Addiction and Harm Reduction Among Survivors of Domestic Violence: What Advocates Need to Know

By Melissa Roark, MA, LPCC | February 19th, 2026

"You use drugs when you don't know how to handle the suffering inside you. When the despair, the anger, the anxiety comes up, you get some drugs or alcohol in order to forget. Instead we can offer compassion, and teach people how to handle the blocks of suffering inside."

— Zen Master Thich Nhat Hanh

When a domestic violence survivor walks through the door of a shelter, a treatment program, or an advocate's office, they may be carrying far more than a bag of belongings. They may be carrying years of trauma, fractured coping strategies, and — in many cases — an addiction that developed not out of weakness or poor choices, but out of survival. Understanding the deeply intertwined relationship between domestic violence and substance use is not just clinically important. It is an act of compassion that every advocate, counselor, and support professional working in this space must embrace.

The numbers are difficult to ignore. Research shows that domestic violence survivors are 15 times more likely to abuse alcohol and 9 times more likely to abuse drugs compared to those who have not experienced intimate partner violence (Clarity Chi, 2025). Alcohol alone is a factor in approximately 40% of domestic violence cases in the United States (Recovery Centers of America, 2024). For advocates and clinicians, the question is rarely "why does this person use?" — it is "what were they trying to survive?"

Maladaptive Coping: When Survival Strategies Become Harmful

Maladaptive coping strategies are behaviors used to manage stress, anxiety, or emotional pain that are initially effective — or feel effective — but over time cause harm to mental health and functioning (Wadsworth, 2015; Thompson et al., 2010). Domestic violence creates conditions that almost guarantee the development of maladaptive coping. Survivors do not enter abusive relationships with broken coping skills. Most arrive with healthy, functional strategies that gradually erode under the constant pressure of abuse. As the relationship persists, those healthy strategies are replaced by whatever is accessible, fast, and capable of dulling the pain — and drugs and alcohol fit that profile precisely.

This cycle is self-reinforcing. Each DV relationship a survivor endures deepens the neurological and psychological grooves of maladaptive coping, making those patterns more automatic and harder to interrupt. As Yvonne Bradley of YWCA observed, "No one wakes up and says, 'I want to be an addict.'" Survivors are doing the only thing that feels available to them in the moment. Understanding this is foundational to any trauma-informed advocacy or clinical approach.

Why Survivors Turn to Drugs and Alcohol: Barriers to Healthy Coping

The barriers that push DV survivors toward substance use are multifaceted and deeply personal. Personal barriers — including eroded self-esteem, perfectionism, shame, and learned helplessness — chip away at a survivor's belief in their own ability to cope differently. Environmental barriers such as an unsafe home, lack of social support, and constant conflict raise baseline stress levels to a point where conventional healthy coping feels unrealistic. Situational barriers including ongoing crises, sudden upheaval, and cumulative grief wear down any remaining resilience. Physical barriers such as chronic pain from injuries, sleep deprivation, or concussion compound the picture. Psychological barriers — trauma-induced anxiety, depression, and PTSD — create an emotional landscape in which the numbing effects of substances become deeply appealing. Cultural barriers, including fear of discrimination, language barriers, or role expectations, can further isolate survivors from the support they need (LinkedIn/AI, 2024).

Neurologically, the appeal of drugs and alcohol is not just psychological — it is biochemical. Substance use increases dopamine (the brain's "feel good" neurotransmitter) while simultaneously decreasing cortisol (the stress hormone). For a survivor living in a constant state of threat and hyperarousal, this dual effect is powerfully reinforcing. The more frequently they use, the higher the tolerance, and the deeper the dependency takes root (Fritz et al., 2019; Zahr & Pfefferbaum, 2017).

Addiction as a Barrier to Leaving — and to Healing

One of the most clinically and practically critical dynamics advocates must understand is that addiction itself becomes a barrier to leaving an abusive relationship. In many DV situations, the abuser actively coerces the survivor into substance use — joining them to deepen control, withholding substances as a form of punishment, or serving as the survivor's primary — or only — supplier. Once addiction is established, leaving the abuser can mean not just losing the relationship, but losing access to substances and facing withdrawal. This is not a lack of motivation or moral failure. It is a predictable consequence of coercive control (IDHS, 2024).

The long-term consequences of addiction on healing are severe. Chronic substance abuse can cause lasting damage to the brain's emotional regulation centers, resulting in hypersensitivity, aggression, irritability, and lethargy even after a survivor has achieved sobriety. Their brain has literally been restructured around survival and substance dependence. Without appropriate support, these changes can cause lasting interpersonal and professional impairment — and in some cases, survivors struggling with these effects become accidental perpetrators themselves as they struggle to regulate emotions in the aftermath of abuse (Koob et al., 2021).

Harm Reduction: Meeting Survivors Where They Are

Harm reduction is a framework built on a simple but radical premise: we do not help survivors by removing their coping strategies without replacing them. Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to reduce the negative consequences associated with substance use without requiring abstinence as a prerequisite for care. For DV survivors, this philosophy is not just pragmatic — it is ethically essential.

Replacement is one of the most important harm reduction interventions. Rather than stripping away a (dys)functional coping tool and leaving a survivor adrift, advocates work collaboratively to introduce alternative behaviors — self-care practices, exercise, hobbies, nicotine cessation aids, or other healthier substitutes. Safety-focused harm reduction supplies also play a vital role: overdose reversal kits including naloxone/Narcan, fentanyl and xylazine test strips, safer sex supplies, sterile materials, and educational resources on safer use practices reduce the risk of fatal outcomes while maintaining the trust relationship between advocate and survivor (SAMHSA, 2023).

Building Programs That Work: Principles of Effective Harm Reduction

Effective harm reduction programs share several core features. They are consistent and reliable, reducing access barriers rather than adding to them. They employ staff who reflect the community's culture, languages, and lived experiences — including people in recovery, people who have experienced homelessness or incarceration, and others with direct knowledge of the DV population. They involve people with lived experience not just as clients, but as designers, evaluators, and advocates. They are saturated with trauma-informed care at every level of their organizational structure. And they engage in ongoing community outreach with humility, building relationships rather than merely delivering services.

Community connection is not an add-on to recovery — it is recovery. Survivors struggling with addiction have a profound need for belonging, purpose, and stable community relationships alongside safe housing and employment to sustain their healing. Isolated survivors are more vulnerable to relapse and to re-entering abusive relationships. Advocates should approach addiction conversations with the same openness and non-judgment they bring to all trauma disclosures, and should ensure that case management plans include clear, individualized pathways to detox, recovery support, and community integration (BWJP, 2024).

Compassion as Clinical Practice

Addiction in the context of domestic violence is not a character flaw. It is a rational, neurologically driven response to prolonged, uncontrollable suffering. As advocates and clinicians, our role is not to judge the coping strategy — it is to understand what it was coping with, and to help build something better in its place. Survivors are doing their best with the tools they were given in circumstances they did not choose. The least we can do is show up with patience, compassion, and a commitment to meeting them exactly where they are.

Be patient. Be compassionate. Be collaborative. And never take away a coping skill without offering something to replace it.

References

BWJP (Battered Women's Justice Project). (2024). Survivors and substance abuse. bwjp.org.

Clarity Chi. (2025). IPV & the high rates of substance use among victims of domestic violence. claritychi.com.

Fritz, M., Klawonn, A. M., & Zahr, N. M. (2019). Neuroimaging in alcohol use disorder: From mouse to man. Journal of Neuroscience Research. doi:10.1002/jnr.24423.

Illinois Department of Human Services (IDHS). (2024). Addressing domestic violence in substance abuse treatment for women. dhs.state.il.us.

Koob, G. F., Arends, M. A., McCracken, M., & Le Moal, M. (2021). Alcohol: Neurobiology of addiction (Vol. 3, 1st ed.). Academic Press.

LinkedIn (AI generated). (2024). How can you identify potential barriers to effective stress management? linkedin.com. Accessed 9.10.2024.

Recovery Centers of America. (2024). Domestic violence and substance use correlations. recoverycentersofamerica.com.

Thompson, R. J., Mata, J., Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Gotlib, I. H. (2010). Maladaptive coping, adaptive coping, and depressive symptoms: Variations across age and depressive state. Behaviour Research and Therapy, 48(6), 459–466.

Wadsworth, M. E. (2015). Development of maladaptive coping: A functional adaptation to chronic, uncontrollable stress. Child Development Perspectives, 9(2), 96–100.

Zahr, N. M., & Pfefferbaum, A. (2017). Alcohol's effects on the brain: Neuroimaging results in humans and animal models. Alcohol Research: Current Reviews, 38(2), 183–206.