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Quick Guide
For Clinicians

Based on TIP 25
Substance Abuse Treatment
and Domestic Violence

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Contents
Why a Quick Guide?  . . . . . . . . . . . . . . . . . . . 2
What is a TIP?  . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction  . . . . . . . . . . . . . . . . . . . . . . . . . 4
Screening for Survivors  . . . . . . . . . . . . . . . . 6
Treatment Planning for Survivors . . . . . . . . . 9
Issues of Child Abuse or Neglect  . . . . . . . . 18
Screening Techniques and Questions 
for Batterers . . . . . . . . . . . . . . . . . . . . . . . . 20
Treatment Planning for Batterers  . . . . . . . 22
Referral and Linkages  . . . . . . . . . . . . . . . . 24
Legal Issues  . . . . . . . . . . . . . . . . . . . . . . . 28
Phone and Internet Resources  . . . . . . . . . 31

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Quick Guide
For Clinicians



This Quick Guide is based almost entirely on information con
tained in TIP 25, published in 1997 and based on information
updated through June 1996. No additional research has been
conducted to update this topic since publication of the original
TIP.
Based on TIP 25
Substance Abuse Treatment
and Domestic Violence

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2
Substance Abuse Treatment and Domestic Violence

WHY A QUICK GUIDE?

This Quick Guide was developed to accompany
Substance Abuse Treatment and Domestic
Violence, Number 25 in the Treatment
Improvement Protocol (TIP) Series published by the
Center for Substance Abuse Treatment (CSAT),
Substance Abuse and Mental Health Services
Administration. This Quick Guide is based entirely
on TIP 25 and is designed to meet the needs of
the busy clinician for concise, easily accessed
"how-to" information.

The Guide is divided into eight sections (see
Contents). These sections will help readers quick
ly locate relevant material.

Clinicians can use the Resources on page 31 to
keep updated with current information on the
most recent developments in the field of domestic
violence.

For more information on the topics in this Quick
Guide, readers are referred to TIP 25.

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What is a TIP? 3

WHAT IS A TIP?

The TIP series has been in production since 1991.
This series provides the substance abuse treat
ment and related fields with consensus-based,
field-reviewed guidelines on substance abuse
treatment.

TIP 25, Substance Abuse Treatment and Domestic
Violence

• Addresses the concerns of a broad range of
readers including substance abuse treatment
clinicians, domestic violence programs, social
workers, medical personnel, program adminis
trators, and policymakers
• Includes extensive research
• Lists numerous resources for further information
• Provides a reference for substance abuse treat
ment clinicians working with adults who have
experienced domestic violence
See the inside back cover for information on how
to order TIPs and other related products.

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4
Substance Abuse Treatment and Domestic Violence

INTRODUCTION

Domestic violence is the use of intentional emo
tional, psychological, sexual, or physical force by
one family member or intimate partner to control
another. Researchers have found that one fourth
to one half of men who commit acts of domestic
violence have substance abuse problems. While
domestic violence affects a variety of populations,
this Quick Guide only discusses the treatment of
adult male batterers and adult female survivors.

The Connections Between Substance Abuse
and Domestic Violence
• Substance abuse doesn't "cause" domestic vio
lence.
• It may afflict both batterers and survivors. 
• Failure to address domestic violence may inter
fere with treatment effectiveness.
• A substance abusing woman may find her abu
sive partner becomes angry when she seeks
help, and his violence could push her to drop
out of treatment.
• Some batterers are worse domestic violence
offenders when they are sober so partners of
such batterers may try to subvert treatment
efforts.

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Introduction 5
ATTENTION: Due to the high correlation between
the two problems, all clients who present for sub
stance abuse treatment should be questioned
about domestic violence.
Goals
• Attaining sobriety
• Ensuring survivors' safety
Create Linkages
To effect lasting change, people working in both
fields must recognize the importance of holistic
treatment and learn to collaborate on the client's
behalf. This Quick Guide presents pertinent infor
mation on holistic treatment of domestic violence
situations substance abuse treatment clinicians
will need. This will include creating linkages with
groups pertinent to a client's recovery, including

• Domestic violence programs
• Health care communities
• The criminal justice system
• Schools and educational institutes
• Employers
• Social welfare 



For more detailed information, see TIP 25, 
pp. xiii–xix.

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6
Substance Abuse Treatment and Domestic Violence



CAUTION: It is important not to ask potentially
painful questions too soon; otherwise, a client may
feel overwhelmed and reluctant to return.
SCREENING FOR SURVIVORS



Clues for the Treatment Provider
• Physical injuries around the face, neck and
throat
• Inconsistent/evasive answers when questioned
about injuries 
• A history of relapse or noncompliance with sub
stance abuse treatment
• Stress related illness and conditions
• Complications in pregnancy
The way in which a client describes her partner's
treatment of her can also be a clue to possible
domestic violence. Does he

• isolate her?
• force her to sell drugs?
• harm other family members or pets?
• threaten to hurt her, himself or others?

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Screening for Survivors 7

Child abuse is also a clue. Research indicates that
a father who abuses his children often abuses his
wife as well.


ALERT: Survivors are often reluctant to disclose
the amount of violence in their lives.


Crisis Intervention 
When a woman informs staff she is a victim of
domestic violence, providers should 

• Ensure her safety: Whether a client is entering
inpatient or outpatient treatment, the immedi
ate physical safety of her environment must be
of chief concern. If inpatient, security measures
should be intensified; if outpatient, a safety plan
should be developed.
• Assure her she is believed: Reinforcement of
the counselor's belief of a survivor's victimiza
tion is a critical component of ongoing emotion
al support. Affirming the survivor's experience
helps empower her to participate in immediate
problem solving and longer term treatment
planning.
• Identify her options: Treatment providers
should ask the survivor to identify her options,
share information that would expand her

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8
Substance Abuse Treatment and Domestic Violence

options, and support her in devising a safety
plan.
• Evaluate health concerns, including any need
for detoxification.
• Attend to anything that may interrupt the initi
ation of treatment.

For more detailed information, see TIP 25, 
pp. 9–11, pp. 38–42.

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Treatment Planning for Survivors 9

TREATMENT PLANNING 
FOR SURVIVORS

Safety From the Batterer
In the early stages of treatment, the substance
abuse counselor should help the client develop a
safety plan by referring her to a domestic violence
service provider. It is also important to address the
batterer's reaction to his partner being in treatment
and minimize the client's risk of harm in order for
her to more easily continue her treatment.

Safety Tips for Survivors and Their Families
The following pages contain tips that can be
relayed to survivors and their families to help keep
them safe from batterers.  The following six pages
are reprinted with permission from the American
Bar Association (see resources section for more
information).

In an Emergency 
If you are at home and you are being attacked:

• Stay away from the kitchen (the abuser can find
weapons there, such as knives).
• Stay away from bathrooms, closets or small
spaces where the abuser can trap you.
• Get to a room with a door or window to escape.

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10
Substance Abuse Treatment and Domestic Violence

• Get to a room with a phone to call for help; lock
the abuser outside if you can.
• Call 911 (or your local emergency number) right
away for help; get the dispatcher's name.
• Think about a neighbor or friend you can run to
for help.
• If a police officer comes, tell him/her what hap
pened; get his/her name and badge number.
• Get medical help if you are hurt.
• Take pictures of bruises and injuries.
• Call a domestic violence program or shelter
(some are listed at the end of this document);
ask them to help you make a safety plan.
How to protect yourself at home
• Learn where to get help; memorize emergency
phone numbers.
• Keep a phone in a room you can lock from the
inside; if you can, get a cellular phone that you
keep with you at all times.
• If the abuser has moved out, change the locks
on your door; get locks on the window.
• Plan an escape route out of your home; teach it
to your children.
• Think about where you would go if you need to
escape.

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Treatment Planning for Survivors 11

• Ask your neighbors to call the police if they see
the abuser at your house; make a signal for
them to call the police; for example, if the
phone rings twice, a shade is pulled down or a
light is on.
• Pack a bag with important things you'd need if
you have to leave quickly, put it in a safe place,
or give it to a friend or relative you trust.
• Include cash, car keys and important informa
tion such as: court papers, passport or birth
certificate, medical records and medicines,
immigration papers.
• Get an unlisted phone number.
• Block caller ID.
• Use an answering machine; screen the calls.
• Take a good self-defense course.
How to make your children safer
• Teach them not to get in the middle of a fight,
even if they want to help.
• Teach them how to get to safety, to call 911, to
give your address and phone number to the
police.
• Teach them to call for help.
• Tell them to stay out of the kitchen.

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12
Substance Abuse Treatment and Domestic Violence

• Give the principal at school or daycare center a
copy of your court order; tell them not to release
your children to anyone without talking to you
first; use a password so they can be sure it is
you on the phone; give them a photo of the
abuser.
• Make sure the children know who to tell at
school if they see the abuser.
• Make sure the school knows not to give your
address or phone number to anyone.
How to protect yourself outside the home
• Change your regular travel habits.
• Try to get rides with different people. 
• Shop and bank in a different place.
• Cancel any bank accounts or credit cards you
shared; open new accounts at a different bank.
• Keep your court order and emergency numbers
with you at all times.
• Keep a cell phone and program it to 911 (or
other emergency number).
How to make yourself safer at work
• Keep a copy of your court order at work.
• Give a picture of the abuser to security and
friends at work.

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Treatment Planning for Survivors 13

• Tell your supervisor—see if he or she can make
it harder for the abuser to find you.
• Don't go to lunch alone.
• Ask a security guard to walk you to your car or
to the bus.
• If the abuser calls you at work, save your voice
mail and save e-mail.
• Your employer may be able to help you find
community resources.
Using the law to help you
Protection or restraining orders
• Ask your local domestic violence program to
help you get a civil protection order and to help
you with criminal prosecution.
• Ask for help finding a lawyer.
In most places the judge can
• Order the abuser to stay away from you and your
children.
• Order the abuser to leave your home.
• Give you temporary custody of your children and
order the abuser to pay you temporary child
support.
• Order the police to come to your home while the
abuser picks up personal belongings.

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14
Substance Abuse Treatment and Domestic Violence

• Give you possession of the car, furniture and
other belongings.
• Order the abuser to go to a batterers' interven
tion program.
• Order the abuser not to call you at work.
• Order the abuser to give guns to the police.
If you are worried about any of the following,
make sure you
• Show the judge any pictures of your injuries.
• Tell the judge that you do not feel safe if the
abuser comes to your home to pick up the chil
dren to visit with them.
• Ask the judge to order the abuser to pick up and
return the children at the police station or some
other safe place.
• Ask that any visits the abuser is permitted are
at very specific times so the police will know by
reading the court order if the abuser is there at
the wrong time.
• Tell the judge if the abuser has harmed or
threatened the children; ask that visits be
supervised; think about who could do that for
you.
• Get a certified copy of the court order.
• Keep the court order with you at all times.

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Treatment Planning for Survivors 15

Criminal Proceedings
• Show the prosecutor your court orders.
• Show the prosecutor medical records about
your injuries or pictures if you have them.
• Tell the prosecutor the name of anyone who is
helping you (a victim advocate or lawyer).
• Tell the prosecutor about any witnesses to
injuries or abuse.
• Ask the prosecutor to notify you ahead of time if
the abuser is getting out of jail.
Be safe at the court house
• Sit as far away from the abuser as you can; you
don't have to look at or talk to the abuser; you
don't have to talk to the abuser's family or
friends if they are there.
• Bring a friend or relative to wait with you until
your case is heard.
• Tell a bailiff or sheriff that you are afraid of the
abuser and ask him/her to look out for you.
• Make sure you have your court order before you
leave.
• Ask the judge or sherif to keep the abuser there
for a while when court is over; leave quickly.
• If you think the abuser is following you when you
leave, call the police immediately.

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16
Substance Abuse Treatment and Domestic Violence

• If you have to travel to another State for work or
to get away from the abuser, take your protec
tion order with you; it is valid everywhere.
Reprinted with permission from the American Bar
Association

Psychosocial Issues
• A key aspect of treatment for substance abuse
is encouraging the client to assume responsibili
ty for her addiction and dispelling the notion
she is responsible for her partner's behavior.
• For some battered women, every aspect of their
life has been controlled by the batterer. Helping
her develop her own decisionmaking skills will
be integral to her recovery.
• Posttraumatic stress disorder, the increased
stress of abstinence, and the client's perception
of her own safety are all issues that can affect her
treatment and should be dealt with in treatment.
Later Recovery Issues
Practical concerns overwhelm many survivors of
domestic violence after they become abstinent.
Linkages with other programs and agencies
become extremely important in meeting the
client's responsibilities. Four areas that may need
special consideration during this time are

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Treatment Planning for Survivors 17

• Social functioning: Social isolation is common
among domestic violence survivors. Providers
should encourage the client to make her own
decisions about new activities and pastimes.
• Parenting: A survivor may need to learn new
skills that take into account the reality of her
status as a domestic violence survivor. Handling
frustration and anger is a crucial life skill that
must be addressed directly in treatment.
• Financial and legal concerns: Treatment
providers should explore with the client her
plans for future education and employment and
should have information on a variety of options.
• Relapse prevention: Revictimization by their
abusive partners poses the greatest risk of
relapse for battered women. Careful attention to
recurring episodes of violence is essential to
working with survivor clients to prevent or mini
mize the negative effects of relapse.
For more detailed information, see TIP 25, 
pp. 12–16, pp. 128–133.

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18
Substance Abuse Treatment and Domestic Violence
The confidentiality regulations in Title 42, Part 2 of
the Code of Federal Regulations require that a
client be given notice regarding the limitations of
confidentiality–orally and in writing–upon admis
sion to a substance abuse program.
ISSUES OF CHILD ABUSE OR NEGLECT



Screening for Child Abuse or Neglect
When family violence comes to the attention of
the treatment provider, it is essential to determine
whether children have been present or have been
involved in any way. It is not advisable for the sub
stance abuse clinician to perform an assessment
of children for abuse or incest; this function
should be performed by personnel with special
expertise.

Reporting Suspected Neglect or Abuse and
Children's Protective Services Agencies 
• Clients must be informed that mandated
reporters, a category that includes substance
abuse treatment providers, are required to noti
fy Children's Protective Services (CPS) if they
suspect child abuse or neglect.
• Clients can be informed of the right to report
their partner's abuse of children.

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Issues of Child Abuse or Neglect 19

• It is ultimately the mandated reporter's
responsibility to ensure CPS is contacted in
the event of suspected child abuse or neglect.
• It is important to prepare for the impact of
reporting child abuse on the children and the
family as whole.
• It is imperative for professionals working with
family members to provide information to them
about what to expect from CPS and, if at all pos
sible, to talk with CPS caseworkers and accom
pany the family to any court hearings. 
The Role of Treatment Providers in
Supporting the Mother
• Help her identify and coordinate various services
available to her.
• Support her efforts to participate in and take
advantage of these services.
• Listen as she voices her frustration about the
difficulties of meeting the demands of the vari
ous agencies.
For more detailed information, see TIP 25, 
pp. 17–19, pp. 44–45.

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20
Substance Abuse Treatment and Domestic Violence



CAUTION: In asking questions about abuse, sub
stance abuse treatment providers must be careful
not to enable batterers to place blame for batter
ings on the victim or alcohol and drugs.
SCREENING TECHNIQUES AND 
QUESTIONS FOR BATTERERS



Questions
• "Some people think that, under certain circum
stances, it's OK to hit your wife (girlfriend, etc.).
Under what circumstances do you think violence
might be justified?"
• "If you were faced with overwhelming stress
(use a hypothetical situation), do you think you
could keep your cool?"
• "What do you think you'd do?"
By taking an open-ended social and family history,
the interviewer can gradually move to specific,
direct questions.

• "Have you ever been physically hurt by someone
in your family?" (If the client's partner has hurt
him or her, the reverse may be true.)
• "Have you ever hurt someone in your family?"

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Screening Techniques and Questions for Batterers 21

The "No-Violence Contract"
Batterers entering treatment for substance abuse
can be required to sign a contract agreeing to
refrain from using violence. "No-violence" con
tracts are most effective when linkages with bat
terers' intervention programs are also in place,
but they can also help structure treatment by
specifying an achievable behavioral goal.

Recovery Pitfalls for Batterers
12-Step programs can play a valuable role in sup
porting batterers' treatment and recovery when
their principles are followed. However, providers
should be alert to signs that clients are misinter
preting 12-Step philosophies to justify, excuse, or
evade responsibility for their violence. 

Ongoing Attention to Issues 
of Domestic Violence
Ongoing attention to issues of domestic violence
is particularly important with these clients
because it may take time for them to begin talking
about the violence in their lives. As they become
abstinent, additional issues can arise that are
integrally related to the violence. The full dimen
sions of a domestic violence problem are seldom
immediately clear and may emerge unexpectedly
at a later stage in treatment.

For more detailed information, see TIP 25, p. 48.

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22
Substance Abuse Treatment and Domestic Violence

TREATMENT PLANNING 
FOR BATTERERS

• Gauge client's acceptance of responsibility.
• Link client's actions with tangible conse
quences, e.g., through a no violence contract.
• Encourage the batterer client to develop enough
self-awareness to recognize the beliefs and atti
tudes that are precursors to violence and to
control the emotions that contribute to violence.
• Formulate a treatment plan with strategies that
ensure safety for the partner and family 
members.
• Help the batterer focus on changing the behav
iors and events that have precipitated violence
or relapse.
• Watch for and stop clients from condoning vio
lence or reinforcing each others' excuse-making.
• Raise the batterer's awareness of the impact his
violence has on his children's future behavior
(young boys often learn violent behavior from
male role models).
• Help batterers adopt nonviolent modes of
behavior through anger management and cop
ing skills.

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Treatment Planning for Batterers 23

• Reinforce the importance of modeling nonvio-
lent behavior in their interactions with their part
ners as well as their children.

For more detailed information, see TIP 25, 
pp. 32–35.

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24
Substance Abuse Treatment and Domestic Violence

REFERRAL AND LINKAGES

Referral
When answers to screening suggest that the client
may be a batterer or a survivor, he or she should
be immediately referred to a domestic violence
program. When referrals are not possible, ongoing
consultation with a domestic violence expert is
strongly encouraged. In some instances, clients
have been mandated into substance abuse treat
ment by courts. Substance abuse providers use
the leverage provided by the criminal justice sys
tem to ensure that clients who batter participate
in batterer's treatment as well.

Referring Survivors
• If the client reveals that she is in immediate
danger, the counselor needs to attend to this
before addressing other issues.
• Advise the client to take simple legal precau
tions and to safeguard important documents,
e.g., social security card, driver license, etc.
• Discuss possible reprisal by the batterer if the
police become involved and plan a response.
• If a survivor client expresses concern about her
children, refer her for shelter and legal advocacy.
• Resources can be identified by contacting a
local domestic violence program, a State pro-

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Referral and Linkages 25

gram or the National 24-Hour Domestic
Violence Hotline, 1-800-799-SAFE. 
Referring Batterers
• When suspected batterers are identified, sub
stance abuse treatment providers should refer
them to batterer's intervention programs as a
key part of treatment planning.
• With the client's signed consent to release infor
mation, substance abuse counselors can share
pertinent information with domestic violence
staff to ensure both problems are being
addressed.
• Family therapy or family intervention for batter
ers and their partners should be provided by a
domestic violence specialist or program.
Linkages
• To effectively treat substance abuse, care must
be coordinated with domestic violence pro
grams and other agencies pertinent to a client's
recovery, e.g., the criminal justice system, the
workplace, etc.
• Substance abuse treatment providers, domestic
violence experts, and legal or other relevant 
professionals should plan client treatment 
collaboratively.
• Substance abuse treatment providers should
get to know what resources and institutions
exist in their communities.

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26
Substance Abuse Treatment and Domestic Violence

1) Domestic Violence Programs
- Hotlines, 

- Shelters,

- Clinicians, 

- Programs, 
2) Health Care Services
- Health Administrators, 
- Primary Care Physicians, 
3) The Justice System
- The Police Department, 
- Judges, 
4) Education/Schools 
- Teachers, 
- Principles, 
- School Social Workers, 
5) Employers, 
6) Social Welfare
- Social Welfare Administration, 
- Social Workers, 
• Cross-screening of various problems by various
agencies is a major step toward linkage.
• Because of its influence on the client, integrat
ing the criminal justice system's efforts should
be one of the first steps in forming linkages.

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Referral and Linkages 27

Due to the increasing call for cost containment,
collaborative endeavors are critical to the future 
of many programs.



Collaborative Care Services
When creating linkages, remember that collabora
tive services should be

• Client centered
• Holistic
• Flexible
• Collaborative
• Coordinated
• Accountable
Case Management
In the case management approach, a specially
trained single practitioner or case management
team is responsible for coordinating linkages to
the wide variety of services needed by many if not
most clients in substance abuse treatment.

For more detailed information, see TIP 25, 
pp. 63–80.

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28
Substance Abuse Treatment and Domestic Violence



CAUTION: Neither this Quick Guide nor TIP 25
should be considered a substitute for competent
legal advice from a qualified attorney.
LEGAL ISSUES 



The Violence Against Women Act
The Violence Against Women Act (VAWA) strength
ens many of the laws regarding violence motivat
ed by gender, outlines Federal as well as State
enforcement provisions and penalties, and makes
crimes against women and children a civil rights
violation. Under VAWA

• Past sexual behavior or alleged sexual predispo
sition of the victim is no longer admissible evi
dence in civil or criminal proceedings involving
sexual misconduct.
• New Federal criminal penalties apply to anyone
who crosses a State line in order to commit
domestic violence or to violate a civil protection
order.
• States are required to enforce civil protection
orders issued by other states.

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Legal Issues 29

• Victims must have the opportunity to testify
regarding the potential danger of the pretrial
release of a defendant.
Disclosure and Consent
• Typically, State laws regulate the disclosure of
patient information related to domestic vio
lence.
• These laws differ from Federal laws that govern
consent to disclose substance abuse-related
information. 
When it comes to reporting crimes that are dis
cussed in treatment to a third party (e.g., the
police or a lawyer), the counselor must ask three
questions: (1) Does State law require the program
to make a report? (2) Does State law permit the
program to make a report? (3) How can a report
be made without violating the Federal law and
regulations governing confidentiality or patients'
records?

Legal Resources
• State Department of Health
• Single State Authority for Substance Abuse
and/or Domestic Violence
• State Attorney General
• Local bar associations

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30
Substance Abuse Treatment and Domestic Violence

• Agency board members who are attorneys
• Local advocacy groups for people experiencing
domestic violence
• Local law schools


For more detailed information, see TIP 25, 
pp. 51–61, pp. 95–109.

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Phone and Internet Resources 31

SELECTED PHONE AND INTERNET
RESOURCES

Hotlines
National Domestic Violence Hotline
(800) 799-SAFE
(800) 799-3224

Rape, Abuse, and Incest National Network (RAINN)
(800) 656-4673
www.rainn.org

Child Help USA/National Child Abuse Hotline
(800) 4A-CHILD
www.childhelpusa.org

General Resources
National Coalition Against Domestic Violence
(303) 839-1852
www.ncadv.org

National Victim Center (NVC)/Infolink 
(800) FYI-CALL
www.nvc.org

American College of Obstetricians and
Gynecologists (ACOG)
(202) 638-5577
www.acog.org

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32
Substance Abuse Treatment and Domestic Violence



Other Services
Center for the Prevention of Sexual and Domestic
Violence
(206) 634-1903
www.cpsdv.org

Domestic Violence Project/Face to Face
(800) 842-4546

Domestic Violence Training Project
(800) 865-3699

Family Violence and Sexual Assault Institute 
(903) 534-5100

American Bar Association Commission on
Domestic Violence
http://www.abanet.org/domviol/home.html

-----------------------------------------------
Ordering Information
TIP 25 Substance Abuse Treatment
and Domestic Violence



TIP 25-Related Products
KAP Keys for Clinicians
based on TIP 25



Do not reproduce or distribute this publication for a fee without spe
cific, written authorization from the Office of Communications,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services.



Easy Ways to Obtain Free Copies 
of All TIP Products
1. Call SAMHSA's National Clearinghouse for Alcohol
and Drug Information (NCADI) at 800-729-6686, 
TDD (hearing impaired) 800-487-4889
2. Visit CSAT's Website at www.csat.samhsa.gov

-----------------------------------------------
Other Treatment Improvement
Protocols (TIPs) that are relevant to
this Quick Guide:



See the inside back cover for ordering information for all
TIPs and related products.


DHHS Publication No. (SMA) 01-3583
Printed 2001
TIP 27, Comprehensive Case Management for
Substance Abuse Treatment (1998) BKD251
TIP 35, Enhancing Motivation for Change in
Substance Abuse Treatment (1999) BKD342
TIP 36, Substance Abuse Treatment for Persons
With Child Abuse and Neglect Issues (2000)
BKD343