Men attending substance misuse treatment are 40% likely to have physically or sexually assaulted their partner in the past year, and 70% likely to have committed psychological abuse—rates far exceeding the general population. Yet few studies have tested interventions that address both substance use and intimate partner violence (IPV) together. The ADVANCE programme aims to fill that gap. Over 60 months, researchers will first interview 45 male perpetrators and their partners to understand how substance use contributes to IPV, then develop an integrated group intervention. A feasibility study will randomly allocate 108 men to the new intervention or treatment-as-usual, and recruit 76 survivors for support services. If successful, a full randomised trial will test whether the intervention reduces IPV and improves partners’ depressive symptoms. If the intervention proves effective, it could give substance misuse services a practical tool to simultaneously tackle addiction and violence—reducing harm for both perpetrators and survivors. This would address a long-neglected overlap between two major public health problems, potentially lowering rates of injury, trauma, and criminal justice involvement among a high-risk population.
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Aims/objectives ADVANCE is a 60-month multi-methods programme with 5 consecutive workstreams(WS) that generate evidence to develop and test an intervention to reduce intimate partner violence(IPV) by men attending substance use treatment and improve depressive symptoms among for their ex/current-partners as a result. Background/rationale 40% of men receiving substance use treatment have been physically or sexually violent towards their partner in the past year rising to 70% for psychological abuse, rates far higher than the general population. Despite this, few studies have been conducted to examine the effectiveness of perpetrator interventions for male substance users. Integrated interventions that address IPV and substance use concurrently show promising results, but there remains a need for further research. Distinct perpetrators types have been described, but the role of substance use within these is poorly understood. Research plan WS1:Understanding IPV perpetrator typologies(months 1-12) A meta-ethnography(synthesis of qualitative literature) will be undertaken to better understand substance users perceptions of the role that substance use may play in IPV perpetration. In-depth qualitative interviews with 45 male IPV perpetrators attending substance use treatment in London and West Midlands (and their ex/current-partners) will be conducted to describe what contributes to IPV and ascertain their relationship/support needs. The Free Association Narrative Interview Method will be used for analysis. A new IPV perpetrator typology will be generated that evidences the relevance of intoxication and substance use to inform intervention development(WS3). WS2:Determining the efficacy of interventions to reduce IPV perpetration(months 1-12) A systematic review will compare and determine the efficacy of different treatment approaches. A narrative review will describe trials that addressed substance use or reported substance use outcomes. Effective interventions will be sourced for review in WS3. WS3:Developing the intervention and training package(months 6-18) An executive group will have overall responsibility for content. Two development groups(expert group and a PPI group) will meet 5 times to agree intervention and training package content. WS4: Feasibility and acceptability study(months 19-30) Approximately 108 male perpetrators receiving substance use treatment will be randomly allocated to the integrated group intervention developed in WS3 or treatment-as-usual(TAU) to inform the parameters required for planning an efficacy trial(WS5). Integrated women s support services will be offered to perpetrators ex/current partners(survivors). 76 survivors(includes 38 whose ex/current partners are allocated to the group intervention) will be recruited. Outcomes will be assessed at baseline and 3 months post-randomisation. The feasibility of obtaining outcome measures from survivors and perpetrators will be assessed. The following outcomes will be considered survivors depressive symptoms, perpetrator and survivor reports of IPV perpetration, respectful communication; awareness of the impact of IPV; substance use; quality of life; mental health; service use and criminal justice involvement. Survivors will also be asked about feeling safe. Various parameters needed to judge the feasibility of an efficacy trial will be estimated. A formative evaluation of the intervention s implementation will be conducted. A staging report(with stop/go criteria) will consider whether progression to full trial is warranted. WS5: Randomised controlled trial(RCT) of an evidence-based intervention developed in WS3 compared to TAU to reduce IPV perpetration among men attending substance use treatment(months 31-57) Trial design, primary and secondary outcomes for the efficacy trial will be the same as described for WS4. Outcomes will be assessed at baseline and 3, 6 and 12 months post-randomisation. It is est
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