CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Module Content Objectives Introduction General Screening For Domestic Violence and Sexual Assault -- Domestic Violence Screening Statements -- Additional Statements of Support Addressing Alcohol Abuse With Domestic Violence Clients -- Screening Instruments for Alcohol Use -- Assessments For Alcohol Use -- Talking About Alcohol Abuse -- Supporting Sobriety Assessing Violence for Women in Alcohol Treatment -- Domestic Violence Screening -- Domestic Violence Assessment Tips Addressing Alcohol Abuse With Men in Treatment For Violence -- Alcohol Screening -- Alcohol Assessment Addressing Domestic Violence With Men in Alcohol Treatment -- Abuse Screening -- Timing for Batterer Intervention/Relapse Prevention Child Maltreatment and Abuse Psychiatric Comorbidities -- Dual Diagnosis Safety Planning Summary of Module References Module 7 Quiz

Domestic Violence Screening Statements

In establishing a bond with the client/patient, the professional must achieve his or her goals in a way that is the least threatening or traumatic to the victim. The phrasing of the following statements can help defuse an otherwise uncomfortable (or even physically confrontational) atmosphere.

• "Because violence is so common in many people's lives, I've begun to ask all my patients/clients about it."
• "I'm concerned that your symptoms may have been caused by someone hurting you."
• "Many of my patients/clients are involved in abusive relationships. I don't know if this applies to you, but some are too scared to bring it up themselves, so I now ask about it routinely." "Do you feel safe in your relationship?"
• "Statistics show lesbian women are in abusive relationships. Does your partner ever try to hurt you?"⁵

Sexual Assault Screening

Many women with alcohol abuse problems have been sexually abused as children. However, knowing how alcohol puts a woman at risk for sexual assault, it is also important to question the client about recent incidences of attack or abuse.^6,7,8

If a client was raped or sexually assaulted recently, it is important to know:

• If the rape has occurred within the past 72 hours, she should not shower or bathe because physical samples will help identify the attacker or provide evidence if she decides to press charges later. A woman's alcohol abuse does not justify sexual assault and cannot be used as an excuse in court.
• If the rape or sexual assault occurred more than 72 hours prior, the victim should still seek medical help because she should be tested for sexually transmitted diseases, HIV, and/or pregnancy.
• Further counseling is recommended to address understandable-and natural-fears of being alone, of men and of sexual problems.
• She must not blame herself. This is the most important thing to remember. The rape was not her fault. Neither her behavior nor her alcohol use caused the rape; the rapist did.

Supportive Statements

Similar to domestic violence screening, when screening for sexual assault, professionals need to establish an environment of trust and safety. The American College of Obstetricians and Gynecologists (ACOG) has developed the following tool. Screening for rape and sexual assault can be conducted by making a statement, and asking the following questions:

"Because sexual violence is an enormous problem for women in this country and can affect a woman's health and well being, I now ask all my patients about exposure to violence and about sexual assault.

1. Do you have someone special in your life? Someone you're going out with?
2. Are you now--or have you been--sexually active?
3. Think about your earliest sexual experience. Did you want this experience?
4. Has a friend, a date, or an acquaintance ever pressured or forced you into sexual activities when you did not want them? Touched you in a way that made you uncomfortable? Anyone at home? Anyone at school? Any other adult?
5. Although women are never responsible for rape, there are things they can do that may reduce their risk of sexual assault. Do you know how to reduce your risk of sexual assault?"

Unless you are specifically trained to counsel sexual assault victims, advise her to call the rape crisis hotline or sexual assault coalition in her community. To find training materials and programs, you can go to www.cdc.gov/ncipc to access their report "Intimate Partner Violence and Sexual Assault: A Guide to Training Materials and Programs for Health Care Providers."