Background
We addressed the gap in perpetrator programmes for men who misuse substances by developing and evaluating the ADVANCE integrated substance use and IPV perpetrator programme for men in substance use treatment services. This new non-court mandated programme aimed to reduce men’s IPV through a focus on IPV in the context of substance use.
Work package 3(i): developing the ADVANCE group intervention
For more detail, see Gilchrist et al.6
Aims
To develop an evidence-based perpetrator intervention for men receiving substance use treatment.
Methods
A theory and evidence-based approach was taken to develop ADVANCE, using findings from WS1 and WS2 alongside the Behaviour Change Wheel framework and Capability, Opportunity, Motivation – Behaviour model: for behaviour (B) to change, it is necessary to change (physical and mental) capability (C), opportunity (O) to develop and implement new skills, and intrinsic and extrinsic motivation (M) (Figure 8).127
FIGURE 8 Behaviour change process. (Figure not reproduced here; see the original article.)
Theories informing ADVANCE
The ADVANCE programme proposes that change is facilitated by increasing understanding of the function of aggressive and abusive behaviours and the contribution made by substance use and gendered attitudes. It promotes motivation by increasing participants’ recognition of areas that need to change and increasing participants’ capabilities by introducing skills for change. ADVANCE highlights individual risks for IPV, including substance use, poor emotional regulation and poor stress-coping, and teaches participants how to reduce these risks by promoting self-regulation (ability to alter a response or over-ride a thought, feeling or impulse)128–130 and personal goal-setting. Poor self-regulation is associated with IPV perpetration.131 Goal-setting is used to enhance task completion by making all goals personal, explicit and specific. These SMART goals132 (specific, measurable, achievable, relevant and time-limited) address reduction in substance use and build positive relationships and healthy lifestyles. Personal goals with self-regulation enhance engagement and self-efficacy. Contingency management133–135 offered incentives or rewards (vouchers) contingent on attendance and linked to participants’ goals, building on the ‘good lives model’136 (Figure 9).
FIGURE 9 Theory guiding the ADVANCE programme. (Figure not reproduced here; see the original article.)
Development of ADVANCE
The ADVANCE intervention addressed the complex interplay between substance use and IPV perpetration in the context of intoxication, withdrawal, craving and acquiring substances identified in WP1 and WP2, and sexual jealousy and entitlement, the wider dynamics of power and control, and psychological vulnerabilities. Findings from our research were used to develop intervention materials, making them relevant to men who misuse substances. To translate evidence into an integrated approach and guide intervention design, a multidisciplinary design team from psychology, addiction, public health, IPV and behaviour change backgrounds followed the steps of the Behaviour Change Wheel.137 Materials were developed collaboratively and presented to Learning Alliances and PPIE groups for consultation. Nominal group techniques (NGTs)138 were used with the two Learning Alliances (total of 20 key stakeholders) to reach consensus on the intervention targets and content. Feedback was considered by the design team using the MoSCoW framework, identifying issues as aspects that Must change; Should change; Could change; Would like to change.139
ADVANCE group intervention
The ADVANCE 16-week intervention, delivered by trained substance use treatment staff in substance use treatment services, includes two (compulsory) to four individual sessions with a keyworker to set goals and enhance motivation, followed by 12 weekly 2-hour group sessions with two facilitators and 12 weekly coaching/check-in sessions (Figure 10; Table 3). A booster group session is available 1 month post intervention. Aftercare includes keyworker support and signposting to other services. ISSs provide support to women and proactively inform them about their (ex)-partner’s involvement. ISS workers attend four case management meetings with facilitators during the intervention to identify and manage any (changes to) risk.
| Session title | Session objectives |
|---|---|
| 1. Introduction | Get to know fellow group membersUnderstand the aims of the groupUnderstand what IPV is and how substance use can affect such behavioursLearn new skills that can help in times of distress |
| 2. Managing myself | Shift focus from managing your relationship to managing yourselfUnderstand how substance use affects self-regulationBe able to identify self-regulation and monitoring skills |
| 3. Being a respectful man | Examine costs and pay-offs when being abusiveIdentify triggering situationsHave improved self-awarenessPractice behavioural analysis |
| 4. Impact of intimate partner abuse (IPA) | Understand the key aspects of IPV behaviours and how substance use affects themUnderstand the impact of IPV on womenContinue to practise behaviour analysis |
| 5. Children and parenting | Recognise the impact of childhood experiencesBe able to identify the impact of witnessing IPV on childrenBe able to identify the impact of parental substance use on childrenAccept the past, build resilience and learn from mistakesIdentify the strategies that lead to repeat or not repeat |
| 6. Relating | Promote respectful and equal behaviours in ongoing relationshipsGive up controlling behaviours within a relationshipBe able to recognise and challenge relationship jealousyBecome aware of unhelpful automatic thoughts and core beliefs |
| 7. Improving communication | Recognise challenges to communication in relationships and when using substancesReduce abusive communication and increase respectful egalitarian communicationDevelop a staying safe plan |
| 8. Dealing with distress | Understand what distress isLearn to manage mood and emotionsUnderstand how substance use affects distressUnderstand thinking errors and their impact |
| 9. Planning to be better | Identify high-risk situations for IPADevelop plans to manage high-risk situationsIncrease skills for staying safe |
| 10. Positive relationships | Understand the impact of behaviours in different relationships: substance-using relationship, non-substance-using partners, substance-using discordant relationshipsBe able to identify features and benefits of equal relationshipsBe motivated and capable of using respectful behaviours in relationships |
| 11. New future, people’s plans, positive activities | Create and engage with positive social networksIdentify meaningful activities and positive behavioursSelect realistic positive goalsIdentify explicit positive life goals |
| 12. Recap ‘what have we learnt’ | Describe new skills, identify strengths and progressIdentify positive resources to help maintain changeIdentify further referralsUnderstand where to reach help, support, follow-up and to say goodbye |
FIGURE 10 The ADVANCE group intervention model (delivered in person). Reproduced with permission from Gilchrist et al.6 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) licence, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/. The figure includes minor additions and formatting changes to the original text. (Figure not reproduced here; see the original article.)
Limitations
There were no available effective interventions to reduce IPV by men that used substances, so ADVANCE was developed based on our research findings and current evidence.
Discussion
The ADVANCE was developed using rigorous methodology. ADVANCE differs from other perpetrator programmes by offering specific knowledge and related skills that addressed IPV in the context of substance use (intoxication, withdrawal and craving, drug seeking and acquisition, substance-using lifestyle) in each session. It also incorporated other mainstream factors involved in IPV, namely masculine power, control, beliefs and attitudes, aggression emanating from emotional dysregulation and a gendered view of substance use.