Domestic abuse and addiction co-occur at rates much higher than the general population — and the relationship between them is bidirectional. Abuse drives substance use as a survival strategy; substance use complicates safety planning and leaving. Approximately 40-60% of women in domestic violence shelters have substance use disorders. Treatment that addresses both — safety first, then trauma and substance use together — produces better outcomes than treating either alone. This article is about the intersection; the next-step resources (above) are what matters most if you're currently unsafe.
Anchored Tides Clinical TeamReviewed by Zoe Tambling, LMFT
Published February 13, 2025Last updated: June 2026
“ATR has been a wonderful organization to work with. I've partnered with them on many occasions on behalf of my own clients. They're trustworthy, ethical and provide excellent clinical care to the women they serve.”
If you've come to this article, you may already be navigating something you didn't have words for. The cultural conversations about abuse and addiction often happen separately — but for many women, they're deeply intertwined. The shame, the secrecy, the survival strategies that look like character flaws from the outside but are actually adaptations to impossible situations. This guide is for women in this intersection, for women who have left and are still navigating it, and for partners and family members trying to understand a pattern that doesn't fit standard narratives.
How Common the Overlap Actually Is
Approximately 40-60% of women in domestic violence shelters have substance use disorders
Women in active domestic violence relationships are 6x more likely to develop substance use problems than women in safe relationships
Substance use disorders are present in roughly 25-50% of women presenting for intimate partner violence services
Approximately 80% of women in addiction treatment have a history of intimate partner violence at some point
The co-occurrence is documented across socioeconomic, racial, and cultural lines
How the Two Drive Each Other
Abuse Drives Substance Use
Self-medication for the psychological pain of ongoing abuse
Sleep — many women in abusive relationships develop substance patterns specifically around sleep, which abuse disrupts
Hypervigilance and chronic anxiety — substances temporarily quiet the nervous system
Sometimes — substances given or pressured by the abuser as part of the control dynamic
Sometimes — abuser-controlled prescription medication used as a control tool
Trauma symptoms (intrusive memories, hyperarousal, dissociation) that substances temporarily blunt
Emotional numbing required to function in the relationship over time
Substance Use Complicates Safety
Substance use is sometimes used by abusers as justification for further harm or to discredit the victim
Substance use can be used against women in custody disputes, in legal proceedings, and in CPS involvement
Substance use can make decision-making in dangerous situations harder
Substance use can isolate women from family, friends, and support that would otherwise help them leave
Many treatment programs and shelters require sobriety, creating impossible double-binds for women navigating both
Active use can be a reason providers don't believe abuse reports — even though use is often a result of abuse, not a sign of unreliability
Forms of Abuse to Know
Domestic abuse isn't only physical. Other forms include:
Reproductive — birth control sabotage, forced pregnancy, forced termination
Spiritual — using religion or beliefs to justify control
Stalking — including post-separation surveillance
Why Women Stay — The Honest Version
The question "why doesn't she just leave?" misses what's actually happening. Reasons women stay in abusive relationships include:
Leaving is the most dangerous time — risk of severe violence or homicide is highest in the weeks and months around leaving
Financial dependence
Children — wanting to protect them, custody concerns
Immigration status concerns
Isolation — friends and family have been pushed away over time
Love — most women in abusive relationships also love their partner, who isn't abusive 100% of the time
Hope that the relationship can change
Religious or cultural pressure to remain
Shame
Trauma bonding — the cycle of harm and reconciliation creates neurochemical bonds that are difficult to break
Practical barriers to leaving — housing, money, transportation, childcare
Substance use — both as factor in the relationship and as something that makes leaving harder
What Safety Planning Looks Like
Safety planning is what trained advocates help with — and is more useful than generic advice. General elements include:
Identifying patterns in escalation and warning signs
Having a safe place to go (specifics worked out with an advocate)
Important documents stored safely outside the home
Money set aside or accessible without partner's knowledge
A communication plan with at least one trusted person
Plans for children, if applicable
Awareness of legal options (protective orders, custody)
If substances are involved, plan for sobriety support that doesn't depend on the relationship
The National Domestic Violence Hotline (1-800-799-SAFE) can connect you with a trained advocate to develop a personal safety plan. Local domestic violence organizations provide this service for free, confidentially.
When You Leave — What Comes Next
Immediate Safety
The period immediately after leaving is often the most dangerous. Working with a domestic violence advocate, having a safety plan, and sometimes pursuing legal protection (protective orders) are part of this stage.
Stabilization
Housing, finances, childcare, and basic life logistics — often in a different configuration than they were during the relationship. Many women need support from multiple agencies during this stage.
Trauma and Substance Treatment
Once basic safety is established, the deeper work of treating the trauma (often PTSD or Complex PTSD) and the substance use that developed alongside the abuse can begin. Treating these together — rather than sequentially — produces better outcomes.
Rebuilding
Friendships, family relationships, identity, work, sometimes parenting in a new context. This is a years-long process, often supported by individual therapy, women's recovery community, and continued connection with domestic violence services.
Why Treating Both Together Matters
Sequential treatment (substance use first, trauma second) often fails because untreated trauma drives return to use
Trauma treatment without addressing substance use can be destabilizing — substances are sometimes the woman's only stabilization strategy until alternatives are built
Both conditions have specific evidence-based treatments — EMDR for trauma, behavioral therapies for substance use, integrated approaches for both
Many women report that addressing the abuse and trauma was what made addiction recovery sustainable
The same protective factors (community, therapy, support) often serve both recovery processes
How Anchored Tides Supports Women in This Intersection
Trauma-informed clinical model — foundational across all programming, recognizing that many women carry intimate partner violence history
EMDR — core trauma modality, strongly supported by research for IPV-related PTSD
Women-only programming — particularly important for women whose trauma has been male-perpetrated; allows the kind of disclosure mixed groups don't
DBT and CBT — for emotion regulation and cognitive patterns shaped by long-term abuse
Three outpatient levels of care (PHP, IOP, OP) — flexible enough for women navigating housing transitions or legal proceedings
Mental Health track for women whose primary need is mental health, including post-IPV PTSD without an active substance use issue
Dual-Diagnosis / Co-Occurring Disorders treatment for the substance use that often accompanies IPV trauma
Coordination with domestic violence advocates — ATR works alongside DV services rather than substituting for them
Holistic care — Reiki, Sound Healing, Adventure Therapy — for nervous-system regulation in women whose systems have been chronically activated
In-network with HMOs, EPOs, and PPOs across Blue Shield, BCBS, Anthem, Highmark, Regence, Premera, Multiplan, and Horizon
Take the Next Step
If you're navigating both abuse and addiction, you need both kinds of support. Our team can coordinate with domestic violence services to provide integrated care — and a confidential conversation can help you understand what's available.
Call (866) 329-6639 or Verify Your Insurance — confidential, no obligation.
If you're in immediate danger, call 911 or the National Domestic Violence Hotline at 1-800-799-7233.
Frequently asked questions
Is what's happening to me really abuse?
If you're asking the question, it's worth talking to someone who can help you sort it out. Abuse isn't only physical — emotional control, financial control, isolation, persistent criticism, intimidation, sexual coercion, and digital surveillance are all forms of abuse. The National Domestic Violence Hotline (1-800-799-SAFE) can help you understand what you're experiencing, confidentially and without pressure.
My substance use is going to be used against me. What can I do?
This concern is legitimate. Strategies that help: documenting abuse separately from any substance use; working with both a domestic violence advocate and an addiction professional who understand the intersection; pursuing addiction treatment proactively (often protective in legal proceedings); having advocates and clinicians who can speak to the context. The unfortunate reality is that women's substance use is sometimes weaponized against them — and proactive, documented engagement with treatment is often the strongest counter.
Can I get sober if I'm still in the relationship?
Sometimes, but the rates are lower. Active abuse drives substance use; the same substances are providing crucial nervous-system regulation in an unsafe situation. Many women find that some stabilization is possible inside the relationship but full sustained recovery requires the safety that leaving (or significant change in the relationship) provides. Outpatient programming can support a woman wherever she is in this process.
My partner controls my access to treatment. What can I do?
This is itself a form of abuse — substance-related control. Working with both a domestic violence advocate and an addiction professional who understand this dynamic is the path. There are often ways to access treatment your partner isn't aware of, through agencies that protect women's confidentiality. The admissions process can be coordinated to minimize visibility if that's a safety concern.
What if I'm worried about my children if I leave?
Concerns about children keep many women in abusive situations. The reality is complex — staying with an abusive partner exposes children to harm; leaving with active addiction creates custody risk. Working with both domestic violence services and family-system clinicians who understand these dynamics produces better outcomes than navigating alone. CPS involvement, when it happens, is often less catastrophic than feared if mothers are proactively engaged with treatment and DV services.
Evidence & accountability
Sources and clinical review
This page was reviewed by Zoe Tambling, LMFT on . The references below informed the specific topics noted with each citation.
Intimate Partner Violence PreventionCenters for Disease Control and PreventionSupports: Intimate-partner-violence definitions, health effects, risk, and prevention
