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. Author manuscript; available in PMC: 2025 Jan 1.
Published in final edited form as: Alcohol Treat Q. 2023 Oct 26;42(1):62–75. doi: 10.1080/07347324.2023.2272799

Recovering Safety: A Pilot Study of a Women’s Empowerment Group for Survivors of Intimate Partner Violence with Substance Use Disorders

Amanda E Sedgewick 1,2,*, Callie L Wang 1, Emily A Levine 1, Shelly F Greenfield 1,2, Dawn E Sugarman 1,2
PMCID: PMC10871666  NIHMSID: NIHMS1939841  PMID: 38370979

Abstract

This pilot study examined the feasibility and satisfaction of the Recovering Safety group, an outpatient empowerment, psychoeducational skills group for women with substance use disorders (SUDs) who have experienced intimate partner violence (IPV). Patient satisfaction, empowerment, and safety were assessed at three time points. Participants (N=8) reported high satisfaction with the group and rated the IPV-informed content, women-only participants, and female therapist as important factors; empowerment increased from pre- to post group. These results support initial feasibility; further study of such treatments is needed to examine efficacy of this group intervention.

Keywords: Intimate partner violence, gender-based violence, substance use disorder, women, domestic violence, group therapy, substance use

Introduction

Intimate partner violence (IPV) is a prevalent, severe problem that damages the health and safety of a significant number of women. Formal studies estimate lifetime prevalence of IPV in the general population at 36.4% (more than 1 in 3) (S. Smith et al., 2018). IPV is defined as a pattern of coercive behavior that is used by a person to gain power and control over the other party in a relationship (Stark, 2007), and includes one or more of the following: physical, sexual, psychological/emotional, economic, legal, and/or spiritual abuse.

The relationship between IPV and substance use disorders (SUDs) is complex and bidirectional. Women with SUDs experience IPV at a higher rate than the general population, with wide ranging estimates of IPV of 25-90% among women receiving substance use treatment (El-Bassel et al., 2000; El-Bassel et al., 2011; Engstrom et al., 2008; Gilbert et al., 1997; Schneider et al., 2009; Weaver et al., 2015). Women abused by an intimate partner are more likely to use substances and develop SUDs (Lipsky & Caetano, 2008; Lipsky et al., 2005; P. H. Smith et al., 2012); women who have experienced moderate or severe IPV have an increased risk of reporting prior hospitalization for drug use (El-Bassel et al., 2019). A 2020 national online survey of women conducted after the start of the COVID-19 pandemic found that of the 20% of respondents who acknowledged IPV, 29% noted worsening IPV since the pandemic and 16% noted worsening drug or alcohol use to cope with relationship problems (Devoto et al., 2022). Women exposed to IPV in the context of substance use may also develop co-occurring posttraumatic stress disorder (PTSD) and other mental health problems (Lagdon et al., 2014; Salom et al., 2015; Sullivan & Holt, 2008). Co-occurring psychiatric disorders and IPV are both associated with decreased odds of completing substance use treatment for women (Lipsky et al., 2010). Current or past IPV can interfere with progress in treatment and recovery from PTSD symptoms; alcohol or drug use is often used to cope with their partners’ abuse (Gilbert et al., 2001).

Women experiencing IPV may be unable to access needed treatment due to lack of safety in their relationships as well as overt interference to seeking treatment by their partner. Abusive partners often use tactics specifically geared towards their partners’ mental health and/or substance use to obtain or maintain control; these phenomena are known as mental health coercion and substance use coercion (Rivera et al., 2015; Warshaw et al., 2013). These tactics are well known to victims, but often not known to the clinicians treating them. When women with IPV do enter SUD treatment, the IPV-related issues are often not identified or addressed as many programs do not offer integrated models or onsite IPV advocates to manage this aspect of their care. This is especially true in mixed gendered settings.

Few treatments have been developed or adapted for women who have experienced IPV, and even fewer target both IPV and substance use (Hameed et al., 2020). Current treatments that address IPV and substance use have been implemented in specific levels of care and/or treatment settings (e.g., methadone maintenance programs, emergency rooms), and vary in type and length of intervention (brief, computerized, individual, group, etc.) (Choo et al., 2016; Fowler & Faulkner, 2011; Gilbert et al., 2006; Gilbert et al., 2015; Tirado-Muñoz et al., 2015; Warshaw et al., 2013) For example, WINGS (Women Initiating New Goals in Safety) is a 1 or 2 session intervention designed to identify IPV, develop safety planning strategies, strengthen social support, and increase access to services for women who use drugs (Gilbert et al., 2006; Gilbert et al., 2015). In a multi-site clinical trial of the intervention, Seeking Safety, for women with PTSD and SUD, a secondary data analysis demonstrated that reductions in PTSD led to greater reduction in alcohol use, but there was minimal evidence for an effect of reduced drinking leading to reductions in PTSD (Hien et al., 2010). In another secondary analysis of Seeking Safety data, results showed that Seeking Safety group participants who were abstinent from substances at baseline were significantly less likely to report IPV in follow up (Cohen et al., 2013). This data provides promising evidence for reduction in both PTSD and substance use, and even some improvements in IPV outcomes for a subset of individuals, but this intervention is not IPV-specific. Further investigation is needed to replicate positive findings of reduction in PTSD, IPV and SUDs (Flanagan et al., 2016). In a metanalytic review of other psychological therapies for women who have experienced IPV, results show limited improvement in mental health symptoms, uptake of IPV services, safety planning, or reducing IPV (Hameed et al., 2020). However, the therapies that were reviewed did not specifically address substance use-. Further development of IPV-specific trauma treatments is needed to address not only past, but also ongoing safety issues related to IPV and to improve short and long-term treatment outcomes of SUDs among women with a past or current history of IPV.

Following the NIH Stage Model for Behavioral Treatment Development (NIH; Rounsaville et al., 2001), this Stage 1a behavioral treatment development trial aimed to (1) further develop an 8-session, gender responsive group intervention for women who have experienced intimate partner violence and have a substance use disorder, and (2) pilot test the group for feasibility, patient satisfaction, and patient’s perception of safety and empowerment.

Materials and Methods

The protocol for this study was reviewed by the Mass General Brigham Institutional Review Board (IRB) and the IRB determined that the study met criteria for exemption. Therefore, written informed consent was not required. Instead, participants were informed about the purpose, content, and risks and benefits of the study via an online study fact sheet, and eligible participants indicated their agreement to participate in the study by clicking on a checkbox next to the statement “I agree to participate in this research.”

Recovering Safety Group Development

The Recovering Safety group adopts a gender-responsive, IPV-informed approach that recognizes how a participant’s IPV experience and current safety concerns influence their symptoms and progress in treatment. The group approaches healing from a non-judgmental, de-pathologizing and empowering position. The focus is on safety, self-care, relapse-prevention, and other skills that are useful for patients struggling with these issues. The group content, influenced by a traditional domestic violence advocacy approach, centers the participants as the “experts” of their own safety and supports their decision-making, while allowing safe discussion around issues related to IPV that are not typically addressed in other group formats. This model sets the stage for women to share and receive support around this experience with other group members.

The principal investigator (AES) initially developed the 8-session Recovery Safety psychoeducational group to provide handouts and resources about IPV and SUDs to women in outpatient treatment for substance use and co-occurring psychiatric disorders who also had a history of IPV. There was, however, no specific treatment manual for the group and it was implemented by the principal investigator (PI) as a psychoeducational group with handouts and resources for patients developed by the PI. Prior to the present Stage 1a trial, the initial version of the Recovering Safety Group had been implemented in clinical practice in two outpatient settings: Portland, Maine in the adult psychiatry clinic at Maine Medical Center (2017-2018) and Belmont, Massachusetts in the McLean Hospital Alcohol, Drug, and Addiction Treatment Program (ADATP) (2019- present). The groups in both settings included women who had substance use disorders and subjectively identified experiencing IPV as part of their history. In an informal assessment through a quality improvement project, group members in the Maine Medical Center Outpatient Psychiatry Clinic (N=10) expressed satisfaction with the initial version of the group, and reported the group filled a needed service in providing educational materials and resources about IPV experiences. While the initial version of the Recovery Safety group had handouts and educational material for patients, the group therapy did not have a treatment manual to provide session-by-session implementation guidance for therapists in addition to handouts and resource materials for patients. Manualized behavioral interventions are necessary in order to be able to replicate treatments across settings, train therapists and measure fidelity, and investigate patient satisfaction and treatment outcomes (NIH).

This study’s first goal, therefore, was to further develop the Recovering Safety group therapy by refining the manual through review and guidance from three experts in the field, including, an expert in intimate partner violence, an expert in co-occurring SUD and trauma, and an expert in behavioral treatment development trials and treatment for women with substance use disorders (SFG). Initial modifications to the Recovering Safety Group manual were made by the therapy developer (AES). These were then reviewed by the three expert reviewers (e.g., Carole Warshaw MD, Denise Hien PhD, and Shelly F. Greenfield MD MPH). The PI then revised the manual according to this expert feedback and guidance. Modifications to the initial treatment model included refining the group themes (described in Text Box 1) and goals, providing a unified approach to concept introduction of IPV-induced trauma and SUDs (content in sessions 1-8), and encouraging use of skills and self-care techniques to define and achieve goals around safety and abstinence from substances (focus on skills in sessions 3-8). The content and skills building include concepts of substance use and mental health coercion (sessions 1-2), (Warshaw et al., 2014) as well as self-care and relapse prevention similar to those found in evidence-based treatments such as the Women’s Recovery Group (Greenfield, 2016) and Integrated Group Therapy (Weiss & Connery, 2011). Sessions 3 through 8 integrate skills from evidence-based behavioral therapies such as Dialectical Behavior Therapy (DBT) (Linehan et al., 2015) Cognitive Behavioral Therapy (CBT), as well as grounding and the window of tolerance concepts, both of which are useful in PTSD treatment (P. Ogden et al., 2006). Group participants are encouraged to practice skills each week and consider adding them to personalized safe coping and self-care plans. At the end of the eight sessions, participants complete individualized safe coping, self-care, and safety/crisis plans to utilize either on their own or with their individual treaters.

Text Box 1. Themes of the Recovering Safety Group.

Theme 1: The first step in recovery is making safety your first priority.

Theme 2: Choosing not to use substances increases safety.

This modified manualized Recovering Safety group was then implemented as part of usual care at McLean Hospital’s ADATP in the outpatient setting. All group sessions were led by a female study therapist (the PI, AES). The 8 topics covered in the Recovering Safety group are listed in Text Box 2.

Text Box 2. Weekly Topics for the Recovering Safety Group.

Session 1: Intimate Partner Violence (IPV)

Session 2: Substance Use Disorders (SUDs) and IPV

Session 3: Co-Occurring Disorders, SUDs, and IPV: Focus on Skills: Mindfulness, Wise-Mind (DBT)

Session 4: Trauma, PTSD, and IPV: Focus on Skills: Grounding

Session 5: Being Good to Yourself (Self-Care): Focus on Skills: PLEASE (DBT)

Session 6: Identifying and Managing Triggers: Focus on Skills: TIPP, COPE Ahead (DBT)

Session 7: Healthy Relationships: Focus on Skills: DEAR MAN, GIVE (DBT)

Session 8: Defining Values and Goals: Focus on Skills: FAST, Self-Validation (DBT)

Due to the Covid-19 pandemic, all outpatient treatment was converted in March 2020 to virtual format (Busch et al., 2021); therefore, the group was conducted virtually via Zoom and had no more than 10 patients participating at a time. During the patient intake process into this clinic group, extensive attention was paid to evaluate safety in participating in the group. For example, if a patient lived at home with an abusive partner, a safety plan was created around privacy for treatment. All patients received resources for local domestic violence advocacy agencies, were asked to identify safe emergency contacts, and to have engagement in outpatient therapy and medication management when clinically indicated. The Danger Assessment was administered to all patients (Campbell et al., 2009). Prior to each weekly meeting, patients received reminder emails containing the weekly handout, forms for development of a “safe coping plan” and templates for generating self-care routines. At the beginning of each group patients checked in with the following questions: 1) How safe do you feel today? (Rate 0-10: 0-unsafe, 10-very safe), and 2) Have you used substances this week? If so, how has this affected your safety? The group lasted 60 minutes, beginning with content review by the group leader, followed by group discussion, and a skills review and practice for sessions 3-8.

Participants

Women were eligible for the study if they were (a) 18 years or older and (b) participating in the outpatient Recovering Safety group therapy as part of their clinical care in the ADATP. Women were excluded if they were (a) unable to provide consent, and/or (b) had another clinical condition that prevented their engagement in study procedures, as determined by clinical staff. Eight women were deemed eligible and approached for the study, all of whom were enrolled. Six participants were enrolled in the study prior to attending any group sessions, one participant was enrolled after attending one group, and one person was enrolled after attending two groups.

Procedures

Participants received links via email to complete study surveys through the Research Electronic Data Capture (REDCap) online application. Participants completed surveys at three timepoints: (1) baseline (ideally prior to 1st group session, but no later than completion of 3rd group), (2) mid-group (after completion of 4th group, but no later than completion of 7th group), and (3) post-treatment (after completion of 8th group). Participants completed the post-treatment survey on average 1.8 weeks after completion of the 8th group; Participants were compensated with a $25 e-gift card for completion of surveys at each of the three study timepoints.

Measures

Demographic characteristics including race, ethnicity, marital status, educational attainment, and number of children were collected at baseline.

Mental health and substance use coercion were measured at baseline using the Mental Health and Substance Use Coercion Questionnaire (Warshaw et al., 2014), an 11-item questionnaire ascertaining the patient’s experiences with mental health and substance use coercion by an abusive partner. Scores of mental health coercion and substance use coercion are calculated by summing the number of “yes” responses to three questions about whether participants had experienced certain mental health coercion tactics and three questions about whether participants had experienced certain substance use coercion tactics. Additional unscored questions are included in this measure to assess help-seeking behavior and whether women have used substances to cope with experiences of IPV.

IPV severity and homicide risk were assessed for each patient prior to attending the Recovering Safety group using the Danger Assessment (Campbell et al., 2009). These twenty clinician-administered questions were administered as part of clinical practice and are used to determine the level of homicide risk by an intimate partner on a scale from 3 to 39. A score less than 8 indicates a variable level of danger, a score of 8-13 indicates increased danger, a score of 14-17 indicates severe danger, and a score of 18 or more indicates an extreme level of danger. For descriptive purposes, the Danger Assessment scores were extracted from the patient’s clinical chart at the end of the enrollment period.

PTSD symptoms were assessed at baseline, mid-group, and post-group follow-ups using the PTSD Checklist for DSM-5 (PCL-5) (Weathers et al., 2018), a 20-item self-report measure that assesses the 20 DSM-5 PTSD symptoms. Each of the 20 items are scored on a 0-4 scale, where higher scores indicate higher severity. A total score of 31 or higher indicates the patient may benefit from PTSD treatment (Weathers et al., 2018).

Substance use was assessed using the Brief Addiction Monitor (BAM; Cacciola et al., 2013), a 17-item questionnaire used to assess past 30-day health, alcohol, and drug use. The BAM consists of three subscales: the Use subscale (3 items; score range 0-12), the Risk Factor subscale (6 items; score range 0-24), and the Protective Factor subscale (6 items; score range 0-24). A score of 1 or higher on the Use subscale calls for further clinical examination and attention. A score of 12 or higher on the Risk subscale or a score of 12 or below on the Protective factor subscales indicate a need for further examination and clinical attention. A higher score on each of the individual subscales indicates higher use, risk, and protection, respectively (Cacciola et al., 2013). The BAM was administered at baseline, mid-group, and post-treatment.

Safety and empowerment were evaluated at baseline, mid-group, and post-treatment using the Measure of Victim Empowerment Related to Safety (MOVERS; Goodman et al., 2015), a 13-item questionnaire that measures safety and empowerment in utilizing resources related to a patient’s safety. A higher MOVERS score indicates increased safety related empowerment (Goodman et al., 2015).

Client satisfaction was measured at post-treatment using the Client Satisfaction Questionnaire (CSQ; Attkisson & Zwick, 1982). The CSQ measures patients’ satisfaction with the services they received. Satisfaction is measured summing ratings on 8 items, each scored on a 1-4 scale for a scale range of 8-32, where a higher score indicates a higher level of satisfaction (Attkisson & Zwick, 1982). Additional questions were added to the end of this measure to assess satisfaction with aspects specific to the Recovering Safety group, such as the group therapist, specific content covered, and women-only nature of the group.

Statistical Analysis

Descriptive statistics were used to characterize the sample and examine substance use and IPV-related variables at each time point. Tests of significance were not performed given the small number of participants in the sample.

Results

All eight women completed all baseline and post-group measures; seven of the eight women completed the mid-group follow up assessments. Table 1 provides a summary of demographic characteristics and IPV severity of the sample. All women participating in the study identified as White and non-Hispanic, with a mean age of 44 years (SD=16). Seven of the eight participants met DSM-5 criteria for PTSD based on the PCL-5 PTSD checklist (Weathers et al., 2018). Participant’s average Danger Assessment score was 11.6 (SD=8.4) indicating a high level of safety risk due to IPV. On average, women scored 2.3 (SD=0.7) on mental health coercion tactics and 1.5 (SD=1.1) on substance use coercion tactics. All women responded ‘yes’ to the question, “Has your partner or ex-partner ever called you ‘crazy’ or accused you of being ‘crazy’?” and 7/8 responded ‘yes’ to the question, “Do you think your partner or ex-partner has ever deliberately done things to make you feel like you are going crazy or losing your mind?” Six out of 8 women responded ‘yes’ to the question, “Have you ever used alcohol or other drugs as a way to reduce the pain of your partner or ex-partner’s abuse?” and 5/8 women responded ‘yes’ to the question, “Has your partner or ex-partner ever pressured or forced you to use alcohol or other drugs, or made you use more than you wanted?”

Table 1.

Participant Demographic Characteristics.

Demographic Characteristics (N=8)
Age (years), M (SD) 43.9 (15.6)
Range 22-65
Race, n (%)
 White 8 (100%)
Ethnicity, n (%)
 Non-Hispanic or Latinx 8 (100%)
Marital Status, n (%) *
 Never married 2 (25%)
 Married 4 (50%)
 Divorced 1 (12.5%)
Children, n (%) 3 (37.5%)
 Number of children, M (SD) 1.3 (0.6)
Education, n (%)
 Graduated from high school 1 (12.5%)
 Some college 2 (25%)
 Graduated from college 5 (62.5%)
Occupational Status, n (%) *
 Employed full-time 1 (12.5%)
 Unemployed/Retired/Disability 5 (62.5%)
 Student 1 (12.5%)
Danger Assessment Score, M, (SD) 11.6 (8.4)
 Range 1-25
Variable Danger (<8): n=3
Increased Danger (8-13): n=1
Severe Danger (14-17): n=3
Extreme Danger (>=18): n=1
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*

Missing data from 1 participant

Satisfaction

Women attended on average 6.3 (SD=1.8) of the eight Recovering Safety group therapy sessions, with two women attending all 8 sessions. Overall satisfaction with the group was high (mean=29.8, SD=3.1; range 24-32). In addition, participants found the experience of having a female group therapist extremely helpful (n=6) or very helpful (n=2); the content of the group sessions extremely helpful (n=7) or very helpful (n=1); and that having all female group members was extremely helpful (n=7) or very helpful (n=1). All participants reported the group helped them deal more effectively with their problem, they would come back to the group, and they would recommend the group to a friend.

Substance Use

Average Use subscale score on the BAM was 2.9 (SD=3.1) at baseline, 2.7 (SD=2.4) at the midpoint follow up, and 0.8 (SD=1.4) at the post-group follow up. However, it is important to note that all women were actively enrolled in SUD treatment at baseline and therefore substance use scores were on average very low, with four women reporting zero use. Average BAM Risk Factor subscale score was 15.5 (SD=2.9) at baseline, 14.7 (SD=5.4) at mid-group, and 12.1 (SD=4.7,) at post-group. On average, protective factor subscale scores increased from baseline (M=11.5, SD=2.9) to post-group (average=12.4, SD=3.6), but dipped at the mid-group timepoint (M=9.6, SD=5.2). Overall, the results showed a reduction in use, a reduction in risk factors, and an increase in protective factors over the course of the group.

Safety, Empowerment, and PTSD Symptoms

Women participating in the Recovering Safety group therapy reported increased empowerment in utilizing community resources to help increase their safety. Baseline average MOVERS total score was 44.1 (SD=9.9), increasing to 48.6 (SD=10.7) at mid-group and to 49.5 (SD=7.4) at the 8-week post-group follow up (Figure 1). Six of the eight participants also reported a reduction in PTSD symptoms from baseline to post-group.

Figure 1.

Figure 1.

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Mean MOVERS total score at baseline, mid-group, and post-group.

Discussion

Previous studies suggest women who have substance use disorders and exposure to past or current IPV differ from those without the experience of IPV in their patterns of use, rates of development of symptoms of SUDs and other co-occurring disorders, and treatment course and compliance (Mehr et al., 2023; S. N. Ogden et al., 2022). Additionally, these women often juggle ongoing risk/safety issues, complicated legal situations, and interruption in provider relationships or treatment programs due to interference by an abusive partner (Warshaw et al., 2013). The aim of the Recovering Safety group is to address the specific needs of women in SUD treatment with an IPV history or active IPV using this targeted approach. This Stage 1a study sought first to develop and expand the Recovering Safety manual and further modify it following expert review and guidance. Once this was accomplished, the revised Recovering Safety group was implemented into routine clinical practice in one outpatient clinic. This pilot study examined the feasibility of its implementation as well as patient satisfaction with this group intervention.

Results of this study support initial feasibility and satisfaction of the Recovering Safety group intervention. The revised manualized group intervention was implemented successfully in an outpatient program as part of usual care. Patients enrolled in the group as part of usual care were provided the opportunity to participate in the study. These participants reported high levels of satisfaction with the treatment intervention, and specifically noted that they found the IPV-specific content, IPV-informed approach, women-only participants, and female therapist as important factors. Participants also showed improvement in many areas of empowerment related to their safety despite noting high levels of ongoing safety risk and mental health and substance use coercion by their intimate partner. There is also some evidence of lower trauma scores from baseline assessment to end of treatment. This study expands the literature on treatment of women with co-occurring SUD and IPV. Building on gender responsive group therapy for women with SUDs with and without trauma (Greenfield et al., 2014; Greenfield et al., 2007) and group therapy for women with PTSD and SUD (Hien et al., 2009; Najavits et al., 1998), this is the first outpatient group therapy designed specifically for women with SUDs and a history of past or current IPV. This study’s indicators of feasibility of implementation as well as initial satisfaction scores and improvements in empowerment warrant additional investigation.

There are several limitations to this pilot study. First, the sample was not of adequate size for significance testing. There was no control group for this Stage 1a behavioral treatment development trial, and therefore we cannot be sure improvements in symptoms and empowerment scores from baseline to group completion were related to the group intervention compared with a control group. Further controlled studies with larger numbers of participants are necessary to demonstrate improvements that are statistically significant compared with a control group. Second, the study was limited by lack of diversity in the sample, as all participants identified as White and non-Hispanic. IPV may be present regardless of race, culture, socioeconomic class, sexual orientation, or gender identity. Other social factors that were not characterized in this study can lead to disproportionately high impact of IPV on women of color and other marginalized populations such as transgender individuals and immigrant women (Fridman & Prakash, 2022; Peitzmeier et al., 2020; Winstead & Stevenson, 2022). It is important to seek diverse perspectives on treatment experiences and outcomes in future studies, to inform content modifications, and ensure inclusion of these perspectives. Third, for this pilot study, the group therapist was also the developer of the treatment (AES). Future studies must also demonstrate successful training of other therapists to implement this group therapy as an indicator that the manual can be utilized by other therapists and may therefore have potential success for dissemination in other sites and clinics. Despite these limitations, the initial feasibility and satisfaction results from this small Stage 1a behavioral therapy development trial are promising.

Conclusions

There is a lack of evidence based, IPV-informed substance use and trauma treatment for women. Given the number of women in SUD treatment affected by IPV, further study of such treatments is needed to provide treatment options to women who have SUDs and have experienced or are currently experiencing IPV. Future research directions include the feasibility of training other therapists in this model, replicating the results in a larger sample, and examining additional post-treatment outcomes at time points distal to the end of treatment. Larger studies with more diverse samples are also warranted to further show feasibility and efficacy of the manualized Recovering Safety group intervention and to better understand the benefits of an IPV-informed approach to addressing mental health and substance use in the context of ongoing or past IPV.

Acknowledgement and Funding statement:

We thank Dr. Carole Warshaw and Dr. Denise Hien for their expert review on revisions of the Recovering Safety manual.

The authors have no conflicts of interest to report. This work was supported by the Sarles Young Investigator Award for Research on Women and Addiction (AES) and the National Institute on Drug Abuse K23DA050780 (DES) and the NIDA Clinical Trials Network New England Consortium Node NIDA U10 DA015831 (SFG)

Footnotes

Portions of this manuscript were presented in poster format at the 2022 American Academy of Addictions Conference and subsequently mentioned in the 2022 American Journal on Addictions as “A Stage Ia Behavioral Treatment Development Trial of "Recovering Safety: A Women's Empowerment Group for Survivors of Intimate Partner Violence with Substance Use Disorders.".

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