ORN Fall 2026 - Beyond Screening: Implementing a Response to Substance Use Coercion in Clinical Practice-Handout - ORN Fall 2026

Handout - ORN Fall 2026 - Samberg

Pdf Summary

The presentation explains substance use coercion (SU coercion) as a form of intimate partner violence (IPV) in which an abusive partner uses substance use or treatment to control, intimidate, or discredit someone. Tactics may include pressuring or forcing substance use, withholding or controlling medication, disrupting treatment, sabotaging recovery, coercing sex, and threatening to report substance use to authorities or use it against the person in custody or legal matters.<br /><br />IPV and SU coercion are common among people seeking substance use treatment and can increase risks of relapse, overdose, and barriers to care. Warning signs may include a partner dominating appointments, missed visits, lost or early-refill prescriptions, unexpected drug-screen results, or resumed substance use.<br /><br />Clinicians are encouraged to ask about coercion privately, routinely, and without judgment. They can normalize the conversation, validate the patient’s experience, and emphasize that abuse is not the patient’s fault. Responses should be individualized and may include assessing immediate safety, agreeing on safe communication methods or telehealth signals, adapting treatment and prescribing, incorporating harm reduction, and connecting patients with domestic violence advocacy and other supports.<br /><br />Documentation requires careful attention to confidentiality and safety, including patient-portal access and the possibility that records may be subpoenaed. Records should accurately describe coercion and its effects while recognizing the patient’s strengths.<br /><br />The “Beyond Screening” toolkit helps clinics prepare and sustain a coordinated response. It includes practice self-assessments, clinical workflows, staff training, documentation guidance, patient materials, safety protocols, and resources for partnerships with domestic violence programs. The presentation emphasizes that effective care goes beyond screening: it requires coordinated, trauma-informed clinical practices that protect privacy, reduce barriers, and support recovery.

Keywords

substance use coercion

intimate partner violence

abusive partner control

treatment sabotage

medication withholding

recovery disruption

domestic violence advocacy

trauma-informed care

confidentiality and safety

harm reduction