CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Health Consequences

Each year, more than 1.5 million women seek medical treatment for injuries related to abuse.²¹ In fact, more women are treated in emergency rooms for injuries related to intimate partner violence than for nonmarital rapes, muggings, and traffic accidents combined.²² Many nurses and doctors are in an ideal position to detect abuse.

Although many battered women seek emergency services, an even greater number see their primary doctor or OB/GYN. Twenty to 25 percent of obstetrical patients have a history of battering. In primary care, the numbers range from 28 to 38 percent.²³ Professionals should suspect the possibility of assault or abuse when the explanation for how an injury occurred does not seem plausible, or when there has been a delay in seeking medical help.

The American College of Obstetrics and Gynecology (ACOG) has recommended routine screening of all women for domestic violence. Nationally, however, doctors are inconsistent in how often they screen and whom they screen. One study from California found that 79 percent of primary care physicians reported they routinely screen injured patients for abuse, but only 10 percent reported routinely screening clients at new patient visits, and 9 percent reported regularly screening them during periodic check-ups. Only 11 percent reported doing so at regular prenatal care visits.²⁴

Lenore Walker, a pioneer in the domestic violence field, stated in her book The Battered Woman that the injuries for women treated in emergency rooms fall into four categories:²⁵

• Serious bleeding injuries. These include wounds that require stitches, especially around the face or head.
• Internal injuries. More specifically, these injuries include damage or malfunctioning organs. Many women will have damage to their kidneys, spleens, or lungs, which are punctured.
• Damage to bones. The most common broken bones are the arms, legs, and jaw. But many women also present with fractures to their vertebrae, skull, and pelvis.
• Burns. Abused women suffer from cigarette burns to all parts of their body, but such burns are usually seen on the abdomen and other parts not exposed on a daily basis. Burns are also caused by hot appliances, including stoves and irons, acids, and scalding liquids.

The clustering of violent acts during an assault often results in multiple injury sites. Typically, these injuries are to the face and central areas of the body rather than the extremities.²⁶ Abused women are 13 times more likely than other accident victims to have injuries to their breasts, chest, and abdomen.²⁷

The frequency with which a woman presents to the doctor or emergency room should also raise some concerns. A woman who comes to the emergency room at least three times with injuries has an 80 percent chance of being a battered woman, whether or not the injuries require stitches.²⁸