Domestic Violence Addiction Treatment
Text: Substance Abuse Treatment and Domestic Violence:
Treatment Improvement Protocol (TIP) Series #25
By: Patricia A. Fazzone DNSc., John K Holton PhD & Beth G. Reed PhD
Copyright © 2001 by:
Institute of Addiction Awareness
24881 Alicia Pkwy., #E-519
Laguna Hills, CA 92653
A. EFFECTS OF DOMESTIC VIOLENCE
1) Domestic violence is the use of __________ emotional, psychological, sexual, or physical force by one family member or intimate partner to control another.
2) Defining and rigidly adhering to men’s and women’s traditional roles is a manifestation of _____________.
a) psychological abuse
b) emotional abuse
c) using privilege
d) a lifestyle choice
3) In the United States, a woman is beaten every fifteen seconds.
4) Research shows what percentage of men who commit acts of domestic violence also have substance abuse problems?
c) 35% - 55%
d) 25% - 50%
5) Research suggest that aggression towards an inebriated victim is considered _________ than aggression toward a sober one.
a) less acceptable
b) the same as
c) more acceptable
d) either B or C
6) The belief that domestic violence will stop once the drinking or drug use stops is _________.
a) usually borne out
b) not usually borne out
c) based on solid clinical research
d) an anecdotal finding under investigation
7) Under what circumstances is a partner’s enabling a substance abuser to drink or use chemicals considered a safety measure?
a) Under no circumstances
b) When the batterer is less violent when sober or abstinent
c) Before the survivor seeks treatment
d) When the batterer is more violent when sober or abstinent
8) Denial, enabling, codependency and powerlessness _________.
a) strike some domestic violence workers as stigmatizing, repressive and counter to appropriate goals for violence survivors
b) form the core of a shared therapeutic vocabulary between substance abuse counselors and domestic violence counselors
c) accurately describe the tools used by the survivor to cope with domestic violence
d) are terms relevant to substance abuse recovery only
9) The chief concern for treatment providers with a client who informs them she is a victim of domestic violence is:
a) validating and believing her.
b) providing for the immediate physical safety of her environment.
c) identifying her options.
d) assuring her that she is believed.
10) Women who were victims of childhood sexual abuse and sexual assault are likely to have _________ when compared to women who were not abused.
a) a higher incidence of substance abuse
b) a lower incidence of substance abuse
c) the same incidence of substance abuse
d) unknown incidence
11) Couples and family therapy _________.
a) is a good treatment modality for domestic violence survivors
b) is more appropriate for substance abusers and their families
c) may be dangerous for domestic violence survivors
d) should be encouraged for batterer’s who have little empathy
12) Cuts and bruises from domestic violence tend to be on the legs, back and other areas covered by clothing.
13) One of the ongoing coping mechanisms used by many survivors is ________.
a) the exaggeration of physical sensations, including physical pain.
b) an increase in somatic complaints
c) a suppression of emotions regarding the abuse
d) the repression of physical sensations, including physical pain
14) For a proportion of domestic violence survivors, decision making is _______ .
a) a new skill that must be acquired for the first time
b) a lost skill that must be relearned
c) a preferred but unnecessary skill for recovery from substance abuse
d) often difficult, but important for recovery from substance abuse
15) What percent of battered women met the criteria for PTSD in Kemp et al’s 1991 study of battered women in a shelter?
16) An additional stressor for a survivor of domestic abuse who is a parent is:
a) the financial responsibility of the children.
b) the fact that some children are not supportive of their mother’s choices.
c) older children (especially boys) commonly ally themselves with the batterer.
d) B and C
17) _______________ poses the greatest risk of relapse for battered women.
a) Failure to identify trigger events
b) Revictimization by their abusive partners
c) The inability to make reasoned decisions
d) Failure to seek psychological counseling
18) Adolescents who have observed their fathers abusing their mothers ________.
a) exhibit high levels of aggression and acting out
b) are at decreased risk of adopting these same strategies in their interactions with their partners
c) are at increased risk of adopting these same strategies in interactions with their partners
d) A and C
19) Treatment providers must adhere to the laws in their states regarding mandated reporting of child abuse and neglect:
a) even if the client perceives those actions as a betrayal of trust.
b) only if doing so will not be perceived by the client as a betrayal of trust.
c) whenever a child is in immediate danger.
d) only if the issue of abuse and neglect will be addressed in therapy.
20) When researchers examined court documents, they found that ______ percent of incarcerated batterers reported a history of drug addiction.
21) Acute intoxication by the male is a better predictor of battering than chronic alcohol abuse.
22) Domestic violence is correlated to:
a) middle income.
b) approval of violence against women.
c) gender-based stereotypes.
d) B and C
23) McClelland’s theory of alcohol and power motivation suggested that ________ might be the factor that accounts for the high correlation between substance abuse and spousal abuse.
a) the need for personal power
b) societal norms for male dominance
c) the need for interpersonal dominance
d) gender-based stereotypes
24) A problem identified by the Consensus Panel regarding anger management group for batterers was that ___________.
a) many are led by clinicians with inadequate skills
b) they may indirectly reinforce battering behavior
c) batterers find them irrelevant to their situation
d) A and B
25) Responsible treatment of batterers includes teaching:
a) techniques of regulating anger.
b) them to reveal their anger.
c) them to repress their anger.
d) them to redirect their anger away from others.
26) Which group of batterers did Gondolf’s study identify as most likely to abuse alcohol?
a) Typical batterers (52%)
b) Antisocial batterers (41%)
c) Sociopathic batterers (7%)
d) All groups used alcohol in a similar manner
27) In Dutton’s program, which type of batterer was most likely to be compliant with treatment?
a) Psychopathic wife assaulters
b) Overcontrolled assaultive males
c) Cyclical/emotionally volatile wife abusers
d) All groups were equally non-compliant
28) Substance abuse treatment providers should not treat batterer and victim couples together without consulting a domestic violence expert.
29) What behavior in a batterer can serve as a barometer for a client’s progress in his substance abuse?
a) The degree to which he assumes responsibility for his actions.
b) The reduction in violent acting out against his spouse.
c) The regularity of his attendance at 12 step meetings.
d) None of the above
30) The focus of treatment for a batterer must be on encouraging the client to:
a) develop enough self-awareness to recognize the beliefs and attitudes that contribute to violent behavior.
b) control the emotions that contribute to his violent behavior.
c) A and B
d) Neither A nor B
31) The Consensus Panel recommends postponing family and couples counseling until the batterer _____________.
a) is removed from the home
b) has demonstrated a pattern of nonviolent and noncoercive behavior for a year
c) agrees to a non-violence contract
d) A and C
D. SCREENING AND REFERRAL
32) Screening for domestic violence in substance abuse treatment is undertaken to:
a) identify a common cause for relapse
b) identify survivors
c) identify batterers
d) B and C
33) Evidence suggests that a father who abuses his children seldom abuses his wife as well.
34) When should a client who may be a survivor of domestic violence never be asked about battering?
a) When someone who might be the batterer is present.
b) When there is no direct evidence of battering, such as bruises.
c) Before trust between the counselor and the client has been established.
d) When criminal charges are pending against the alleged batterer.
35) The client who has been sexually assaulted by her partner may _________.
a) exaggerate the experience if it is an infrequent occurrence
b) fail to recognize the experience if she was sexually abused as a child
c) normalize the experience particularly if it has been a repeated one
d) all of the above
36) What concept(s) is it important to convey to a survivor when framing screening questions about domestic violence?
a) Substance abuse is no excuse
b) There is no justification for battering
c) The counselor is non-judgmental about the role of the survivor in the cycle of abuse
d) A and B
37) In some cases of domestic violence, denial is _________.
a) an adaptive survival technique developed as a direct response to unsuccessful attempts to obtain help
b) a maladaptive coping skill that keeps the survivor in the dependent victim role
c) a survivor’s way of maintaining control over the substance abusing batterer
d) B and C
38) Avoiding the implication that substance abuse is the “cause” of violence is:
a) more important in screening batterers than in screening survivors.
b) less important in screening batterers than in screening survivors
c) as important in screening batterers than in screening survivors.
d) unimportant in the screening process for domestic violence.
39) Inquiries into possible child abuse should not occur until _________.
a) the counselor suspects the children are in physical danger
b) the client has been notified that the counselor is a mandated reporter of suspected child abuse or neglect
c) the children are safe from the abuser
d) the counselor receives an independent report of child endangerment
40) If a treatment provider suspects that the child of a client has been a victim of violence, he or she must ________:
a) contact CPS or home health services immediately
b) interview the child to determine if there is abuse in the home
c) refer the child to a health care provider immediately
d) act only if the child appears to have been harmed
41) In order to ensure that both problems are addressed, substance abuse counselors can share information with domestic violence staff _____.
a) at any time during the course of treatment
b) if the client has signed a written release for exchange of information
c) whenever a substance abuse treatment provider suspects violence is interfering with the client’s recovery
d) when both treatment providers believe it is in the interests of the client’s treatment program to do so.
42) No-violence contracts can help structure treatment by specifying an achievable behavioral goal for the batterer.
43) Survivors benefit in participating in ________.
a) mixed gender groups that use confrontational techniques
b) mixed gender groups that do not use confrontational techniques
c) same sex groups that use confrontational techniques
d) same sex groups that do not use confrontational techniques
E. LEGAL ISSUES
44) The Violence Against Women Act ____.
a) made domestic violence a criminal offense
b) made domestic violence a civil rights violation
c) is part of the Violent Crime Control and law Enforcement Act
d) B and C
45) Many abused women are afraid to seek child support because they fear that doing so:
a) will interfere with their receiving child welfare benefits.
b) will result in the batterer receiving visitation rights, which would force disclosure of their new location.
c) will force them into a welfare to work program.
d) will result in their being responsible for debt the batterer incurred in their absence.
46) The most common and easily obtainable mechanism of relief for victims of domestic violence is _________.
a) a civil protection order
b) a criminal restraining order
c) a civil injunction
d) A and C
47) Treatment providers must not let ________ prevent them from routinely inquiring about domestic violence in the course of providing appropriate care to clients.
a) confidentiality restrictions
b) developing a therapeutic alliance
c) establishing trust with a client
d) B and C
48) Federal confidentiality laws regulations:
a) permit substance abuse treatment programs to comply with State mandatory child abuse reporting laws.
b) do not permit substance abuse treatment programs to comply with State child abuse reporting laws.
c) give substance abuse treatment programs the option of complying with State child abuse reporting laws.
d) allow substance abuse programs to exceed permit substance abuse treatment programs to exceed the requirements of State child abuse reporting laws.
49) Under Federal law, a law enforcement agency may use information about a person’s substance abuse treatment to _______.
a) prosecute the batterer for a separate crime
b) make recommendations to the court in pending civil matters, such as child custody and visitation cases
c) revoke his or her participation in treatment in lieu of criminal justice processing
d) A and C
50) When does a substance abuse treatment provider have the “duty to warn”?
a) When the law requires them to do so.
b) When there is a serious threat of violence towards a particular person.
c) When a client gives permission to do so.
d) When there is a serious threat towards an identified group of people.
51) A substance abuse program can report a client’s stated suicidal intent to medical personnel if ___________________.
a) the client gives permission
b) the client is not identified as a substance abuser
c) the threat poses an immediate danger to the health of any individual and requires immediate medical intervention
d) A, B or C
52) Federal confidentiality laws permit a program to reveal information about a client’s status as a substance abuser __________.
a) only if the client gives written consent
b) if the client threatens an assault or perpetrates an assault on the premises of the program
c) if the client is in the program as a condition of release from prison or jail
d) A and B
53) If a counselor knows that a client is a fugitive from justice, a refusal to assist or give officers information is a criminal offense in some States.
F. COMMUNITY RESPONSE
54) A search warrant does not authorize the program to permit the police to enter the premises:
55) When treating substance abusers who are also involved in domestic violence, managing the coordination of services should be handled by:
a) the legal system in charge of the criminal aspects of the case.
b) the batterer’s substance abuse counselor.
c) substance abuse treatment providers, domestic violence expe.rts, and legal and other relevant professionals should plan treatment collaboratively
d) the survivor’s domestic violence counselor.
56) When establishing a collaborative relationship between a substance abuse treatment program and a domestic violence program, an important first step for both programs is to ________.
a) clarify terminology used by each program
b) ask for feedback to ensure that all parties are interpreting information in the same way
c) A and B
d) clarify the limitations imposed on each by State and Federal laws
57) One reason that domestic violence has not been incorporated into the concepts of managed care is that _______.
a) domestic violence is a social and legal problem
b) some advocates have rejected the use of a medical model to define the problem
c) insurance companies often reject claims as “self induced harm”
d) case management can interfere with the domestic violence programs structure
58) What psychological risk markers has research identified for becoming a victim of adult domestic violence?
a) High dependency needs
b) Antisocial traits
c) Poor anger management skills
d) none of the above
59) What does United States Code, Title 42, and Title 42, Part 2, of the Code of Federal Regulations guarantee?
a) The strict confidentiality of information about all persons receiving substance abuse prevention and treatment services.
b) Access to substance abuse treatment regardless of ability to pay.
c) The limited confidentiality of information about persons receiving substance abuse treatment in Federally funded substance abuse programs.
d) The separation of substance abuse and mental health treatment programs.
60) Information that is protected by Federal confidentiality regulations may always be disclosed ______________.
a) after the client has signed a proper consent form
b) after a client has given verbal consent or the counselor to do so
c) if the court orders it
d) to further a criminal investigation
61) Which of the following items is required on a valid release of information consent form?
a) the name of the client
b) the purpose of the disclosure
c) a statement that the client may revoke the consent at any time
d) all of the above
62) Under what circumstances must a substance abuse program obtain the parent’s signature to make a disclosure to anyone else about a minor in treatment?
a) Every time information is to be disclosed.
b) Only if state law requires parental permission before a minor may be treated for substance abuse.
c) If the minor’s parents so stipulate in writing.
d) a, b and c
63) Any disclosure made with written client consent must be accompanied by a written statement that the information disclosed is protected by Federal law and that the recipient may not make any further disclosure unless permitted by the regulations.
64) Client-identifying information __________.
a) includes name, age, race and other personal identifiers
b) is information that identifies someone as a substance abuser
c) does not include requests for verification of information from a relative
d) a and c
65) When may a program communicate with a third party payer who may be responsible for funding the client’s treatment?
a) After they have obtained a client’s written consent to do so.
b) After the client has agreed to treatment.
c) a and b
d) At any time after services have been delivered.
66) If a client does not want the insurance carrier to be notified and is unable to pay for treatment:
a) the program may refer the client to a publicly funded program.
b) the program may bill the insurance company anyway.
c) the program must continue to treat the client regardless of payment.
d) b and c
67) Referrals by a member of the substance abuse treatment team to another agency for services for a client are exempt from Federal confidentiality laws.
68) Federal regulations regarding confidentiality define a “medical emergency” as:
a) a condition resulting from an accident or illness which requires the attention of a physician or surgeon.
b) any condition which requires more than basic first aid to maintain or restore an individual’s health or well-being.
c) any condition that is serious and requires urgent medical attention.
d) a condition which poses an immediate threat to the health of any individual and which requires immediate intervention.
69) If someone telephones a client at a program:
a) staff may not reveal that the client is at the program unless the program has a written consent form signed by the client to make a disclosure to that particular caller.
b) staff may reveal that the person is at the program if the individual gives verbal permission for them to do so.
c) staff may reveal that the person is at the program if the individual has signed a general consent to release information over the telephone.
d) b or c
70) A criminal justice system consent __________.
a) may be revoked by the client before its expiration date
b) may not be revoked before its expiration date or event
c) falls under Federal confidentiality laws
d) b and c
71) Any information received by one of the eligible criminal justice agencies from a treatment program may be used ______________.
a) by that justice agency in connection with its official duties with respect to all criminal proceedings in which the client is involved
b) by that justice agency in connection with its official duties with respect to all drug-related criminal proceedings in which the client is involved
c) by that justice agency only in connection with its official duties with respect to that particular criminal proceeding
d) by that justice agency only in connection with its official duties at its discretion with the courts
72) Under Federal regulations a program may reveal client-identifying information in a way that does not reveal the client’s status as a drug or alcohol abuse client.
73) A subpoena, search warrant, or arrest warrant signed by a judge _________.
a) is not sufficient standing alone to require or even permit a program to disclose information
b) is sufficient standing alone to require or even permit a program to disclose information
c) is the same as an authorizing order if it is signed by a Federal judge
d) b and c
74) A Qualified Service Organization:
a) can reveal information a substance abuse program cannot under the Federal
b) should only be used when an agency or official outside the program is providing a service to the program itself.
c) may be used between programs providing alcohol and drug abuse services.
75) a and c
75) Under Federal regulations clients have a right to see their clinical records:
a) at the discretion of the program.
b) whenever they wish.
c) for good cause as determined by the client
d) when the program permits the client to view or obtain copies of their records.
NOTE: Record answers on Course Completion form - do not send in your exam.
This advanced course provides guidelines for substance abuse treatment providers in the public sector and in community programs. Based on clinical research and interviews with expert service providers, this course contains a summary of information available regarding the effects of domestic violence on the treatment of substance abuse, statistics describing domestic violence in this country as it pertains to substance abuse, and practical methods for developing an effective community-based treatment protocol to address the relevant issues. Also included are Federal confidentiality regulations.
After completing this course, the participant will be able to:
1) define domestic abuse.
2) identify the signs and symptoms of abuse in a recovering batterer or survivor.
3) list the characteristics of a batterer or victim.
4) explain the links between substance abuse and domestic violence.
5) recognize effective interventions for domestic violence.
6) prepare a plan for coordinated community-based care for survivors of domestic violence.
7) state the basic requirements and limitations of Federal confidentiality regulations.