Resources for Mental Health and Substance Use Treatment and Recovery Support Providers

At the National Center on Domestic Violence Trauma & Mental Health (NCDVTMH), one of our priorities is to support collaboration between the domestic violence (DV) field and the mental health and substance use disorder treatment and recovery fields. Our work is designed to enhance system responses to survivors of intimate partner violence (IPV) who are experiencing the mental health and substance use-related effects of IPV and other lifetime trauma. A 2012 study conducted by NCDVTMH in partnership with the National Association of State Mental Health Program Directors (NASMHPD) found that the majority of states who participated had a strong interest in further coordination and/or training on these issues.

The information that follows is intended to support mental health and substance use disorder treatment and recovery support providers in their work with survivors of IPV and their children. You will find toolkits, best practice guidelines, webinars, research reviews, and policy briefs to help inform your practice. These can be found below under:
» Research on the Intersection of Domestic Violence, Substance Use and Mental Health
» Responding to IPV in the Context of Mental Health and Substance Use Treatment and Recovery


In This Section:

» Why Address IPV?
» Prevalence if IPV in Behavioral Health Settings
» Impact of IPV
» Mental Health and Substance Use Coercion
» Opioids and IPV
» Impact of IPV on Children and Parenting


Research on the Intersection of Domestic Violence, Substance Use and Mental Health:

Why address intimate partner violence in mental health and substance use disorder treatment and recovery settings?

Being abused by an intimate partner can have traumatic mental health and substance use-related effects. At the same time, there are high rates of intimate partner violence (IPV) among people who receive treatment in mental health and substance use disorder treatment settings. We also know that people who perpetrate IPV deliberately use mental health and substance use-related issues to undermine and control their partners and to keep them from achieving their treatment and recovery goals. These forms of abuse – referred to as mental health and substance use coercion – not only jeopardize the well-being of survivors and their children, but also compromise the effectiveness of mental health and substance use disorder treatment, underscoring the need for behavioral health agencies to implement policies and practices for addressing IPV. Knowing how to respond appropriately when a person is in immediate danger or contending with an abusive, controlling partner is critical to supporting the safety and well-being of survivors and their children.

How common is intimate partner violence in the U.S.?

According to the Centers for Disease Control (CDC), 35.6% of women and 28.5% of men experience abuse by an intimate partner over the course of their lives, and more than 12 million women and men are victims of rape, physical violence or stalking by an intimate partner each year. Women who are victimized by an intimate partner are significantly more likely than men to experience physical or sexual assault, coercive control, serious injury, and health and mental health consequences. Rates are as high or higher among people who identify as lesbian, gay, bisexual and transgender. Rates of IPV are also significantly higher for Native women.

How common is IPV among people seen in mental health and substance use disorder treatment settings?

Women seen in mental health settings report high rates of intimate partner violence (30% of women in outpatient settings, and 33% in inpatient settings). Studies conducted in inpatient psychiatric settings have reported lifetime prevalence rates of severe IPV ranging from 30% to 60%, with women experiencing higher rates as compared to men. Studies conducted in substance use disorder treatment settings have also found high rates of IPV victimization among women accessing those services (47%-90% lifetime, 31%-67% within the past year). For LGBT and gender non-conforming young adults, experiencing IPV is also associated with higher rates of mental health service use.

For more information about the prevalence of IPV in mental health and substance use disorder treatment settings, see:

What is the impact of intimate partner violence on substance use and mental health?

Research conducted over the past 35 years has consistently shown that being victimized by an intimate partner may increase a person’s risk for depression, posttraumatic stress disorder (PTSD), eating disorders, insomnia, substance use, and suicidality, as well as a range of chronic health conditions, including chronic pain. Some of these conditions are the direct result of physical and sexual violence while others are related to the traumatic psychophysiological effects of ongoing abuse.

For more in-depth reviews of the health, mental health and substance use effects of IPV see:

Mental Health and Substance Use Coercion: What is important to know about abuse specifically targeted towards a person’s mental health or use of substances? How does IPV impact a person’s mental health or substance use treatment and recovery?

In addition to experiencing the traumatic psychophysiological effects of abuse, many survivors experience coercive tactics specifically related to their mental health or use of substances as part of a broader pattern of abuse and control. For example, while survivors of IPV may use substances to cope with trauma, abusive partners may also force or coerce them to use. A pair of studies by NCDVTMH and the National Domestic Violence Hotline on mental health and substance use coercion found disturbingly high rates of abuse specifically targeting a partner’s mental health and/or substance use. Callers reported that their abusive partners intentionally undermined their sanity; prevented them from accessing treatment, controlled their medication; sabotaged their recovery efforts; and then used their mental health or substance use “condition” to discredit them with friends, family, helping professionals, and the courts. At the same time, experiencing a mental health or substance use disorder places people at greater risk for being controlled by an abusive partner. Stigma associated with substance use and mental illness contributes to the effectiveness of these abusive tactics and can create additional barriers for survivors and their children when they try to seek help.

For more information on IPV Targeted Toward a Partner’s Mental Health or Substance Use see:

What Is the relationship between opioids and IPV?

Being abused by an intimate partner increases a person’s risk for opioid use and a significant proportion of people accessing opioid use disorder treatment programs have experienced IPV. While abuse, trauma, and violence across the lifespan play a key role in people’s use of opioids, there has been little attention paid to the role of IPV and substance use coercion in people’s opioid use, opioid-related medical complications, and opioid-related deaths – issues that are critical to consider in developing strategies to address the opioid epidemic. IPV survivors who use opioids encounter a unique constellation of risks that directly threaten their physical safety and wellbeing. For example, it is not uncommon for abusive partners to introduce a partner to opioids, control their supply, and then threaten them with withdrawal, loss of custody, incarceration, or physical violence if they try to reduce their use, access treatment, call the police, or resist demands to engage in illegal activities, including human trafficking. Other unique risks include coercion into unsafe use, medication sabotage, and being stalked while attending regular appointments. This growing recognition of the potential impact of substance use coercion on the current opioid epidemic underscores the importance of incorporating IPV-specific interventions into opioid use disorder treatment and recovery services and addressing IPV as part of broader opioid prevention efforts.

For more information on the intersection of opioids, trauma and IPV see:

How can IPV impact children and parenting?

People who perpetrate IPV often actively try to undermine their partners’ relationships with their children, creating risks for a child’s development and their physical and mental health. While exposure to IPV can impact children’s physical, psychological, and emotional well-being, research consistently shows that attachment to the non-abusive primary caregiver is what is most protective of children’s resilience and development. Research has also shown that prevention and early intervention efforts are effective in reducing child abuse and IPV. Understanding the dynamics of IPV – including abusive behavior targeted at a partner’s substance use, mental health, or parenting – is critical to supporting children and families.

For additional resources on supporting parents and children affected by DV, see:


In This Section:

» System Responses to IPV
» What Treatment Providers Can do to Address IPV
» Resources for Responding to IPV
» Trauma Treatment and IPV
» Mental Health Treatment and IPV
» Substance Use Treatment and IPV
» Treatment for Children Affected by IPV
» Policy Implications


Responding to IPV in the Context of Mental Health and Substance Use Treatment and Recovery

How have mental health, substance use and trauma treatment systems addressed IPV?

Over the past decade, state mental health and substance use disorder treatment systems have been successfully implementing trauma-informed and trauma-specific treatment services, with substantial advancement in these areas. While awareness of trauma has increased in recent years, trauma in the context of ongoing IPV remains a largely unaddressed issue. State-level partnerships between the domestic violence and mental health and substance use treatment fields do exist in a handful of states, leading to improved access to IPV-informed services for survivors and their children.

What can mental health and substance use disorder treatment and recovery support organizations do to address IPV?

Responding effectively to people who are experiencing ongoing abuse by an intimate partner requires a distinct set of policies, procedures, and practices, including:

  • Ensuring that all staff receive orientation and ongoing training on how to support people experiencing IPV
  • Incorporating questions about IPV into screening and assessment protocols, including questions about mental health and substance use coercion
  • Developing consultation and referral relationships with local domestic violence programs
  • Incorporating best practices for responding to IPV into counseling, treatment, documentation, reporting and referral protocols
  • Offering trauma treatment modalities that have been shown to be effective for survivors of IPV and their children

What resources exist for responding to IPV in the context of mental health and substance use disorder treatment and recovery support?

For Resources on Responding to Mental Health and Substance Use Coercion, see:

For Resources on Trauma Treatment in the Context of IPV, see:

For More Detailed Information on Mental Health Treatment Including Suicide Prevention in the Context of IPV, See:

For More Information on Substance Use Treatment in the Context of IPV see the following webinars:

For More Information on Trauma Treatment for Children Affected by IPV, see:

Addressing IPV in the Context of Mental Health and Substance use Disorder Treatment and Recovery: What are the policy implications?

There are a number of potential strategies for improving system-level responses to people experiencing mental health and substance use effects of IPV. These include initiatives to promote education and training on IPV; incentives for incorporating attention to IPV into agency-level policies and practices; strategies to encourage partnerships between domestic violence and mental health/substance use disorder treatment service providers; and strategies for incorporating questions about mental health and substance use coercion into relevant state and national data collection initiatives.

For Additional Policy Recommendations, see:


For Information About Training and Technical Assistance on the Intersection of IPV, Trauma, Substance Use and Mental Health, contact us at: kalegria@ncdvtmh.org

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