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

Pretreatment Intervention

	Abstinence	Low-Risk Use	At-Risk Use	Problem Use	Abuse/Dependence
Pretreatment Intervention			X	X	X

A pretreatment intervention is sometimes referred to as an intervention. It is a carefully planned meeting with no more than two or three people who talk with the woman about their concerns. These are usually the leading informal/family caregiver, the leading formal/health or social caregiver, and an addictions expert or other skilled counselor. The leading family caregiver is often the spouse or parent (guardian).

A formal process that includes a progressive interaction between the counselor and the family or friends is conducted for at least 2 days prior to meeting with the patient. The counselor helps plan the intervention and educates the family about substance abuse and its prevention.¹ Participants are coached on how to offer information in an emotionally neutral, factual manner while maintaining a supportive, non-accusatory tone. The key is to present incontrovertible evidence to the loved one that a problem exists.

When using this approach with women especially if they have been abused it is important to limit the number of people involved, because:

• Most of the women are already in denial about their situation. Being confronted by too many people at one time will overwhelm them, which may precipitate an avoidant response. The most influential person to include in interventions or any other pretreatment activity may be a spouse (only when there is no abuse), cohabitant, parent or guardian, caregiving son or daughter (if an older adult), clergy member, or visiting nurse or caseworker, depending on the particular social network of the client.

Because denial is also a part of psychoactive prescription drug dependence, an intervention may help move psychoactive drug abusers toward detoxification or other formal treatment. However, extra caution is advisable. Many women may have difficulty accepting the diagnosis of abuse or dependence and the need for treatment. It is particularly difficult because, in almost all cases, their initial use of psychoactive prescription drugs was sanctioned by a health care provider. The drugs usually have been prescribed as a remedy for a legitimate medical problem or complaint (often related to the violence).

As with treatment, pretreatment activities, such as interventions, may be conducted best in the client's home and can be coupled with other personal or social services^2,3 or with home-based detoxification services.⁴ An intervention should never be conducted in the home when there is evidence of abuse, because it is an unsafe environment for the woman.

References

1. Johnson, V. E. (1973). I'll quit tomorrow. New York: Harper and Row.
2. Fredriksen, K. I. (1992). North of market: Older women's alcohol outreach program. Gerontologist, 3, 270-272.
3. Graham, K., Saunders, S. J., Flower, M. C., et al. (1995). Addictions treatment for older adults: Evaluation of an innovative client-centered approach. New York: Haworth Press.
4. Cooper, D. B. (1995 Dec. 14). Alcohol home detoxification: A way forward. British Journal of Nursing 4(22),1315-1318.

See Module 8, Treatment, for more information.