Purpose: Prior studies have documented general associations among substance use, intimate partner violence (IPV) and sexual assault, with a majority of studies suggesting that violence victimization predicts later substance use, though results are conflicting. The purpose of this study was to more comprehensively assess the specific mechanisms through which substance use (women's or their male partners'), especially during adolescence, increases risk for violence victimization, and how substance use and IPV collectively result in poor sexual and reproductive health in adolescent and young adult women. Methods: Semi-structured, audio recorded, face-to-face interviews exploring IPV and sexual assault were conducted with 47 heterosexual, White and African American women ages 18-30 seeking services at 24 family planning clinics in Western PA. Interviews in which substance use was identified (38/47 interviews, 81%) were examined further using grounded theory methods to characterize relationships among substance use, IPV, and sexual and reproductive health. Results: Alcohol was the most commonly reported substance used by women and their male partners, followed by cannabis, opioids, and benzodiazepines. Adolescent and young adult women who described forced or coerced sex typically reported that their perpetrators coerced them to consume alcohol, or that alcohol was consumed by the perpetrator immediately prior to the assault. Respondents often did not define these experiences as sexual assault or rape because of their own concomitant alcohol consumption. When women's first sexual experience was an assault, this occurred most often in early adolescence, between ages 12 and 14. Self-blame about their exposure to unwanted sex was common. Young women also described forced condom non-use, pregnancy coercion, and other forced sexual acts in the context of their partners' alcohol use. When drug use by intimate partners was reported, the severity and frequency of physical and emotional abuse escalated with the couple's drug use. Escalating violence and substance use by male partners resulted in young women's fear to negotiate condom use and sexual activity. Young women addicted to alcohol or other drugs reported trading sex with male partners for money and drugs. Conclusions: Substance use by male partners is common among female family planning clients who have experienced IPV and sexual assault, which greatly increases sexual risk in this population. Family planning clients with histories of substance use or with substance-using partners may benefit from traumainformed clinical services that recognize the health impacts associated with violence exposure in the context of substance use.
McCauley, H. L., Silverman, J., Broyles, L. M., Decker, M. R., Tancredi, D., Zelazny, S., & Miller, E. (2014). Substance Use, Intimate Partner Violence and Sexual Assault Among Adolescent and Young Adult Female Family Planning Clients. Journal of Adolescent Health, 54(2), S7–S8. https://doi.org/10.1016/j.jadohealth.2013.10.030