The Intersection of Abuse and Addiction

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:

• Emotional and psychological — controlling behavior, isolation, intimidation, threats, persistent criticism, gaslighting
• Financial — controlling access to money, sabotaging employment, accumulating debt in your name, monitoring all spending
• Sexual — coerced or unwanted sexual contact, reproductive coercion, sexual humiliation
• Digital — monitoring phones, social media, locations, controlling communication
• Substance-related — forcing or pressuring use, controlling prescriptions, sabotaging recovery efforts
• 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.