Feature Story
by Bob CurleyMore than a third of women in addiction treatment have been physically forced to have sex, according to experts looking at the relationship between addiction, HIV, and sexual abuse among female addicts and alcoholics.
People who abuse alcohol and other drugs are both more likely to act out violently and be the victims of sexual violence, pointed out Jerry Flanzer, DSW, a social scientist with the services research branch of the National Institute on Drug Abuse. Flanzer spoke during a workshop at the 2003 annual conference of the National Association of Alcoholism and Drug Abuse Counselors, held last month in Washington, D.C.
Nabila El-Bassel, DSW, director of Columbia University's Social Intervention Group (SIG), said addiction, HIV, and violence are interrelated problems that disproportionately affect women. Women in addiction-treatment programs are three times more likely to be victims of partner violence than the general population, she noted, and studies have shown that 50 to 80 percent of women in treatment have been victims of childhood sexual abuse.
Moreover, many women who abuse alcohol or other drugs or are in relationships with men who do also are forced to have sex without the use of condoms, said El-Bassel, who said that some of the Latino and African-American men studied viewed requests for condom use as a sign of infidelity, or an insult to their masculinity. Some women in El-Bassel's study group, which consisted of women in methadone treatment programs, also reported being forced to have anal sex and being physically abused when they raised concerns about HIV and AIDS.
In some cases, women were forced to trade sex for drugs, then were abused by their partner for doing so, El-Bassel said. Disputes about using or sharing drugs also was a common flashpoint for partner abuse.
Different Drugs, Different Problems
Studies have also shown that use of particular drugs can lead to distinct forms of sexual and physical conflict. For example, said El-Bassel, heroin use can initially trigger increased sexual desire, but later causes a decline in interest in sex and also causes impotency. Female crack users typically dislike physical contact, while male users often suffer from premature ejaculation. Methadone use can cut sex drive as well as vaginal secretions. Any of these scenarios may spark angry outbursts among sex partners, experts say.
Nor is conflict limited to heterosexual couples: A survey of treatment providers found that intimate-partner violence is common among both gay and straight people entering treatment, said Louisa Gilbert, MSW, co-director of the SIG.
Most treatment providers believe that domestic violence should be addressed in treatment, according to the survey. But few feel they have adequate training to address domestic violence, according to Gilbert, and some providers said that tackling such issues could distract from their focus on addiction and recovery.
Moreover, addiction-treatment providers expressed concern about their ability to provide physical safety for women in abusive relationships, as well as for their own staff members. Many also expressed frustration about raising issues like physical abuse when short treatment stays and lack of referral resources prevent them from adequately addressing such problems.
Model Program
The SIG's Women's Wellness Project developed a model intervention program for abused women, and is testing it with a study group of 38 female treatment participants. The study will not only look at the model's impact on addiction but also related outcomes pertaining to HIV and unprotected sex.
A key component of the intervention is to empower women and "improve their self-efficacy to prevent violence," said Gilbert. The 12-session program will raise women's awareness of the interrelation between HIV, partner violence, and addiction, boost problem-solving abilities to avoid triggering conflicts, and improve negotiating and communication skills so that women can set boundaries on topics such as unprotected sex.
The latter is especially important, experts said, because violence is often a tool of domination, especially in situations where one partner is already economically or socially reliant upon another. The SIG's research has shown, on the other hand, that women who always use condoms during sex are less likely to be the victims of partner violence. "We think that's because norms have been established in the relationship," said El-Bassel.
The SIG model intervention also includes social-support sessions. Early results from the study show that many women feel more comfortable discussing partner violence in group-therapy sessions rather than in individual counseling, and that holding discussions outside the treatment facility helped women overcome confidentiality concerns.
"Some of the women got together socially after group, creating a potential support network in their daily lives. That really helps," said Gilbert.
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