- 1 in 3 women experience intimate partner violence (IPV).
- The pandemic has exacerbated domestic violence and overdose cases.
- Stigma and other barriers impact women’s ability to access recovery and safety services, especially in rural areas.
It’s January 2019 in rural Vermont. Snow covers the ground as the temperature drops. Janet*, a former nurse and Vermont native, is pinned down in the snow by her abuser. He kicks her, leaving her in the snow with only her pajamas, and locks her out of the house. It is 28 degrees outside. While Janet has spent the last year removing herself from this situation, for women in abusive relationships living in rural areas, this is their reality.
Since the onset of the pandemic, these realities have only become more dire as domestic violence and overdose cases increase. During stay-at-home mandates, victims of intimate partner violence (IPV) with opioid use disorder (OUD) were forced to quarantine with their abusers. In cities like New York City and Portland, Oregon, domestic violence arrests jumped from 10% to 20%. And more than 40 states reported increases in opioid-related mortality since March.
Although opioid use and partner violence are seen as separate issues, a recent September study published in The Journal of Rural Health examined the synergistic relationship between the two through interviews with 33 women living in rural Vermont.
The study, led by researchers of Suffolk University and the Boston University School of Public Health, found that rural women with OUD and IPV experienced many barriers when accessing safety and recovery services—many of which often make the difference in lifting women out of abusive situations. Janet sought out care, and with the help of advocacy organizations left her abusive relationship and has been sober for 15 months.
To better serve rural communities experiencing IPV and OUD concurrently, researchers suggest increasing access to this type of care and encouraging collaboration between IPV and substance use service providers.
What This Means For You
If you or someone you know is experiencing IPV and/or OUD, call the National Domestic Violence Hotline or the Substance Abuse and Mental Health Services Administration National Helpline. Through both, you can access year-round, 24/7 service providing help and a plan for safety. Local IPV and OUD resources are also available at each respective organizations’ websites.
How Are IPV and OUD Connected?
The study found a two-way relationship between opioid use and partner violence. “People that experience partner violence might be more likely or susceptive to experience opioid use, and vice versa,” Julia Campbell, MPH, injury and violence prevention research coordinator at the Boston Medical Center and one of the study authors, tells Get Meds Info.
“One in three women in the United States experienced partner violence,” Campbell says, which can include the physical, emotional, financial, and sexual abuse of partners or spouses in intimate relationships. “The likelihood that you know somebody that has been impacted by partner violence is high.”
Julia Campbell, MPH
If someone was experiencing addiction, the abusive partner would control their access to opioids or treatment.
Research shows that abusive partners may coerce their partners to take drugs or interfere with treatment. IPV survivors often describe how substance use can worsen violence and their partner’s paranoia and jealousy. “He had me up against the wall by my neck with his arm, basically choking me out,” Janet tells Get Meds Info.
When Janet broke her leg due to a fall, she was prescribed oxycodone for the pain and soon after became addicted. “I was swallowing them at first. And then I started snorting them with time,” Janet says. “It was a vicious cycle.”
Opioids are a class of drugs to relieve pain and are often prescribed for treating acute and chronic pain such as a broken bone. However, regular use of opioids can lead to dependence and addiction. Opioid overdose is higher among rural communities compared to urban areas due to fewer options for OUD treatments.
Janet took opioids not only to reduce her pain at first but also as a coping mechanism for the abuse she experienced. “It starts with a bad relationship. I think a lot of women do it because it’s an escape from the abuse,” she says.
When the partner becomes reliant on opioids, abusers then use drugs as a means to control their partners and hold power over them. “If someone was experiencing addiction, the abusive partner would control their access to opioids or treatment,” Campbell says. “They would hold drugs over their heads and say, I’m not going to give you these drugs, unless you do XYZ.”
For Janet, her partner’s control over her medication meant life or death. “He started using the drugs to manipulate me,” she says. “He was doing illegal stuff that I was pretty much forced to be involved with. I was in fear that he would leave me for dead or put me in some situation where I would either overdose or die.”
Opioids are not the only factor abusers use to garner control over their partners. “For a lot of women in our study, they weren’t allowed to have access to finances,” Rebecca Stone, PhD, assistant professor and researcher of women’s victimization at Suffolk University and study author, tells Get Meds Info. “Her abuser would take the car keys or take all the warm jackets, and not let her leave the house right in the middle of winter.”
When Janet would stand up to her partner, he would financially abuse her further. “He would sell my pills and pocket the money. He wouldn’t even let me buy new underwear,” she says. The control of finances is just one warning sign of abuse.
Abusers also tend to isolate their partners, separating them from friends and family. “I was isolated with him,” Janet says. “He chased away just about anybody that cared about me and made me embarrassed to reach out to people.”
What Are Some Other Warning Signs of an Abuser?
- Showing extreme jealousy when time is spent away from them
- Insulting, demeaning, and shaming you privately or in front of other people
- Preventing you from working or attending school
- Pressuring you to have sex or perform sexual acts that you are not comfortable with
- Threatening to take away your kids or pets
- Intimidating you with weapons or sharp objects
- Destroying your belongings or where you live
Barriers To Seeking Help
These power dynamics coupled with other hurdles can make it difficult for women to access safety and recovery services. Researchers identified five barriers keeping women from accessing services:
- Geographic isolation and transportation difficulties
- Inaccessibility of existing services
- Lack of integrated substance use treatment and domestic violence services
- Social isolation
- Amplification of stigma in small rural communities
Due to the remoteness of rural areas, women involved in the study experienced difficulty accessing clinics and domestic violence shelters. “People couldn’t get to the services that did exist, either because they were far away, did not have transportation there, or they just didn’t serve people well,” Stone says.
The mean distance traveled to the nearest IPV resources was three times greater for rural women than urban women. For Janet, living a mile and a half away from town made access to safety and recovery difficult.
In addition to geographic isolation, these existing substance use treatment and domestic violence services had long wait times. Participants of the research study shared that they faced a two-week wait for a bed in a treatment center.
There are even fewer providers that can provide service for opioid use and IPV. “You might have in your community victim advocacy organization and substance use treatment providers like recovery coaches or methadone clinics,” Stone says. “There’s no service that understands both.”
Clinics that treat IPV and OUD separately make it difficult for women to coordinate their care. Providers and clinics miss opportunities to notice signs of IPV. “Participants would tell us about the times when they were reaching out for help, and the person they were reaching out didn’t see the opportunity to connect,” Stone says. “The participant was not adequately screened for partner violence and not connected to advocacy resources.”
For example, according to Stone, women who went to the hospital and sought care for head trauma weren’t screened for IPV.
Despite treating IPV and OUD separately, many programs helped lift the women in this study out of abusive relationships, showing how crucial increasing accessibility is in many of these rural areas. Because of the support and work of community advocacy organizations, Janet was able to access IPV support and therapy.
“I really feel like I’m in a place in my life where I’m a lot stronger. I believe they saved my life,” she says. Today, Janet helps support other women and serves on the advisory board for women with domestic violence and abuse issues.
Still, stigma prevents many rural women from seeking the care they need. According to Campbell, rural communities tend to be small and tight-knit which can deter women from seeking help.
“There’s already so much stigma around opioid use and partner violence and when you pair that with living in a rural area where everyone knows everyone, women describe not wanting to go to the clinics,” Campbell says.
The pandemic provides a silver lining, with teleservices booming. Stone and Campbell’s research secured funds to provide phones and tablets directly to community organizations. “We were able to get about $6,000 directly to an organization to purchase those kinds of things and give to people who need them,” Stone says. “That was an amazing thing to come out of a research project.”
As IPV and OUD loom on rural communities, Stone suggests people educate themselves about stigma. “If you want to learn more, victim advocacy organizations are amazing. Find one in your community to see if they’re running an education event,” she recommends. “If you don’t feel like it’s a personal issue for you, it’s an issue for your community. We need all the resources in our community to be strong and healthy.”
How To Support People Experiencing IPV and OUD
If you or someone you know is experiencing IPV, you can call the National Domestic Violence Hotline. The service is free, confidential, and provides help 24/7. When calling you can expect to get help, identify abuse, plan for safety, and support others.
If you or someone you know is experiencing substance use disorder, you can call the Substance Abuse and Mental Health Services Administration (SAMHSAs) National Helpline at 1-800-662-4357. Similarly to the National Domestic Violence Hotline, you can access free, confidential service 24/7, 365 days a year.
*In order to respect their privacy, Janet’s name has been changed.