Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford, University Medical Center, Palo Alto, CA, USA.
Subst Abuse Treat Prev Policy. 2012 Sep 7;7:37. doi: 10.1186/1747-597X-7-37.
Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems.
We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse.
Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program's mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV + status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs.
SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical needs. However, policy change can modify barriers to treatment integration and service linkage, such as reimbursement restrictions and lack of staff training.
物质使用障碍和亲密伴侣暴力（IPV）的实施是相互关联的，是主要的公共卫生问题。
我们对加利福尼亚州的一组物质使用障碍治疗计划（SUDP；N=241）和 batterer 干预计划（BIP；N=235）的主任进行了调查，以研究 SUDP 解决 IPV 的程度，以及 BIP 解决物质滥用的程度。
一般来说，SUDP 并没有以正式和全面的方式解决共同发生的 IPV 实施问题。很少有政策要求评估潜在客户，或监测入院客户，以确定暴力行为；近四分之一不允许有 IPV 实施行为的潜在客户入院，只有 20%有解决暴力问题的组成部分或轨道。大约三分之一的客户因参与暴力行为而被停职或开除。SUDP 提供 IPV 服务的最常见障碍是预防暴力不是该计划使命的一部分，工作人员缺乏暴力培训，以及缺乏此类服务的报销机制。相比之下，BIP 倾向于以更正式和全面的方式解决物质滥用问题；例如，有一半的政策要求潜在客户接受评估，三分之二的政策要求对入院客户的物质滥用情况进行监测，近一半的政策有解决物质滥用问题的组成部分或轨道。SUDP 的客户资源较少（婚姻、就业、收入、住房），问题更为严重（酒精和药物使用障碍、双重物质使用和其他精神健康障碍、HIV+状态）。我们发现，尽管大多数 SUDP 和 BIP 主任都认为，应该在单独的项目中同时获得两种问题的帮助，但很少有证据表明针对同时存在物质滥用和暴力问题的个人的服务是集中的。
SUDP 可能难以解决暴力问题，因为他们的客户资源相对较少，心理和医疗需求更为复杂。然而，政策的改变可以改变治疗整合和服务联系的障碍，例如报销限制和缺乏员工培训。
