A Strength-Based Approach to Domestic Violence Survivors’ Substance Abuse and Mental Health Issues

Posted: 10.31.2017


With the opioid epidemic stronger than ever in Ohio, it continues to be as important as ever to pay attention to domestic violence in families. This includes understanding the intersection of domestic violence, mental health and substance abuse issues.  For example, perpetrators sometimes interfere with their partner’s efforts to attend treatment. Other perpetrators will use the children as weapons to manipulate their partner for money to do drugs. For example, a perpetrator may threaten to not return the children to his partner unless she gives him money for drugs.


Domestic violence survivors who are addicts or struggle with mental health issues can experience a constellation of problems. Women’s use of opioids has an association with domestic violence. They are also more likely than men to be introduced to opioid use by a partner versus a peer. This may occur in the context of coercive control. Often, for women, the use of opioids occurs as part of an intersection of mental health issues such as post-traumatic stress disorder and anxiety (DHS, Office on Women’s Health, 2016).    Both of these disorders have a correlation with domestic violence.  While it is important to understand the nature of the problem, it is also important to focus on the strengths and protective factors that are present with domestic violence survivors – even when there are addiction and/or mental health issues. In this article, we will explore what it means to apply a strength-based approach to working with domestic violence survivors who may be suffering substance abuse addiction and/or mental health issues. First we’ll look at some of the common assumptions about domestic violence survivors as parents. Then we’ll examine how the data points support a strength-based approach even with survivors who have multiple issues. The article will close with some tips on how to turn this information into domestic violence-informed practice.


There is often a constellation of interlocking negative assumptions swirling around domestic violence survivors. For example, there may be assumptions that: 1) all domestic violence survivors suffer from emotional and behavioral health issues like depression, anxiety, or substance abuse; and 2) these problems automatically impede mothers’ ability to effectively parent. Current research underscores that when domestic violence survivors do experience mental health problems or turn to substance use, it is often as a result of domestic violence victimization. Thus, addressing issues such as mental health as the cause or simply a co-occurring unrelated issue, rather than a consequence of violence is problematic (Humphreys & Stanley, 2015; Humphreys & Thiara, 2003; Hutchison, 2003; Kroll, 2004). While acknowledging the importance of this observation, this briefing goes further: challenging the assumption that most women in homes with domestic violence suffer from severe illness and/or abuse substances. For example, Carlson et al. (2002) found that, depending on the protective factors (such as social support, education, health, self-esteem, etc.), depression rates for women who experienced severe domestic violence could be as low as 16.7% and anxiety rates could be as low as   33.3%. Furthermore, rates of depression and anxiety were even lower for women experiencing less severe violence (Carlson, McNutt, Choi, & Rose, 2002). These rates of depression and anxiety for women reporting high levels of protective factors and/or lower levels of violence   are actually similar or even lower than sample-wide rates of depression indication found using the same questionnaire in Spitzer’s 1994 study. Spitzer found that 26% of respondents scored positively for indicators of depression and 18% scored positively for indicators of anxiety (Spitzer et al., 1994).


While rates of mental illness were higher for domestic violence survivors with fewer protective factors, such as social support, it is   important to note that most women who experience domestic violence report similar levels of social support to those women not experiencing domestic violence (Carlson et al., 2002). Similarly, rates of substance abuse by mothers in homes with domestic violence are typically lower than one might expect. For example, two large-scale analyses found, respectively, that 76-86% of women experiencing domestic violence do not take drugs and the majority of women do not abuse alcohol to the point of drunkenness, with only 4% regularly getting drunk (Hutchison, 2003; Kantor & Straus, 1989).


Based  on  this  research,  automatic  assumptions  that  most  mothers  in  homes with domestic violence are likely to suffer from mental illnesses and/or abuse substances appear misguided. When this data is combined with research that suggests that some mothers with substance abuse and mental health issues are similar to other mothers, we have even more reason to focus assessments on actual parenting behavior instead of  a  mother’s  status as  a domestic violence survivor with mental health or substance abuse issues. (Baker & Carson, 1999; Brown, 2006; Colten, 1982; Litzke, 2005; Montgomery, Tompkins, Forchuk, & French, 2006; Suchman & Luthar, 2000).


What does this mean for your practice?

  • When working with domestic violence survivors who have addiction or mental health issues, do not assume that they are not capable parents. Individually assess their substance abuse patterns, mental health issues and their parenting abilities. 
  • Always seek to understand how the perpetrator’s patterns of behavior may be impacting the adult survivor’s substance abuse and/or mental health issues. Did he coerce her into using drugs? Did his behavior exacerbate an existing mental health or substance abuse issue? Is he interfering with her getting help for her issue(s)?
  • Assess the nature of the exposure to violence, not just the presence of domestic violence in the family. Often times we think in terms of binaries: “Is there domestic violence present in the family or not?” This isn’t the best assessment lens. Domestic violence-informed assessment teaches us to understand each perpetrator’s pattern. This is the best way to understand the perpetrator’s impact on child and family functioning which includes the adult survivor’s mental health and substance abuse issues.
  • Seek to increase the adult protective factors, like social supports, that may help an adult survivor avoid more serious mental health and substance abuse issues.
  • Remind adult survivors that even when they have addiction and/or mental health issues, that they are not responsible for the perpetrator’s choices to become violent. Clearly communicating this message can reduce his ability to manipulate her and increase your rapport with her. Making sure survivors do not feel blamed for their partner’s violence can help them focus on what they do have control over – like getting sober.


 *This article was adapted from a longer Domestic Violence-Informed Research Briefing entitled “Domestic Violence Survivors’ Parenting Strengths” by David Mandel and Claire Wright. To read the entire Research Briefing

© 2017 Published by the Safe and Together Institute, PO Box 745, Canton CT, 06019/safeandtogetherinstitute.com



Baker, P. L., & Carson, A. (1999). “I take care of my kids” mothering practices of substance-abusing women. Gender & Society, 13(3), 347–363.

Brown, E. J. (2006). Good Mother, Bad Mother: Perception of Mothering by Rural African-American Women Who Use Cocaine. Journal of Addictions Nursing, 2006, Vol.17(1), p.21-31, 17(1), 21–31. https://doi.org/10.1080/10884600500505802

Campbell, J. C., & Boyd, D. (1997). Violence Against Women: Synthesis of Research for Health Care Professionals (No. NCJ199761). National Institute of Justice, U.S. Department of Justice. Retrieved from https://www.ncjrs.gov/app/publications/abstract.aspx?ID=199761

DHS. Office on Women’s Health. (2016). White Paper: Opioid Use, Misuse, and Overdose in Women. Retrieved from https://www.womenshealth.gov/files/documents/white-paper-opioid-508.pdf

Carlson, B. E., McNutt, L.-A., Choi, D. Y., & Rose, I. M. (2002). Intimate Partner Abuse and Mental Health: The Role of Social Support and Other Protective Factors.

Violence Against Women, 8(6), 720–745. https://doi.org/10.1177/10778010222183251

Colten, M. E. (1982). Attitudes, Experiences, and Self-Perceptions of Heroin Addicted Mothers. Journal of Social Issues, 38(2), 77–92. https://doi.org/10.1111/j.1540-4560.1982.tb00119.x

Humphreys, C., & Stanley. (2015). Domestic Violence and Child Protection: New Challenges and Developments. London: Jessica Kingsley Publishers. Humphreys, C., & Thiara, R. (2003). Mental health and domestic violence:“I call it symptoms of abuse.” British Journal of Social Work, 33(2), 209–226.

Hutchison, I. W. (2003). Substance Use and Abused Women’s Utilization of the Police. Journal of Family Violence, 18(2), 93–106. https://doi.org/10.1023/A:1022889131043

Kantor, G. K., & Straus, M. A. (1989). Substance Abuse as a Precipitant of Wife Abuse Victimizations. The American Journal of Drug and Alcohol Abuse, 15(2), 173–189. https://doi.org/10.3109/00952998909092719

Kroll, B. (2004). Living with an elephant: Growing up with parental substance misuse. Child & Family Social Work, 9(2), 129–140. https://doi.org/10.1111/j.1365-2206.2004.00325.x

Litzke, C. H. (2005). Social Constructions of Motherhood and Mothers on Drugs: Implications for Treatment, Policy, and Practice. Journal of Feminist Family Therapy, 16(4), 43–59. https://doi.org/10.1300/J086v16n04_03

Montgomery, P., Tompkins, C., Forchuk, C., & French, S. (2006). Keeping close: mothering with serious mental illness. Journal of Advanced Nursing, 54(1), 20–28.

Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., Verloin deGruy, F., Hahn, S. R., … Johnson, J. G. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. Jama, 272(22), 1749–1756.

Suchman, N. E., & Luthar, S. S. (2000). Maternal addiction, child maladjustment and socio-demographic risks: implications for parenting behaviors.

Addiction, 95(9), 1417–1428