incident and/or context specific, whereas women reported violence as part of an ongoing pattern of abuse and controlling behaviour. Men were more likely to describe violence as bi-directional. Women’s accounts of hypervigilance (being constantly aware and assessing the environment for signs that violence may occur) featured. Women who used substances often fought back. Perpetrators considered their behaviour to be protecting their partners against other men or the woman’s escalating drug use however survivors experienced the man’s behaviour as controlling and stifling. Both partners brought histories of adversity, psychological disorders, childhood abuse and IPV in previous relationships with them.

Overall a complex interplay between the psycho-pharmacological effects of intoxication, withdrawal and craving, gendered power relations and controlling behaviours were found.

Intoxication was found to exacerbate IPV within the context of anger, aggression and sexual jealousy and could be the tipping point into violence, although other contributory factors were involved. Whilst both partners blamed intoxication for the violence, men viewed their violence as a one-off incident in isolation while often blaming their partner in some way for their violence. Women however were more likely to report IPV as part of a long-standing pattern of abusive and controlling behaviours.
Withdrawal, craving and ‘coming down’ from substances presented conflict situations due to the psychopharmacological impact of the drug making them irritable or frustrated. In addition, when the need for procuring funds to support dependent substance use became the focus, some men coerced their partners into sex work or other criminal activity, threatening them to provide money or using the family finances to support their habits. Exerting financial control over the women sometimes involved threats of and actual physical violence. In relationships where both partners used substances disputes around unequal shares of substances or procuring funds to support substances could spill over to physical violence or jealousy over sex working. Women who use substances are made particularly vulnerable by their substance dependence often keeping them in abusive relationships. Secretive substance use, whether due to relapse or otherwise was also an area for conflict where the woman was unaware of their partner’s use/relapse, sometimes intensifying a situation in which IPV could occur.

Recommendations:
• Perpetrator programmes need to address the multifaceted complex interplay between substance use and IPV.
• The findings should be used as robust and scientific evidence to help support the funding and commissioning of services within central Government and locally, which target both the substance use and IPV within substance use services.

Next steps:
• These findings have informed the development of the ADVANCE group intervention which is currently being tested among 108 male perpetrators in substance use treatment settings in England. Findings will be reported by the end of 2019.

Financial implications:
In England, the costs associated with alcohol and illicit drug use, are estimated at over £32 billion in terms of economic, social, health and crime.19 In England and Wales, domestic violence costs around £16 billion including costs of (largely public) services to those who experience domestic violence; the value of lost economic output; and the associated human and emotional costs.20 The estimated cost of social services supporting and caring for children where there has been domestic violence are £283 million.20 Investing in interventions which tackle the behaviours that result in such financial costs to society and the tax payer would help to reduce those costs potentially representing substantial savings.

Acknowledgements
ADVANCE https://www.kcl.ac.uk/ioppn/depts/addictions/research/drugs/advance.aspx is funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP-PG-1214-20009). The views expressed here are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

About the National Institute for Health Research
The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health and Social Care, the NIHR:

• funds high quality research to improve health
• trains and supports health researchers
• provides world-class research facilities
• works with the life sciences industry and charities to benefit all
• involves patients and the public at every step
• For further information, visit the NIHR website www.nihr.ac.uk

References
1 World Health Organization (2012) Understanding and Addressing Violence Against Women. Geneva: WHO.
2 Office for National Statistics (2016) Compendium Intimate personal violence and partner abuse. Results from the Crime Survey for England and Wales 2015.
3 Tirado-Muñoz, J., et al. (2018) Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study. Arch Women Mental Health, 21:259–269.
4 Gilchrist, G., Blazquez, A., Torrens, M. (2012) Exploring the relationship between intimate partner violence, childhood abuse and psychiatric disorders among female drug users. Adv Dual Diagnosis, 5(2):46-58.
5 Gilchrist G, et al. (2015) Factors associated with physical or sexual intimate partner violence perpetration by men attending substance misuse treatment in Catalunya: A mixed methods study. Crim Behav Mental Health, 25(4): 239-257.
6 Smith, P.H., et al. (2012) Intimate partner violence and specific substance use disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Psych Addict Behav, 26:236–245.
7 Fleming, P.J., et al. (2015) Risk factors for men’s lifetime perpetration of physical violence against intimate partners: Results from the International Men and Gender Equality Survey (IMAGES) in eight countries. PLoS One, 10(3), E0118639.
8 Chermack, S.T., et al. (2008) Partner aggression among men and women in substance use disorder treatment: correlates of psychological and physical aggression and injury. Drug Alc Depend, 98:35–44.
9 Choenni, V., et al. (2017) Association Between Substance Use and the Perpetration of Family Violence in Industrialized Countries. A systematic review. Trauma Viol Abuse, 18(1):37-50.
10 Cafferky, B., et al. (2018) Substance use and intimate partner violence: A meta-analytic review. Psych Viol, 8(1):110-131.
11 Leonard, K.E., Quigley, B.M. (2017) Thirty years of research show alcohol to be a cause of intimate partner violence: future research needs to identify who to treat and how to treat them. Drug Alcohol Rev, 36:7–9.
12 Graham, K., et al. (2011) Alcohol may not cause partner violence but it seems to make it worse: a cross national comparison of the relationship between alcohol and severity of partner violence. J Interpers Viol, 26(8):1503-1523.
13 Gilchrist, G., et al. (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 Alcohol Rev, 31(1):34-51.
14 Hughes, L., Fitzgerald, C., Radcliffe, P., Gilchrist, G. (2015) A framework for working effectively and safely with men who perpetrate intimate partner violence in substance use treatment settings. London: King’s College
15 Stephens-Lewis, D., et al. Interventions to Reduce Intimate Partner Violence Perpetration by Men who use Substances: A Systematic Review and Meta-Analysis of Efficacy. Trauma Viol Abuse (under review)
16 Gilchrist, G., et al. (2019) The interplay between substance use and intimate partner violence perpetration: A meta-ethnography. Int J Drug Policy, 65:8-23.
17 Gadd, D., et al. The Dynamics of Intimate Partner Violence Perpetrated by Substance Using Men. Br J Crim (under review)
18 Radcliffe, P., et al. How do men and women explain Intimate Partner Violence and what is the role of substance use in this? (in preparation)
19 Public Health England (2018) Alcohol and drug prevention, treatment and recovery: Why invest?
20 Walby, S. (2009) The Cost of Domestic Violence: An Update, 2009. Lancaster University, Lancaster.

UK Domestic Violence and Health Research Forum – invitation for presentations

The next meeting of the UK Domestic Violence and Health Research Forum has been scheduled for Wednesday, 12th of June 2019 from 09:45 am to 14:45 pm at University College London (UCL). The London School of Hygiene and Tropical Medicine (Gender Violence and Health Centre) and UCL will be co-hosting the forum on this occasion. The aim of the UK Domestic Violence and Health forum is to present and share research in the field of domestic violence and health. This would include research in progress, completed research studies and the future direction and challenges arising within these studies, prospective areas of research as well as news and events.

The organisers are inviting 15 minute presentations that will be followed by a 15 minute discussion. If you would like to present, please do send an expression of interest with a brief abstract by the 30 April 2019.  If you would like to attend or present please contact  lynn.sardinha@bristol.ac.uk  

 

 

Learning from the ADVANCE intervention: cycle one

The three intervention development staff working on ADVANCE have reviewed the first cycle of work having run the intervention in three sites in England. Their key learning points were derived from feedback from staff, clients and their own weekly contact with facilitators of the group. Key learning points include:

  • Sites giving similar feedback strengthened the view that some changes needed to be implemented
  • Amendments needed to be incorporated while ensuring continuity of the programme
  • Seeing facilitators prepare and provide sessions highlighted if materials really worked
  • Participants took away more from the material than was originally anticipated due to the skill of facilitators
  • Reducing the amount and complexity of material in each session has been an important piece of feedback
  • Facilitators are used to listening to clients and not rushing through exercises therefore reducing the amount to cover in sessions was recommended
  • Facilitators found it hard to decide which exercises should be discarded for the next phase as they were seen as all being beneficial
  • The men varied in how much they talked in a session so time to cover each week’s material may vary considerably.
  • Using less wordy verbal tasks does not diminish the impact of a session
  • Using more action and reflection in key messages is beneficial in sessions
  • It is important for the ADVANCE development team to trust that facilitators and clients will understand the main points of each session
  • Good feedback and engagement from staff and participants has increased confidence that the programme can work
  • Feedback indicated that facilitators liked the ADVANCE programme and believed it enhanced their practice

Here are some quotes made directly from the ADVANCE developers about their learnings from cycle one.

‘Much of the feedback which has resulted in amendments was coming from more than one site which reassured me that it was sensible to make the change. It was important to maintain the designed elements and flow of the programme while making amendments which address the delivery experience.’ Sara Kirkpatrick RESPECT

‘Much of the time the participants were taking more from the material than had initially been considered, a great deal of this being linked to the group work skills and sophisticated understanding of both substance use and intimate partner abuse from the facilitators.’ Professor Liz Gilchrist University of Worcester

‘Sessions packed with exercises and tasks created pressure on workers who are used to taking time to listen to clients – moving the session along could seem abrupt and dismissive of clients’ discussion.’ Dr Mary McMurran Independent Psychology Consultant

 

 

 

Kylie Dembrey murder in Berkshire: Police review domestic abuse case

Police are reviewing a domestic violence case. Mark Sinclair murdered his on/off partner Kylie Dembrey.  Thames Valley Police’s will aim to establish if “there are any areas or lessons to be learned” from this case because despite there being a safety plan in place this has not prevented the murder. Sinclair was sentenced to 21 years in prison after he strangled Kylie Dembrey until she was unconscious and then stabbed her in the neck and heart.

Judge Paul Dugdale who sentenced Sinclair at Reading Court commented that through the couple’s 12-year, on-off relationship, Sinclair had “punched, kicked, manhandled, and spat” at his girlfriend and the murder came “at the end of an extensive history of regular violence… in a domestic context”.

Sinclair’s sentences for his convictions against Ms Dembrey “varied from a community order with a domestic violence programme in 2008, to a prison sentence in 2012”, the court heard.

You can read more about the case here.

UK Channel 5 documentaries highlight the effects of domestic violence

A new documentary was aired  in the UK by Channel 5 which focuses on domestic violence.  Two women Hazel and Kellys’ stories are told using footage gathered by the police officer’s body cameras who attend the scene, taped recordings of the women’s 999 calls and interviews with the women in the months that follow their last assaults. Both women now have restraining orders, further harassment has occurred and both discuss a persistent feeling of being unsafe.

You can access the programme The Abused here. You can access another documentary on Channel 5 focusing on how to leave an abusive relationship safely here.

NSPCC calls for the law to recognise children as victims of DV

Data suggests that around 250,000 children currently living with domestic violence in England but they are not treated as victims. The NSPCC is calling for a change in the law to recognise the life long effects of experiencing DV in the household as a child.

They commented that the current proposals “ignore the effect growing up in abusive households has on children” and leaves them without support.

The NSPCC said the situation could be legally recognised in the government’s Domestic Violence and Abuse White Paper. A consultation closed in May 2018 but the government have yet to publish the outcome of this consultation. A further argument is  that giving children legal recognition as victims of domestic abuse would allow increased use of protection orders, help professionals intervene and authorities to provide trauma services.

You can read more here.

England hospital admissions for addiction soar as treatment budgets are reduced

 

 

Jonathan Ashworth (Shadow health secretary) UK.

The Guardian has reported that more than half of the local authorities in England have cut their budgets for alcohol and drug treatment, even though admissions to hospital for problems related to addiction are soaring, say MPs.

Liam Byrne, the chair of the cross-party parliamentary group for children of alcoholics, and Jonathan Ashworth, the shadow health secretary, have both spoken of the trauma of growing up with an alcoholic father. They are among a number of MPS who are challenging the cuts.

The data comes from a freedom of information (FoI) request by Byrne to local authorities, which are responsible for drug and alcohol treatment in their areas while stuggling to provide recources with huge cuts to budgets.

Bryne commented “Every child of an alcoholic comes to learn the brutal hard way that we can’t change things for our parents, but we can change things for our children,”.

This data has been indicating that alcohol-related hospital admissions are up by 13%, which constitutes 39,000 more in 2018 than in 2009. This is occuring alongside alcohol treatment budgets being cut by 4%.

You can read more here.

DRIVE Project domestic abuse intervention year two results published

The Drive Project launched in April 2016 and is being piloted in three areas across England and Wales from 2016-2019. It is being developed and run as part of a partnership between Respect, SafeLives, and Social Finance in collaboration with the PCCs, local authorities, and service providers, and delivered by DVIP (division of Richmond Fellowship), Hampton Trust, Safer Merthyr Tydfil, and the Change Project.

Drive targets the perpetrators of domestic abuse and improves outcomes for victims and children. The key objectives are to: reduce the number of serial perpetrators of domestic abuse; reduce the number of repeat and new victims; reduce the harm caused to victims and children; intervene earlier to safeguard families living with high-harm domestic abuse.

The University of Bristol, acting as independent evaluators for the pilot, have now reported on their second year findings from Drive. The aim of the University’s first year’s feasibility study was to determine whether the intervention could be safely delivered and ensure that sufficient data could be captured to enable evaluation. The Year 2 evaluation is an interim report assessing outcome findings to date and developing a deeper understanding of the model. The Year 3 evaluation, which is currently underway and due at the end of 2019, will focus on a full evaluation, over the three-year pilot period, of outcomes, process, and cost-benefit analysis.

Indicative findings are continuing to be positive, demonstrating that Drive is reducing harm to victims and children by targeting perpetrators of domestic abuse.

Please click here to read the executive summary that highlights these key findings.

UK Government tendering for the development of a training for professionals working on DV

The Secretary of State for the Home Department in the UK is tendering for the development of a written training pack to support frontline professionals working with people who may be victims or perpetrators of domestic abuse who are also experiencing alcohol misuse. The frontline professionals and practitioners that this training pack will support are those working in domestic abuse or alcohol treatment services, GPs and police. Levels of knowledge and experience of domestic abuse, alcohol misuse and the interplay between them is likely to vary between professionals in these groups, depending on the primary role and focus of the service in which they work.

The purpose of the training materials is to:
• raise awareness of the impact alcohol misuse can have in relationships where domestic abuse is present;
• encourage practitioners to actively seek to identify where alcohol misuse and domestic abuse are co-occurring and to give pointers on signs, risk assessment and responses covering both victims and perpetrators of domestic abuse; and
• encourage greater join-up between alcohol and domestic abuse services and engagement by GPs and police through the incorporation of these materials into training and practice.

The closing date is 12th February 2019.

To find out more click here.

New report published detailing accounts of survivors of multiple disadvantage including domestic abuse

The report ‘Hand in Hand’ was co-produced by peer researchers with the charities AVA (Against Violence and Abuse) and Agenda, the alliance for Women and Girls at Risk, for the National Commission on Domestic and Sexual Violence and Multiple Disadvantage.

The peer researchers were made up of 11 survivors of domestic and/or sexual abuse. The report is based on their interviews with women facing ‘multiple disadvantage’ – who have experienced violence and abuse, and continue to face issues like homelessness, mental ill-health and substance use.

The report found 1/3 of the women involved had received a mental health diagnosis, just under a 1/3 described using drugs to cope with their situation and 1/4 reported that social services were involved with their children. Chlo Winfield (a peer researcher on the project) commented that:

“Our report paints a bleak picture for the most disadvantaged women – with too many falling through gaps due to service failures, cuts to support and ever-increasing thresholds for getting help,”