22. People experiencing or perpetrating domestic abuse

How to identify, assess and respond to domestic abuse among both victims and perpetrators in alcohol treatment services. It covers safety planning, staff training, multi-agency approaches and appropriate referral pathways and working with specialist domestic abuse services.

22.1 Main points

There is a high proportion of both victims and perpetrators of domestic abuse in the alcohol treatment population, compared to the general population.

Problem alcohol use alone does not directly cause domestic abuse, but it may increase the risk of domestic abuse occurring and increase the risk of more serious harm resulting from domestic abuse.

Alcohol treatment services should have domestic abuse policies and procedures that they regularly review.

Alcohol treatment services should be aligned with the multi-agency approach to domestic abuse and have pathways and working arrangements with specialist domestic abuse services.

Alcohol treatment services should make sure staff are trained to:

  • ask about domestic abuse in a safe, trauma-informed and appropriate way
  • respond to disclosure (by a victim or perpetrator) in an empathic way which prioritises the safety of the victim
  • identify and assess immediate risks to safety
  • refer to specialist domestic abuse services, and where appropriate sexual assault and abuse services and child safeguarding services
  • contribute to a multi-agency approach to working with people experiencing or perpetrating domestic abuse

Alcohol treatment services should promote an environment that encourages disclosure of domestic abuse and helps victims, children and perpetrators to access appropriate support.

Asking about and responding to domestic abuse should be a routine part of the role of alcohol treatment staff.

Alcohol treatment staff should offer referral to specialist domestic abuse services for victims and for perpetrators, intervening at an early stage where possible. They should work with specialist domestic abuse services to reduce immediate risk and offer longer risk management and support.

When working with a perpetrator of domestic abuse, the safety of adult victims and children is the priority. Alcohol treatment staff also need to identify and respond to the needs of the person perpetrating the abuse.

Domestic abuse puts children at risk of significant harm, including where they see, hear or experience the effects of domestic abuse in their household. Practitioners must act in line with national child safeguarding legislation and organisational procedures. In England and Wales, the Domestic Abuse Act 2021 recognises affected children as victims of domestic abuse in their own right.

Where both partners in an abusive relationship have an alcohol problem (including where the partnership no longer exists), services should make arrangements so that the victim does not attend the same service as the perpetrator. If this is not possible, victims and perpetrators should be seen at different sites and confidentiality boundaries should be very carefully maintained.

The person (victim or perpetrator) and their family are likely to need help from several services. Alcohol treatment staff and domestic abuse staff should work together and with other relevant services so there is an integrated multi-agency approach to their care and support.

Alcohol treatment services should be part of local strategic multi-agency partnerships to reduce domestic abuse and follow protocols for multi-agency bodies that manage high risks for victims or perpetrators of domestic abuse, such as:

  • multi-agency risk assessment conference (MARAC)
  • multi-agency public protection arrangements (MAPPA)
  • violence against women and girls strategic partnerships
  • adult and child safeguarding referrals, assessments and conferences

22.2 Introduction

This chapter provides guidance on identifying and responding to domestic abuse in alcohol treatment services. This includes victims and perpetrators of domestic abuse and their children.

Addressing domestic abuse requires a co-ordinated multi-agency response and, alcohol treatment services should be part of this multi-agency response.

22.2.1 Definition of domestic abuse

England, Wales, Scotland and Northern Ireland each have national legislation that defines domestic abuse. The legislation is:

You can find more details in annex 1 on relevant legislation and guidance.

Alcohol treatment services should be aware of the definition in their relevant national legislation and associated guidance.

The term domestic abuse includes abuse between intimate partners or ex-partners, as well as abuse between adult family members. For example, sons or daughters abusing their parents. Other forms of abuse carried out by or at the request of family members include honour-based abuse (including forced marriage and female genital mutilation). Young people under 18 may also use abusive behaviour in their own intimate relationships or towards their parents.

Children may experience domestic abuse directly. Seeing, hearing of experiencing the effects of domestic abuse also puts children at risk of significant harm. National safeguarding legislation and related guidance in all 4 UK nations takes account of the harmful effects of domestic abuse for children. Practitioners must follow national child safeguarding legislation and guidance and organisational procedures.

Through the Domestic Abuse Act 2021, children and young people in England and Wales are recognised as victims of domestic abuse in their own right. This includes children who have seen, heard, or experienced the effects of domestic abuse, and are related to either the victim of the abusive behaviour, or the perpetrator.

The terms victim and survivor are used interchangeably in the research literature. In this chapter, we largely use the term victim, but many people go on to become survivors of domestic abuse.

22.2.2 Prevalence of domestic abuse victimisation

Women, men and non-binary people can be victims of abuse and violence in heterosexual and LGBTQ+ relationships.

Research suggests that around 1 in 20 women have experienced extensive physical and sexual violence during their life, compared with 1 in 100 men (Scott and McManus, 2016). Of these women:

  • more than half have a common mental health problem
  • 1 in 5 have experienced homelessness
  • around a third have an alcohol problem

The Office for National Statistics report Domestic abuse in England and Wales overview using data from the Crime Survey for England and Wales, estimated that 2.3 million people aged 16 years and over (1.6 million women and 712,000 men) experienced domestic abuse in the year to March 2024.

Between 2019 and 2020, about 1 in 15 children under the age of 17 lived in households where a parent is a victim of domestic abuse (Home Office, 2022).

22.3 Domestic abuse and alcohol

22.3.1 Alcohol as a risk factor for domestic abuse

The World Health Organization (WHO) guidance Preventing intimate partner and sexual violence against women: taking action and generating evidence identified alcohol as one of 50 risk factors that increase a person’s likelihood of being a victim or a perpetrator of domestic abuse.

WHO suggests that problem alcohol use alone does not directly cause domestic abuse, but it may increase the risk of domestic abuse occurring and increase the risk of more serious harm resulting from domestic abuse. Domestic abuse is also more likely and more severe when both the perpetrator and victim have been drinking.

The Home Office report Analysis of domestic homicide reviews: October 2022 to September 2023 found that where vulnerabilities were recorded, problem alcohol use was a vulnerability for 24% of victims and for 26% of perpetrators. Other vulnerabilities for both victims and perpetrators include illicit drug use and mental health conditions.

Alcohol Change UK’s Rapid evidence review: alcohol’s contribution to violence in intimate partner relationships found:

  • a strong association between alcohol use and intimate partner violence (IPV) perpetration and victimisation in heterosexual relationships
  • women appear to be at a higher risk of having physical IPV perpetrated against them by a male partner who has been drinking than the other way around
  • alcohol-related IPV occurring in lesbian, gay, bisexual or transgender relationships is understudied

One study found that around 60% of men in alcohol or drug treatment were violent to their intimate partners in the preceding year (O’Farrell and others, 2004).

22.3.2 Alcohol and abusive relationships

There are several ways in which alcohol can be involved in abusive relationships.

Victims of domestic may use alcohol as an attempt to self-medicate by drinking to relieve the symptoms of trauma resulting from the abuse. They may then develop problem alcohol use or pre-existing problem alcohol use may get worse.

Victims of domestic abuse are likely to be more vulnerable to abuse when they are intoxicated as they may not react as quickly as they would do when not intoxicated.

People who perpetrate domestic abuse can try to exploit a victim’s problem alcohol (or drug) use. For example, they can try to sustain a victim’s dependence or threaten to expose this to health and care professionals, family members or communities. This can be particularly threatening to victims with children, or those from cultural backgrounds where drinking alcohol is not considered acceptable.

Perpetrators may deny responsibility for their abuse and (wrongly) blame the victim for the abusive behaviour, citing the victim’s problem alcohol use as the reason for their abusive behaviour. They may say that the person’s (usually the woman’s) problem alcohol use justifies abusive behaviour.

Where people who perpetrate domestic abuse have an alcohol problem, they may cite intoxication or a hangover as an excuse or to justify their abusive behaviour.

When there has been an incident where both partners have been violent to one another and alcohol is involved, responders can find it hard to understand who the victim is in the relationship, particularly where the life circumstances of both partners are challenging and disorganised.

It is helpful for staff in alcohol treatment services and domestic abuse services to be aware that these elements sometimes exist in abusive relationships where problem alcohol use is involved. Staff should be clear that while alcohol may be one risk factor, neither the alcohol use of the victim or the alcohol use of the perpetrator can justify or explain domestic abuse.

22.4 Working with victims of domestic abuse

22.4.1 Overview

This section summarises guidance, best practice principles and recommendations on addressing domestic abuse that is relevant to alcohol treatment and recovery services. They have been drawn from a range of guidance developed by national domestic abuse and substance use specialists, including:

Given the prevalence of both victims and perpetrators of domestic abuse in alcohol treatment, treatment services and their staff have a vital role to play in:

  • identifying victims and their children
  • intervening at an early stage where possible
  • helping victims and their children to access specialist support
  • contributing to a multi-agency response

Alcohol treatment services and their staff also have an important role to play in:

  • identifying perpetrators of domestic abuse
  • identifying and responding to safety needs of their victims and children
  • helping perpetrators to access specialist support

22.4.2 Domestic abuse policies and procedures in alcohol treatment services

Alcohol treatment services should have domestic abuse policies and procedures that they regularly review. These should include:

  • lines of accountability for managing risks to adult victims and child safeguarding risks
  • requirements and arrangements for staff training and supervision for work involving domestic abuse

  • clinical processes for:

    • assessing immediate risk
    • escalating the risk internally
    • making referrals to domestic abuse services and other relevant services including child safeguarding services
    • collaborative safety planning
  • involvement with local strategic approaches to domestic abuse and membership of multi-agency forums to address risk
  • information-sharing arrangements and protocols
  • supporting staff who have been affected by domestic abuse

22.4.3 Staff training

Working with domestic abuse is complex and sensitive, often linked to high risks to safety. Commissioners and services should make sure staff are trained to ask about and respond to domestic abuse in a way that prioritises the safety of adult victims and affected children. It is essential that staff receive appropriate training so they can safely ask about domestic abuse and respond appropriately.

Practitioners should be trained in both level 1 and level 2 on domestic abuse, as described in NICE PH50 and outlined below.

Level 1 is training to respond to a disclosure of domestic abuse (as a victim or a perpetrator) sensitively and in a way that ensures people’s safety. Practitioners trained to level 1 should also be able to direct people to specialist domestic abuse services and help them to access these.

Level 2 is training to ask about domestic abuse (both as a victim and a perpetrator) in a way that makes it easier for people to disclose it. This includes:

  • risk factors for domestic abuse
  • understanding which groups of people are more likely to experience higher levels of domestic abuse
  • how it affects people’s lives
  • their role and the role of other professionals in intervening safely
  • responding with empathy and understanding
  • assessing someone’s immediate safety to help prevent further incidents
  • referring to specialist domestic abuse services and other relevant services

Training should include an understanding of honour-based abuse (including forced marriage and female genital mutilation) and an understanding of equality and diversity issues.

Training should be provided by qualified trainers, use accredited materials where possible and include face-to-face contact, as well as online content. Training should be ongoing, and staff should have supervision and support for their work with domestic abuse.

It can be helpful if services appoint a named domestic abuse lead, with appropriate training and competence, to promote good practice and provide support and supervision to staff. In some services the safeguarding lead also leads on domestic abuse.

Services should regularly update staff on:

  • local policy
  • protocols for identifying and assessing risk
  • information-sharing
  • pathways to and from specialist domestic abuse services

22.4.4 Pathways with domestic abuse services

Increasing safety for victims of domestic abuse needs a multi-agency approach at a strategic and a service delivery level.

Commissioners and services should be aligned with the strategic multi-agency approach to domestic abuse in their local area. They should also agree pathways and working arrangements between alcohol treatment services and specialist domestic abuse services and with sexual assault and abuse services where domestic abuse has involved sexual assault or abuse. They should make sure that frontline practitioners from these services:

  • are aware of the pathways
  • know how to make referrals and support people to access appropriate services
  • know and can explain what each service offers

Services and staff should be aware of and refer people to domestic abuse services or professionals for specialist needs where appropriate. For example, there may be specific pathways for:

  • young people aged 17 years and under experiencing or perpetrating domestic abuse
  • older people
  • people from specific minority ethnic groups
  • refugees and asylum seekers
  • people with disabilities
  • LGBTQ+ people
  • male victims

See the resources section for GOV.UK links to specialist domestic abuse support including helplines.

Alcohol treatment services should be part of a muti-agency approach to supporting people experiencing or recovering from domestic abuse. They should work with the adult victim, domestic abuse services and other relevant services such as:

  • sexual assault and abuse services
  • child safeguarding services
  • physical health services
  • mental health services
  • substance use services
  • social care services
  • housing support services

In some areas, alcohol treatment services and domestic abuse services provide regular in-reach sessions in each other’s services to reduce barriers and support partnership working. People can then access support for domestic abuse or for problem alcohol use in whichever service they feel most comfortable.

Services should regularly update staff about pathways and working arrangements with domestic abuse services.

22.4.5 Information-sharing arrangements

Services should have information-sharing arrangements with all other agencies working with people experiencing domestic abuse. Confidentiality is important for everyone that comes to alcohol treatment services, but it is particularly vital for people experiencing domestic abuse. This is because any information that gets to a perpetrator can put the victim at increased risk of abuse. Some perpetrators of domestic abuse can be persistent in seeking out information about victims and their movements.

Alcohol treatment services should develop or adapt information-sharing agreements about people at risk of, experiencing and perpetrating domestic abuse within their service and between services. The information-sharing agreements should specify:

  • the duty of confidentiality
  • what information should and can be shared and with whom
  • circumstances in which information can be shared without consent
  • technical information-sharing systems, which must be secure

It is always best to have consent to share information, but information can be shared without consent for child safeguarding and if an adult is at serious risk. A practitioner should involve the accountable professional in the service or organisation (for example, domestic abuse lead or safeguarding lead) if they are making a decision about sharing information without consent.

Services should be aware of and comply with information-sharing protocols of local multi-agency risk assessment forums.

Services should make sure their staff are aware of the information-sharing arrangements and protocols and regularly review them with staff.

22.4.6 Promoting an environment that encourages disclosure

Alcohol treatment services should clearly display information in waiting areas and other suitable places about the support they offer for people affected by domestic abuse and about specialist domestic abuse services. They should also display the information in places that people can read it in private, like toilets. Information should include contact details of relevant local and national helplines. Services should display information in local community languages, in accessible formats and in simple language.

It is essential that any question or discussion about domestic abuse takes place in a private setting. Services should make sure these private spaces are available.

A perpetrator and victim should not be seen in the same service because this could put the victim at risk. If there is only one local service, the victim and perpetrator should be seen at different sites and great care should be taken to preserve confidentiality about the victim’s attendance.

Domestic abuse is traumatic, and victims of domestic abuse may have multiple experiences of trauma. So, it’s important that services and practitioners use a trauma-informed approach. You can read more about a trauma-informed approach in section 2.2.8 in chapter 2 on principles of care.

Offering a choice of either a male or female practitioner may help the person to feel safe enough to discuss their situation.

22.4.7 Alcohol treatment practitioners asking about and responding to domestic abuse

Alcohol treatment practitioners should ask about and respond to domestic abuse as a routine part of their work and require training to do this. Trained practitioners should know how to ask and respond sensitively and in a way that prioritises people’s safety.

Services should make sure that questions about domestic abuse are routinely part of assessment, whether or not there are potential indicators of domestic abuse.

There is guidance on assessing domestic abuse in section 4.9.15 in chapter 4 on assessment and treatment and recovery planning.

A victim is unlikely to disclose abuse and can be put at greater risk if they are asked about their experience in the presence of the perpetrator or in some cases, other family members or members of their social network.

If a service is using interpreters, these should be independent from the person’s family and social network so that victims can speak confidentially and avoid potential risks from family members.

The practitioner should:

  • explain the service’s duty of confidentiality
  • reassure people that their attendance at the service and their treatment and support will never be discussed with the perpetrator
  • explain the circumstances when information can be shared without consent

Victims of abuse may find it hard to disclose because they are afraid of the perpetrator finding out, being judged, or intervention from local children’s services. They may also (wrongly) believe the abuse is their own fault or they may not recognise the perpetrator’s behaviour as abusive. However, they may appreciate the chance to disclose. When alcohol treatment practitioners use a sensitive, empathic, trauma-informed approach and make efforts to build a trusting relationship, a victim is more likely to disclose their experience and consider accessing specialist support.

People often do not disclose abuse when they first contact services. So, if practitioners see indications that the person might be experiencing domestic abuse, they should ask them about it again as they build a relationship and review treatment and recovery plans. For example, a person may refer to their partner not allowing them to do something or appear fearful.

22.4.8 Helpful questions

Alcohol treatment practitioners need to be sensitive in the way they ask questions.

They can start with broad, generic questions, such as:

  • how are things at home?
  • how are things with your partner?
  • how are you feeling?
  • how are you managing at the moment?

Then, where appropriate, they can follow up with more direct questions that use non-judgemental language, for example:

  • how do you and your partner work out arguments?
  • do arguments ever result in you feeling put down or bad about yourself?
  • do arguments ever result in hitting, kicking or pushing?
  • has anyone ever made you feel frightened or scared at home?
  • do you ever feel controlled by your partner?

You can also communicate that other people have similar experiences and explain why you are asking these questions and they are not alone.

If the person has an injury, rather than asking how it happened, they can ask “who hurt you?”.

Active listening helps establish rapport and build trust. It helps the person to disclose their feelings and helps to gather information. The practitioner could ask more questions to clarify the extent of abuse disclosed and to identify the level of risk that exists, such as:

  • do you feel safe right now?
  • do you feel safe leaving this appointment, or going home?
  • what do you fear might happen in future? (to find out about what types of abuse could happen to them)
  • what threats has the perpetrator made to you or your children?

22.4.9 Responding to a disclosure of domestic abuse or concern the person is at risk

Indications of domestic abuse

Alcohol treatment practitioners should be trained to recognise potential indicators of domestic abuse and to respond appropriately to a disclosure. If they have any concern that the person may be experiencing abuse, they should ask the person about it. They should ‘make every contact count’ and not delay asking about it until a later appointment, as the person could be in immediate danger or they might not return to the service. They should ask questions sensitively and in a completely private setting.

Referring to specialist domestic abuse services

When a victim discloses current or past experience of domestic abuse, practitioners should:

  • respond with empathy and understanding
  • identify whether the person and any children are likely to be at immediate risk
  • complete the service risk assessment process for domestic abuse in a sensitive way
  • offer referral to specialist domestic abuse services for managing immediate risks and for longer term specialist support
  • discuss the situation, including the risk assessment and what to do next, with their manager and the accountable person in the organisation (for example, the domestic abuse lead, the safeguarding lead

Specialist support services can help to address the emotional, psychological, physical and sexual harms arising from domestic violence and abuse. They can offer advice, help to develop plans for the future and increase the safety of those affected.

People may be anxious about contacting domestic abuse services, so practitioners should offer to make the initial referral or support the person to make contact. The practitioner should be familiar with local domestic abuse services, so they can explain what they offer and how they can help the victim.

Risk assessment

Alcohol treatment staff should be trained to make an initial assessment of any immediate safety risks. Risk assessments and risk management (safety) plans should adequately reflect the seriousness of:

  • the risk associated with problem alcohol use and domestic abuse
  • other risk factors, such as a person’s mental health
  • the fact that risks can change rapidly

Alcohol treatment staff who are trained to do so can use tools to help identify the current level of risk to a person from domestic abuse. Services should train any staff who are expected to carry out an assessment of risk from domestic abuse and on the use of appropriate tools.

An example of a tool used in risk assessment is the SafeLives Dash (domestic abuse, stalking and honour-based abuse) risk checklist, which has versions adapted for use in each UK nation. The checklists are not definitive assessments of risk but help identify and assess risk based on structured professional judgment.

Professionals using checklists, or other risk assessment tools, should be alert to the risk to children as well as adults. It is essential to identify changes, such as escalation in severity and frequency of abuse. Statutory guidance for the Domestic Abuse Act 2021 highlights that:

risk assessments should holistically encompass specialist professional judgement, survivor perceptions of risk, along with additional indicators relevant to minority groups.

In England and Wales, there is a mandatory duty to report female genital mutilation. In addition to safeguarding legislation, the Scottish Government and Northern Ireland Assembly have published national multi-agency guidance on responding to female genital mutilation in their respective nations (see annex 1 on legislation and statutory guidance).

Current risk

If a victim and any children are currently at risk, their safety is the priority. Specialist domestic abuse services can intervene to help the person to create a safety plan, provide specialist advice and access to support. Services for victims at current risk include:

  • local and national helplines
  • safety planning
  • advocacy
  • access to refuges
  • access to legal advice
  • counselling
  • MARAC for people at high risk

People at high risk will need a multi-agency response to reduce risk and to address health and care needs. In England and Wales, services should refer them to the local MARAC. In Scotland and Northern Ireland, they should refer people to equivalent multi-agency risk management structures.

A MARAC is a regular meeting where information is shared to provide a fuller picture of risk to adult and child victims, between representatives of:

  • independent domestic violence advocate services
  • housing services
  • children’s services
  • the Probation Service
  • primary care
  • mental health
  • alcohol and drug treatment services
  • adult social care

Alcohol treatment services should follow local protocols for making referrals to MARAC or equivalent multi-agency structure. In some parts of the UK, services use the Dash risk checklist as a referral to MARAC.

After information-sharing, the MARAC agrees co-ordinated actions to reduce risk. Member organisations share information in between meetings to monitor risk and improve safety, observing the information-sharing protocol.

Alcohol treatment services should be members of their local MARAC and related multi-agency panels, for example MAPPA. These take a multi-agency approach to monitoring and managing people who pose a risk to others, including domestic abuse perpetrators.

If the person does not agree to access specialist domestic abuse services or give consent to share information, the practitioner should inform their manager and the accountable professional (such as the domestic abuse lead and safeguarding lead) and discuss next steps.

It is always best if a person consents to their information being shared but in some cases, the practitioner or accountable person will need to share information without the person’s consent. This includes situations where children are at risk, or an adult is at serious risk of harm.

The practitioner must follow:

  • child and adult safeguarding legislation and organisational procedures
  • organisational risk management procedures and information-sharing protocols
  • multi-agency domestic abuse risk management procedures

They should inform the victim they will be sharing information and explain their reasons unless doing so would put children at further risk.

Ongoing support

Domestic abuse affects many aspects of a person’s life. If the adult victims and their children are not currently at risk of harm but they have been affected by domestic abuse, specialist domestic abuse services can intervene to provide legal, emotional and social and housing support.

Services include:

  • floating support and outreach
  • legal advice and advocacy
  • housing support
  • support groups
  • skills training
  • access to talking therapies for adults and children and young people

22.5 Children and young people

22.5.1 Children experiencing or affected by domestic abuse experienced by a relative

Children may experience domestic abuse directly. Seeing, hearing or experiencing the effects of domestic abuse also puts children at risk of significant harm and are grounds for a child safeguarding referral. National safeguarding legislation and related guidance in all 4 UK nations takes account of the harmful effects of domestic abuse for children. Practitioners must follow national child safeguarding legislation and guidance and organisational procedures.

Through the Domestic Abuse Act 2021, children and young people in England and Wales are recognised as victims of domestic abuse in their own right. This includes children who have seen, heard or experienced the effects of domestic abuse, and are related to either the victim of the abusive behaviour or the perpetrator. This important recognition helps ensure locally commissioned services continue to carefully consider and address the needs of children.

Where one or both parents have problem alcohol use, children and young people will be affected and may be at risk of significant harm from both alcohol related behaviours and domestic abuse, compounding the harms they experience.

22.5.2 Young people experiencing or perpetrating domestic abuse in their own relationships

Young people experiencing or perpetrating abuse in their own relationships need to be supported in a way that is tailored to their needs, although they may often have to rely on specialist services designed for adult victims that are not always appropriate. It is vital that young people who experience domestic abuse in their own relationships are referred through a multi-agency risk assessment.

In responding to cases of abuse involving young people aged 17 and under, child safeguarding procedures should be followed as set out in national legislation and statutory guidance. Professionals should be mindful that young people may be reluctant to discuss relationships or their concerns around abuse with adults. Also, it may be particularly difficult for young people to deal with certain practical challenges, such as moving home to escape the abuse or managing their own finances.

Staff in young people’s alcohol treatment services should be equipped to identify and respond to children and young people experiencing domestic abuse, drawing on the range of support available, including specialist domestic abuse professionals, from early intervention to crisis stage. Best practice responses involve an integrated response that combines child safeguarding and high-risk domestic abuse expertise, particularly in relation to risk assessment and safety planning.

22.5.3 Young people using abusive behaviour towards a parent

Statutory guidance for the Domestic Abuse Act 2021 (England and Wales) says:

It is important that a young person using abusive behaviour towards a parent or family member receives a safeguarding response, which should include referral to a Multi-Agency Safeguarding Hub or local equivalent in the first instance where a parent advocate may attend, followed by referral to MARAC if necessary, regardless of whether any police action is taken.

22.6 An integrated multi-agency approach

People experiencing or affected by domestic abuse often experience multiple disadvantage, including:

  • alcohol and drug use
  • mental health conditions
  • physical health conditions or disability
  • trauma
  • homelessness or inadequate housing
  • poverty
  • contact with the criminal justice system

Several of these factors can increase vulnerability to domestic abuse.

People at risk of or affected by domestic abuse will not all meet the high risk threshold for MARAC (or the threshold set by an equivalent multi-agency structure) but they still need a multi-agency approach. Practitioners should work with multiple agencies including:

  • domestic abuse services
  • children’s services
  • adult social care
  • the police
  • probation
  • healthcare
  • mental health services
  • housing and homelessness services

Services need flexible engagement approaches to make it easier for women and those with severe disadvantage to access the service. They also need to reach out to groups who might not usually approach services, including women from ethnic minority groups and other people with protected characteristics. There is guidance on developing inclusive services in chapter 25. There is information on specialist domestic abuse support in the resources section below.

Women coming to alcohol treatment who have experienced domestic abuse are likely to benefit from access to women-specific, trauma-informed services. Mixed gender alcohol services can feel intimidating and uncomfortable and can re-traumatise some women. Holding women’s groups or sessions in an area where male clients cannot enter, see into or potentially harass women leaving, can help to create emotional safety for women.

While most victims of domestic abuse are women, a significant number of men and people who identify as non-binary also experience domestic abuse. Domestic abuse occurs in heterosexual relationships and in LGBTQ+ relationships. Services need to consider a person’s needs for physical and emotional safety and agree with the person how the service can best support them to feel safe and supported while they are in treatment.

22.7 Working with perpetrators of domestic abuse

22.7.1 General principles

Similar principles apply to services and staff working with perpetrators of domestic abuse as those set out in this chapter for working with victims of domestic abuse. This includes practitioners sensitively and non-judgementally asking about current and historic domestic abuse as part of standard practice and responding appropriately if a person discloses they have perpetrated domestic abuse. A trauma-informed approach and developing a trusting relationship are important to encourage disclosure and discussion about perpetrating domestic abuse.

Any interventions with the perpetrator must prioritise increasing the safety of the adult victim and affected children.

22.7.2 Acting on a disclosure of domestic abuse (person perpetrating abuse)

After a person discloses they have perpetrated domestic abuse, practitioners should respond non-judgementally, while not condoning the abuse in any way. Practitioners should discuss this as soon as possible with appropriate staff members and follow national legislation and guidance and their organisational domestic abuse procedures. They should discuss any disclosures with:

  • their line manager
  • the accountable person such as domestic abuse lead or child and adult safeguarding lead
  • other relevant staff who need to know

The practitioner, appropriate lead and line manager should then agree on actions to take, prioritising the safety of the adult victim and children.

Practitioners should:

  • follow protocols for MARAC, MAPPA and adult and child safeguarding referrals where relevant
  • be aware of local resources and be confident about how to use local pathways to specialist domestic abuse services for victims and for perpetrators
  • share information with relevant services according to local information sharing protocols and arrangements
  • obtain consent to share information wherever possible but be clear with people about how and when they will need to break confidentiality without consent
  • continue to support and work positively with the perpetrator and give them hope and optimism that it’s possible to change their behaviour

In England and Wales, there is a mandatory duty to report female genital mutilation. The Home Office and Department for Education has published guidance on the mandatory reporting of female genital mutilation. In addition to safeguarding legislation, Scotland and Northern Ireland have published national multi-agency guidance on responding to female genital mutilation in their respective nations (see annex 1 on legislation and statutory guidance).

People with problem alcohol use who perpetrate domestic abuse are likely to have complex needs, possibly including their own histories of abuse, neglect or mental health problems. This does not reduce responsibility for the abuse but may suggest they need to be referred to support services according to an individual assessment and formulation of their needs.

People should be offered referral to specialist evidence-based services for people who perpetrate domestic abuse. They may be able to access a Respect accredited perpetrator intervention. These interventions aim to keep victims and survivors safe and hold perpetrators accountable, while offering them meaningful opportunities to change. There are interventions for adults and for young people. See resources section 22.7 for more on the work of Respect.

Making changes in problem alcohol use and in abusive behaviour is not a linear process. Alcohol treatment practitioners, perpetrators and victims of domestic abuse should not assume that if the person makes changes in their alcohol use, or begins a perpetrator programme, the risk to victims no longer exists. Specialist staff on the perpetrator programme can advise on this. The safety of the adult victim of domestic abuse and children should continue to be monitored and managed.

22.7.3 A framework for alcohol and drug treatment services to work with perpetrators

There is a lack of evidence about the effectiveness of interventions in alcohol treatment to address domestic abuse perpetration and so these guidelines cannot make detailed recommendations at present.

King’s College London has published A framework for working safely and effectively with men who perpetrate intimate partner violence in substance use treatment settings (PDF, 949KB). The framework is specific to drug and alcohol treatment services and clarifies the capabilities staff need for working with men who use drugs and alcohol and who perpetrate IPV. These capabilities include:

  • knowledge
  • attitude and values
  • ethical practice
  • skills and reflection
  • professional development

22.8 Resources

Domestic abuse: how to get help

Domestic abuse: how to get help is aimed at people who are experiencing domestic abuse or know someone who is. It provides information on domestic abuse and on sources of support across all 4 UK nations including national helplines. Information translated into several languages is available.

Domestic abuse: specialist sources of support

Domestic abuse: specialist sources of support on the UK government website provides information on specialist sources of support. It includes information:

  • about helplines and services for people from different groups with protected characteristics
  • about help for children and young people
  • about welfare benefits and housing advice
  • for people who do not have settled status in the UK
  • on specific types of abuse

Women’s Aid

The Women’s Aid website provides information and support for women who experience domestic abuse, including:

Respect

Respect is the UK charity stopping perpetrators of domestic abuse. It was established to focus on perpetrators of domestic abuse, as well as working with young people who cause harm and providing expert support to male victims of domestic abuse. They do this work by:

  • conducting research
  • engaging in practice and piloting new interventions
  • accrediting services
  • influencing policy

22.9 References

Home Office. Domestic Abuse Act 2021: statutory guidance, 2022.

O’Farrell T, Murphy C, Stephan S, Fals-Stewart W and Murphy M. Partner violence before and after couples-based alcoholism treatment for male alcoholic patients: the role of treatment involvement and abstinence. Journal of Consulting and Clinical Psychology 2004: volume 72, issue 2, pages 202 to 217 (registration and subscription required for full article).

Scott S and McManus S. Hidden hurt: violence, abuse and disadvantage in the lives of women. DMSS research for Agenda, 2016.