Intimate partner violence (IPV), substance use, and HIV are syndemic and have compounding risks that contribute to the collective physical and mental health burden among women in the United States. These syndemic factors may contribute to the significant gender-related disparities in substance use disorder (SUD) treatment. IPV is a source of stress and trauma for women, with known interactions with SUD; however, SUD services generally lack trauma-informed treatment modalities to address IPV-related health impacts. The goal of this dissertation was to improve the understanding of the associations between IPV, substance use behaviors, and SUD treatment utilization, and to inform the response to women’s needs related to IPV experiences and substance use within healthcare settings. We employed a mixed-methods approach to understand the interplay of IPV with subsequent substance use behaviors and utilization of SUD services, along with identifying differences by HIV status. We used quantitative methods to evaluate the association of specific forms of IPV (psychological, physical, and sexual) with subsequent substance use (Chapter 2) and SUD service utilization (Chapter 3), and qualitative methods to explore women’s perspectives on how IPV experiences influenced their substance use behaviors and SUD treatment and recovery (Chapter 4). The study in Chapter 2 found that incident IPV experiences were associated with increased risk of subsequent substance use, with physical IPV being more consistently associated than other IPV forms. The study in Chapter 3 found recent IPV experiences to be associated with increased SUD service utilization, whereas lifetime IPV experiences were associated with decreased utilization. Both quantitative studies highlight the complex relationship between IPV and substance use and SUD service utilization. This relationship varies by IPV form, with the syndemic interaction of IPV and HIV exacerbating adverse outcomes. In Chapter 4, qualitative findings explained mechanisms of IPV’s contribution to substance use behaviors and impediment of SUD service engagement and recovery. The interviews also highlighted the value of mental health and IPV supportive services, along with SUD treatment, for a successful SUD recovery. Overall, the findings of this dissertation emphasize the importance of using a trauma-informed approach to address IPV to facilitate women’s SUD recovery. / 2026-05-16T00:00:00Z

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<p dir="ltr">For many, spiritual beliefs and religious affiliation exist as a protective factor, providing significant emotional, psychological, and social support (Ibrahim & Dykeman, 2011). However, for others, abuse within the power structures of religion can also inflict great harm—particularly within marginalized communities—resulting in religious trauma. The LGBTQIA+ community has historically experienced marginalization and discrimination within various religious contexts and doctrines, becoming a group particularly vulnerable to religious trauma (Simmons et al., 2017; Swindle, 2017). This type of trauma has often been overlooked in the therapy room and within the broader Marriage and Family Therapy field. This thesis addresses this gap through the creation of an introductory training for therapists on religious trauma that many in LGBTQIA+ community experience. Grounded in religious trauma research and trauma-informed client care, the training seeks to enhance therapists' capacity to navigate these complex terrains with empathetic and informed care (Ellis et al., 2022). The aim is to create a therapeutic landscape where healing and self-compassion become more accessible to LGBTQIA+ individuals impacted by religious trauma.</p>

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