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Promise and pitfalls: trauma informed care, trauma services, and efforts to address both substance use disorders and intimate partner violence

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Intimate partner violence (IPV) and substance use disorder (SUD) frequently co-occur and are rarely addressed together despite evidence indicating benefits of combined interventions. Both are linked to trauma. Scholars have theorized attention to trauma may facilitate engagement with IPV and SUD but have not studied this potential empirically.


Using service system level quantitative data on organizations focused on IPV or SUD (n = 281) in a midwestern city in the United States and semi-structured interviews with policymakers, funders, and practitioners in both areas (n = 27), this paper uses grounded theory to explore whether attention to trauma facilitates attention to IPV and SUD.


While quantitative data suggest addressing trauma and both IPV and SUD are associated at the service system level, analysis of interview data indicates greater complexity. Despite consensus on trauma-informed care’s potential, competing understandings of temporality (when trauma occurs in relation to IPV or SUD), different liabilities associated with addressing trauma, and different intervention approaches combine to limit engagement by both IPV and SUD organizations. Rather than adopting trauma-informed care, both types of organizations more typically engage trauma selectively, offering discrete services rather than holistic intervention. Findings have implications for addressing co-occurring IPV, SUD, and trauma and for practice, policy, education, and research.


There is need for greater consensus about what it means to address trauma, increased investments in practitioner education and training around intersections of IPV, SUD, and trauma, and additional supports to incentivize movement from a trauma services approach towards meaningful implementation of trauma-informed care.

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The author gratefully acknowledges Elizabeth A. Armstrong, Beth Glover Reed, Jason Owen Smith, Eve Garrow, Mathieu Despard, and Michelle McClellan for their support and feedback on the larger project from which this article was developed, Larry Bennett for his essential connections and ongoing encouragement, Kayla Thompson for her research assistance, and the anonymous reviewers at Journal of Family Violence for their insightful feedback.


This investigation was supported by the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award T32 DA007267. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Additional support for this project came from the University of Michigan Center for the Education of Women and Rackham Graduate School.

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Correspondence to Elizabeth Marie Armstrong.

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Armstrong, E.M. Promise and pitfalls: trauma informed care, trauma services, and efforts to address both substance use disorders and intimate partner violence. J Fam Viol 38, 841–853 (2023).

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