انگیزه برای تغییر مصرف مواد مخدر در مجرمان خشونت خانگی

Substance use alone leads to increased rates of violence, reduction in adherence to treatment regimes, and other negative psychiatric sequelae. Given the high rates of co-occurring substance use and family violence-related problems, substance use was assessed among offenders of domestic violence who were mandated by court to attend anger management classes. Rates of substance dependence diagnoses ranged from 33 to 50%, while rates of substance abuse diagnoses ranged from 60 to 75%. This study evaluated the effectiveness of a motivational enhancement intervention on readiness to change substance use. Two anger management groups were targeted to assess substance use, violence, and motivation to change substance use behaviors. One group was randomly chosen to partake in a motivational enhancement intervention session. The comparison group was offered standard anger management classes. Forty-one clients were evaluated for substance abuse and dependence diagnosis using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. A brief motivation to change survey, adapted from the Readiness to Change subscale of the Stages of Change Readiness and Treatment Eagerness Scale was administered pre- and postsession. Results indicate that a motivational enhancement intervention is feasible and effective in increasing readiness to change substance use among domestic violence offenders. The results illustrate the importance of assessing and treating substance use among offenders of domestic violence, as this may be an important indicator for higher dropout rates and reoffenses among this population.

Rates of co-occurring substance use and domestic violence are high, ranging from 40 to 92%. Brookoff et al. (1997) showed that 92% of assailants used alcohol or drugs on the day of the domestic violence assault, 44% had prior arrests for charges related to violence, and 72% had arrests related to substance use. Other researchers have tried to assess the variables that place individuals at risk of being a perpetrator of family violence. The common risk factor for family violence is substance use. In fact, one of the correlates of domestic abuse is early onset of drug- and alcohol-related problems (Bennett et al., 1994). Substance use is also related to severity of violence. For example, Holtzworth-Munroe and Stuart (1994) found that alcohol and drug use was highest among a moderate to highly violent group of batterers. Rivera et al. (1997) found alcohol and illicit drug abuse to be related to an increased risk of violent death in the home. Despite these high rates of co-occurring substance use and domestic violence, treatment for these problems is often ordered separately. Domestic violence arrests will most likely lead to standard anger management or domestic violence treatments. It is only when the batterers incur repeated offenses and show glaring evidence of substance use that courts refer patients to substance abuse treatment (Collins et al., 1997). There is some initial evidence that when substance use and domestic violence are addressed in an integrated way, there are better treatment outcomes (Goldkamp et al., 1996.) For example, Goldkamp et al. (1996) examined treatment outcomes and same-victim reoffending in clients who attended an integrated substance use-domestic violence treatment program versus clients who did not participate in this hybrid approach. The findings showed that the integrated treatment approach was more successful at getting offendees and probationers to attend treatment (43% of the control group were no-shows, as compared to 13% of the integrated treatment group). The integrated treatment approach had a greater success in keeping participants in treatment as well as having lower rates of same-victim reoffending.