Implementation of a group intervention to reduce intimate partner violence among women with substance use disorders

Abstract

Background: Intimate partner violence (IPV) is a global public health problem that impacts negatively on women's physical, psychological, sexual, and reproductive health. IPV is more prevalent among women with substance use disorders (SUD) than women in the general population, with studies reporting prevalence ranging from 40% to 70% among women with SUD compared to 15% to 40% among women in the general population in developed countries. Objectives: The overall aim of this dissertation was to adapt and evaluate a specific intervention to address IPV, substance use and depression among women with SUD. Methods: Firstly, a systematic review with meta-analysis to evaluate the efficacy of Advocacy interventions and Cognitive Behavioral Therapy interventions (CBT) in reducing IPV among female victims was conducted. Only one intervention in the review was developed for women with SUD. This intervention was adapted and then tested in a pilot randomized controlled trial among 14 women in Barcelona seeking treatment for SUD who had experienced IPV in the past month. The potential efficacy of the intervention in reducing IPV victimization (assessed using the Composite Abuse Scale), substance use (assessed using a substance use consumption table based on the Time Line Follow-back) and depressive symptoms (assessed using the Beck Depression Inventory BDI-II) at 12 months follow up was also assessed. Participants were randomly assigned to receive the 10 sessions CBT (Intimate Partner Violence Therapy: IPaViT-CBT) group intervention (an integrated substance use and IPV group intervention) or treatment as usual. Intention to treat analysis was conducted. Results: The meta-analysis found that both Advocacy interventions and CBT interventions resulted in significant reductions in physical and psychological but not in sexual or any IPV. The adapted evidence-based intervention tested in Barcelona reduced psychological maltreatment, increased assertiveness; reduced aggressiveness in the partner relationship, and reduced the frequency of drinking 1-month post intervention. It did not reduce the likelihood of any IPV victimization, or improve depressive symptoms, quality of life or health status, up to 12-months post intervention. Conclusions: The adapted intervention tested in a pilot study, showed some initial positive effects and was feasible to deliver in a community substance abuse centre. Despite this, we cannot conclude firmly that the IPaViT-CBT intervention is effective in reducing IPV, substance use or depressive symptoms due to the small sample size, nor that change were maintained in the long term. Future research should replicate these results with an adequately powered trial. It may also be useful to consider further adaptation to the intervention before replication as perhaps 10 sessions are not sufficient to reduce IPV.

Date of Award	17 Apr 2015
Original language	English
Supervisor	Marta Torrens Melich (Director) & Gail Gilchrist (Director)