Many people who look for addiction or mental health treatment are also living with, or recovering from, abuse. That connection is well documented, and it changes what good treatment looks like. This guide explains how the two are linked, what to look for in a program, and what to do when the systems meant to help you seem to be pulling in opposite directions.

Last reviewed: August 2026  ·  Reading time: about 15 minutes  ·  Sources: listed in full below  ·  Need help now? Hotlines and next steps

1. Why abuse and substance use are so often connected

The relationship runs in more than one direction, and pulling the threads apart matters because each one calls for a different response.

Substances used to cope. Alcohol or drugs can quiet the symptoms that follow abuse — sleeplessness, flashbacks, panic, a body that will not stand down. This works in the short term, which is exactly why it is hard to stop, and it tends to cost more over time than it gives back.

Abuse that begins or worsens during substance use. Substance use does not cause abuse. Plenty of people who use drugs and alcohol are never violent, and plenty of people who abuse their partners never touch either. But substance use can escalate the severity of violence already happening, and it complicates leaving.

Substance use that an abusive partner has deliberately created or exploited. This is the least discussed of the three, and it has a name. It is covered in section 2.

There is also the sequence that many survivors describe: a prescription after an injury, then dependence, then an abusive partner who controls the supply. The National Center on Domestic Violence, Trauma & Mental Health notes that experiencing abuse from an intimate partner raises a person’s risk of opioid use, which is part of why a substantial share of people in opioid treatment have a history of domestic or sexual violence.

2. Substance use coercion: the part that often goes unnamed

Survivors and advocates have described this for decades. It was given a name and a research base more recently, largely through the work of the National Center on Domestic Violence, Trauma & Mental Health, and it is the single most useful concept on this page.

Substance use coercion is the use of a partner’s substance use as a tool of control, as part of a wider pattern of abuse. It takes recognizable forms:

• Deliberately introducing a partner to substances, or pressuring and forcing them to use
• Controlling the supply, then threatening withdrawal if the person does not comply
• Interfering with treatment — withholding transportation, childcare or money, refusing to allow meetings or appointments, calling a program to get someone discharged, turning up where they receive care
• Actively sabotaging recovery, including leaving alcohol around the house or provoking a return to use
• Controlling medication, including medication for opioid use disorder
• Threatening to report the person’s substance use to police, a child welfare agency, an employer or a family court, and using the stigma around substance use to discredit them if they disclose the abuse

That last one is the hinge. It explains a pattern that otherwise looks baffling from the outside: someone who will not call the police, will not tell a doctor, will not leave. If your partner has made clear that any disclosure ends with you losing your children, your job, or your liberty, then silence is not passivity. It is a calculation, and often a correct one.

NCDVTMH publishes a full library on substance use coercion, including material written for advocates and clinicians. If you are a professional reading this page, that is where to go next.

3. What the current data shows

Statistics in this field are widely recycled, often from surveys a decade old, and often without the caveats the researchers attached. Here is what the most recent federal data says, with those caveats attached.

The CDC’s National Intimate Partner and Sexual Violence Survey released a new sexual violence data brief covering 2023 and 2024 — the first new figures since the 2016/2017 cycle. It found that 45.1% of women and 16.9% of men in the United States have experienced some form of contact sexual violence in their lifetimes.

Three things the CDC says about those numbers that most articles quoting them leave out:

• They should not be compared with earlier NISVS cycles. The methodology changed and new questions were added, so an apparent rise or fall between cycles would not mean what it appears to mean.
• Data collection did not include transgender and nonbinary people, anyone under 18, or adults in institutional settings or experiencing homelessness. Several of those groups face elevated risk, so the true picture is not fully captured.
• State-level figures should not be compared between states, because responses were tied to where a person currently lives rather than where the violence happened.

The same cycle measured technology-facilitated sexual violence for the first time: 10.3% of adult women and 6.9% of adult men reported experiencing it in the previous twelve months.

What none of this tells you is anything about your own situation. Prevalence figures are useful for arguing about funding. They are not useful for deciding what to do on a Tuesday night, and a page that leads with them is usually written for search engines rather than for you.

4. The gap between two systems

This is the practical problem most survivors run into, and almost nothing written about this topic names it plainly.

Domestic violence services and substance use treatment grew up as separate fields, with separate funding, separate training and separate buildings. The result is that a person who needs both can fall between them.

From the shelter side. Some domestic violence shelters have limits on what they can accommodate when someone is actively using, whether because of licensing, insurance, staffing, or the safety of other residents and children. Policies vary a great deal between programs and many have worked hard to change this — NCDVTMH runs a dedicated project on substance use and DV shelters — but a survivor can still find that disclosing substance use narrows their housing options at the exact moment they need somewhere to go.

From the treatment side. Many addiction programs are not built around abuse, and some default practices are actively unsafe for someone in an abusive relationship. Couples or family sessions that include an abusive partner are the clearest example. Confrontational group approaches, mandatory disclosure, and rigid rules about contact can also land badly on someone whose life is already governed by someone else’s rules.

The good news is that this gap is recognized and being worked on. Federal agencies, NCDVTMH and the addiction treatment field have all moved toward integrated approaches over the past decade. But the change is uneven, and it means the burden of asking the right questions still falls on the person seeking help. Section 6 is designed to make that easier.

5. What trauma-informed treatment actually means

“Trauma-informed” appears on a great many treatment websites and means very little on its own. Here is what it refers to, and what the evidence currently supports.

As an approach to care

SAMHSA describes trauma-informed care as an organizational stance rather than a specific therapy: services delivered in ways that prioritize physical and emotional safety, trust, collaboration, and the person’s own choice and control over their treatment. Notably, working in a trauma-informed way does not require you to disclose what happened to you. A program that pressures you to tell your story before you are ready has misunderstood the idea.

As specific treatment

Where someone has both post-traumatic stress and a substance use disorder, the older model was sequential — get sober first, address the trauma later. Current guidance points the other way. The evidence supports treating both at the same time, either concurrently or in an integrated model.

Two named approaches come up repeatedly:

Seeking Safety is a coping-skills model that does not involve revisiting traumatic memories. It is the most widely implemented approach for co-occurring PTSD and substance use, and it is well accepted by patients and clinicians.

COPE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure) combines exposure therapy for PTSD with relapse prevention. The VA’s National Center for PTSD notes that a randomized trial comparing the two found COPE produced greater reduction in PTSD symptoms than Seeking Safety, and that evidence generally favors trauma-focused approaches for PTSD symptoms specifically.

We are not going to tell you which of these is right for you, because that depends on your history, your current stability and your own preference, and it is a decision to make with a clinician. What is worth knowing is that both exist, that being asked to wait months before anyone addresses the trauma is no longer standard practice, and that evidence-based therapies including CBT, DBT and EMDR are commonly used in this area.

6. Questions worth asking a treatment program

You can ask these on a first phone call. You do not have to explain why you are asking, and you do not have to disclose anything about your situation to ask them. How a program answers tells you as much as what it says.

1. Do your clinicians have training in domestic violence and sexual assault, and do you screen for it? “We’re trauma-informed” is not an answer to this. Ask what the training was and who has it.
2. Do you treat PTSD and substance use at the same time, or do you require a period of sobriety first? Both models exist. You want to know which one you are walking into.
3. Would you ever involve my partner or family in treatment, and can I decline that? The answer to the second half should be an immediate yes.
4. What are your confidentiality rules, and under what circumstances would you contact someone else about me? Ask specifically about family, employers, and anyone listed as an emergency contact.
5. Do you have a relationship with local domestic violence services? Programs that already work with an advocacy organization or a family justice center are usually further along on this.
6. Can you accommodate someone who cannot use their own phone freely, or who cannot keep to a fixed appointment time? A practical question that quickly reveals how flexible a program actually is.
7. Is my care affected if I am not ready to leave my relationship? Many survivors are not, for reasons that are often sound. Treatment should not be conditional on that decision.
8. Are you licensed in this state, and do you hold any accreditation? Licensing is the baseline. Accreditation is additional and optional.

If a program’s answers feel evasive, or if you are pushed toward admission before any of this is addressed, that is information. You are allowed to call somewhere else.

7. Confidentiality, custody and legal worries

For many survivors this is the real barrier, ahead of cost or availability. The fear of losing children by asking for help keeps people out of treatment, and abusive partners know it — threatening exactly that is one of the documented coercion tactics.

Two honest points, and we are not going to pretend either is simple.

Substance use treatment records carry federal protections that are stronger than ordinary medical privacy. The rules governing them are specific and there are exceptions, so the useful step is to ask any program directly, in advance, what its disclosure obligations are in your state.

Reporting duties vary by state and by profession, particularly where children are involved. What triggers a report in one state may not in another. This is a question to put to a professional who knows your state’s law, not one to resolve from a website.

8. Paying for treatment when money is controlled

Financial abuse — controlling access to money, sabotaging employment, running up debt in a partner’s name — is common enough to be a recognized part of the pattern. It also creates a specific problem: treatment is expensive, and the person who needs it may not control any money or may be on a health plan the abusive partner administers.

Some things worth knowing:

Medicaid covers substance use and mental health treatment, and eligibility is based on individual income in most circumstances. Coverage varies by state.

State-funded and sliding-scale programs exist in every state and do not depend on private insurance. The SAMHSA helpline can identify them in your area.

Crime victim compensation programs operate in every state and can cover counseling and some medical costs for victims of violent crime. These are administered separately from treatment funding and are frequently unclaimed.

Explanation of benefits statements can be a safety problem. If you are on a plan held by someone else, a claim may generate paperwork they see. Ask the program and your insurer about confidential communication requests before you use the coverage.

Our free tools and calculators cover treatment cost estimates and coverage checks without a sign-up.

9. If you are supporting someone else

People close to a survivor often want to fix the situation quickly, and quick tends not to work here.

Do not make your support conditional on them leaving. Leaving is the most dangerous period in an abusive relationship, and someone who stays may be reading the risk accurately. If your help is available only on the condition that they go, you have made yourself one more person applying pressure.

Do not treat their substance use as the thing to solve first. If substance use coercion is part of what is happening, then confronting them about drinking is repeating a move their partner already makes.

Be specific about what you can offer. A spare room, childcare on a Thursday, a phone they can use, money that does not go through their household, a lift to an appointment. Concrete offers are easier to accept than open ones.

Keep the door open. Most people leave and return more than once before it is final. Reacting to a return with frustration is understandable and it also teaches them not to tell you next time.

You can call the National Domestic Violence Hotline yourself, as a friend or family member, to talk through how to help. You do not need their permission and you do not need to name them.

10. Getting help today

All of these are free, confidential and independent of us. None of them require you to have decided anything.

Finding local advocacy

Every state and territory has a domestic violence coalition that maintains a list of local programs. The National Network to End Domestic Violence lists all of them. Local advocates can usually help faster than a national line with the things that are specific to where you live: shelter beds, protective orders, and which treatment programs in your area actually work well with survivors.

Finding treatment

RehabSeekers lists more than 17,600 treatment providers across all 51 states and the District of Columbia, down to city and neighborhood level. Every facility we list holds a current state license, which is our minimum bar for inclusion. Where a facility also holds accreditation from bodies such as The Joint Commission, CARF or LegitScript, we show that on the listing — many licensed facilities are not accredited, and we do not imply otherwise. You can read how our verification works in full.

We are not a treatment provider. We do not own or operate any facility we list, and we have no financial relationship with them. Listings link to the facility’s own contact details, so there is no call center between you and the program — which matters here more than in most places, because a call center has a reason to place you somewhere and no reason to ask whether it is safe for you.

You can browse by state, or look at programs for women and programs for men, which some survivors prefer. Use the questions in section 6 when you call.

Find treatment near you

11. Sources and how this page was made

Every factual claim on this page comes from the sources below, and where the researchers attached caveats we have carried them across rather than quoting the headline figure alone.

• National Center on Domestic Violence, Trauma & Mental Health — Substance Use Coercion, Opioids, and Domestic Violence
• NCDVTMH — Substance Use and DV Shelters
• CDC — National Intimate Partner and Sexual Violence Survey: 2023/2024 Sexual Violence Data Brief
• National Sexual Violence Resource Center — summary of the 2023/2024 NISVS findings and their limitations, January 2026
• CDC — Intimate Partner Violence, Sexual Violence and Stalking Among Men
• SAMHSA — Trauma-Informed Approaches and Programs
• SAMHSA — TIP 57: Trauma-Informed Care in Behavioral Health Services
• VA National Center for PTSD — Treatment of Co-Occurring PTSD and Substance Use Disorder
• Office for Victims of Crime, US Department of Justice — national hotline directory
• Administration for Children and Families — ACF hotlines and helplines
• National Network to End Domestic Violence — information and resources for survivors
• National Domestic Violence Hotline — internet and digital safety guidance

About RehabSeekers. RehabSeekers is an independent directory of addiction and mental health treatment providers in the United States, listing more than 17,600 facilities. Listings are built from SAMHSA’s federal treatment locator and state licensing records, alongside facilities that write in to request inclusion and pass the same licensing checks. Our reviewers confirm licensing details against source records by hand. We are not owned by a treatment provider and we have no financial relationship with the facilities we list.

Not medical or legal advice. This page is general information. It is not medical, clinical or legal advice, and it is not a substitute for talking to a qualified professional about your own circumstances. Laws on confidentiality, reporting and custody vary by state and change over time; confirm anything legal against your own state’s current law or with an attorney or legal advocate.

Language note. We describe people as people. You will not find “addict” or “abuser” used as nouns for a person on this site, because the language someone hears at the start shapes what they think is possible.