The comparative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) and substance abuse treatment alone: a randomized controlled trial

Fleur L Kraanen,Paul Mg Emmelkamp,Agnes Scholing,Ellen Vedel

doi:10.1186/1471-244x-13-189

Abstract

BackgroundResearch has shown that treatments that solely addressed intimate partner violence (IPV) perpetration were not very effective in reducing IPV, possibly due to neglecting individual differences between IPV perpetrators. A large proportion of IPV perpetrators is diagnosed with co-occurring substance use disorders and it has been demonstrated that successful treatment of alcohol dependence among alcohol dependent IPV perpetrators also led to less IPV. The current study investigated the relative effectiveness of Integrated treatment for Substance abuse and Partner violence (I-StoP) to cognitive behavioral treatment addressing substance use disorders including only one session addressing partner violence (CBT-SUD+) among patients in substance abuse treatment who repeatedly committed IPV. Substance use and IPV perpetration were primary outcome measures.MethodPatients who entered substance abuse treatment were screened for IPV. Patients who disclosed at least 7 acts of physical IPV in the past year (N = 52) were randomly assigned to either I-StoP or CBT-SUD+. Patients in both conditions received 16 treatment sessions. Substance use and IPV perpetration were assessed at pretreatment, halfway treatment and posttreatment in blocks of 8 weeks. Both completers and intention-to-treat (ITT) analyses were performed.ResultsPatients (completers and ITT) in both conditions significantly improved regarding substance use and IPV perpetration at posttreatment compared with pretreatment. There were no differences in outcome between conditions. Completers in both conditions almost fully abstained from IPV in 8 weeks before the end of treatment.ConclusionsBoth I-StoP and CBT-SUD+ were effective in reducing substance use and IPV perpetration among patients in substance abuse treatment who repeatedly committed IPV and self-disclosed IPV perpetration. Since it is more cost and time-effective to implement CBT-SUD+ than I-StoP, it is suggested to treat IPV perpetrators in substance abuse treatment with CBT-SUD+.Trial registrationClinicalTrials.gov: NCT00847873

Highlights

Research has shown that treatments that solely addressed intimate partner violence (IPV) perpetration were not very effective in reducing IPV, possibly due to neglecting individual differences between IPV perpetrators
Several studies demonstrated that up to more than half of male and female patients in substance abuse treatments committed at least one act of physical IPV in the past year (e.g., [1,2,3,4,5]; Kraanen, Vedel, Scholing, Emmelkamp: Do specific substance use disorders or combinations of specific substance use disorders predict past year intimate partner violence in patients referred to substance abuse treatment?, submitted)
Patients who relapsed to alcohol use after successful alcohol use disorder treatment were much more likely to relapse to IPV perpetration than patients who abstained from alcohol [23,24]

Summary

Introduction

Research has shown that treatments that solely addressed intimate partner violence (IPV) perpetration were not very effective in reducing IPV, possibly due to neglecting individual differences between IPV perpetrators. Several studies demonstrated that up to more than half of male and female patients in substance abuse treatments committed at least one act of physical IPV in the past year (e.g., [1,2,3,4,5]; Kraanen, Vedel, Scholing, Emmelkamp: Do specific substance use disorders or combinations of specific substance use disorders predict past year intimate partner violence in patients referred to substance abuse treatment?, submitted). These figures are substantially higher than in the normal population, where about 20% of the population committed IPV in the past year [6]. Patients who relapsed to alcohol use after successful alcohol use disorder treatment were much more likely to relapse to IPV perpetration than patients who abstained from alcohol [23,24]

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