In the United States, the Centers for Disease Control and Prevention (CDC)1 reports that 1 out of every 5 adults has a disability. The most common disability is a mobility limitation, which can cause a person to have difficulty climbing stairs or walking. Even more alarming is the fact that the CDC reports nearly 40 million Americans struggle with a physical functioning difficulty.2 In addition to mobility challenges, many Americans suffer from visual and auditory impairments. Spinal cord injuries and traumatic brain injury (TBI) are common as well.
Individuals who suffer from physical disabilities may be at a higher risk of alcohol and drug abuse. The National Rehabilitation Information Center (NARIC) reports that around half of those who suffer from disabilities may also abuse substances. This is in comparison to about 10% of the general population. Disabled World reports that people who struggle with mobility disabilities like spinal cord injuries, amputations, vision impairment, orthopedic disability, deafness, arthritis, or multiple sclerosis (MS), may be between 2 and 4 times more likely to abuse drugs or be heavy alcohol drinkers.3
A genetic history of addiction can also trigger problematic drug and alcohol abuse. Emotional trauma, high-stress levels, and environmental factors all play a role in the onset of addiction.4 Physical disabilities may present additional risk factors for drug and alcohol abuse.5 These include the following:
- Enabling by family or society: Loved ones may allow the person to “have their vices” as a result of their disability and to remain dependent on substances.
- Inadequate treatment: Individuals who suffer from physical disabilities may not receive the proper emotional and physical support necessary to learn healthy coping skills.
- Improper preventative services: Individuals may not be fully educated regarding the dangers of misusing medications, drug, and/or alcohol use and abuse.
- Self-medication: Individuals may self-medicate untreated pain, mental or physical discomfort, emotional distress, or health issues. They may use substances to escape reality or as stress relief.
Drug and alcohol abuse can complicate treatment for a physical disability by interfering with medications and also with rehabilitation, therapy, and counseling sessions.6 The reverse is also true. A physical disability may disrupt and complicate addiction treatment and recovery. Therefore, addiction treatment for individuals who also have a physical disability should be comprehensive and needs to include specialized services that attend to both the physical and emotional needs of the co-occurring disorders.
Overcoming Potential Treatment Barriers
There are numerous possible barriers for everyone to overcome when it comes to addiction treatment. These can range from a person not “feeling like they need help” or a person being in denial about the extent of their addiction.
For people who also have physical disabilities, there are several additional treatment barriers. These can include accessibility issues and social stigma surrounding the addition. The current rehab culture is often insensitive to those who have both physical limitations and addiction issues, which then results in a lack of necessary programs, educational information, and properly trained staff members.
For example, individuals who use wheelchairs require mobility-specific accommodations like ramps and elevators to physically move around a treatment center. However, some treatment centers are not equipped to allow this movement to occur. Even more challenging is the need for hallways and doors to be wide enough to accommodate a wheelchair.
Floors inside treatment centers have to be even and not slick. For those who are sight-impaired, Braille signs and other sensory navigational features will need to be prominently displayed all over the treatment center. For those who have hearing-related disabilities, an interpreter and TTY options on the phone are mandatory to ensure they receive the kind of care and attention they deserve.
According to the American Association on Health and Disability (AAHD), physical accessibility negatively impacts treatment for individuals with disabilities on a routine basis.7 A random survey showed that around half of those with traumatic brain injury (TBI) or spinal cord injury who were seeking addiction treatment were turned away from treatment facilities and declined services due to a lack of physical accessibility. This means that for those who have both physical limitations and addiction challenges, finding a physically accessible treatment center is crucial.
Lack of cultural sensitivity and social stigma can make it difficult for individuals with disabilities to receive proper addiction treatment.8 That means that now more than ever, the presence of staff members and medical providers who are specially trained to care for individuals with co-occurring issues is important.
Support groups and group therapy sessions can be highly beneficial in dispelling social isolation and helping to provide a healing environment for both those who suffer from addiction and their loved ones. However, even in the support group setting, attention needs to be paid to the specific set of disabilities a person might have. For example, sight-based programs like videos and training booklets will need to be altered for groups who are vision-impaired, for example, and sign language interpreters are required for hearing-impaired sessions.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2009, there were only 5 inpatient and 4 outpatient programs that provided specific treatment services for individuals who were deaf and battling addiction.9
Options for the deaf community in recovery are limited. They mainly center on telehealth treatment services that aim to connect individuals to specially trained treatment providers, support groups, recovery services, and more. The SAMHSA behavioral health treatment services locator tool can help people to find treatment facilities near them, and it provides information on what types of services are offered.
Integrated Treatment for Disabilities and Addiction
Addiction treatment generally includes detox services, prevention, and educational programs, therapy, counseling, and support groups; it can also include relapse prevention and aftercare services. For someone who is also physically challenged, the map of addiction recovery is structured a little differently.
Other considerations need to be factored in when creating the appropriate treatment plan. These include vocational rehabilitation (VR), medication management, medical attention, and disability-specific accommodations.
SAMHSA Treatment Protocol points out that while a facility needs to accommodate a physical disability, it should not enable the individual either.10 Making proper accommodations simply means treatment is provided equally for anyone, including those who have physical limitations. Maneuvering throughout a facility is important, but so too is learning how to cope with and manage situations that might be mentally difficult. VR and therapies can teach effective methods for managing daily life concurrent with living with a disability.
Family education is an important part of the program. Family members need to undergo counseling and be educated on their loved one’s issues so they can learn the potential warning signs of relapse. Family counseling also provides skills to encourage a disabled person to become more independent.
Therapy and counseling provided during treatment can help disabled people learn new strategies for becoming more self-reliant, which can breed self-confidence and help minimize drug and alcohol use. During VR, individuals are taught how to draw on their strengths instead of dwelling on any physical inadequacies. Treatment providers seek to understand better what motivates the individual to develop an enhanced treatment and recovery plan moving forward.
Depression, anxiety, and other mental health concerns often accompany addiction and physical disability. Treatment services should work to manage all aspects of both addiction and disability together. Stress management techniques and relapse prevention tools are important aspects of Cognitive Behavioral Therapy (CBT), a standard in most addiction treatment programs.
Individuals who suffer from physical pain related to a disability may benefit from learning non-medication-based methods for managing pain. Mindfulness meditation, acupuncture, chiropractic care, and yoga may all be helpful complementary therapeutic techniques. This treatment approach encourages a person to explore natural and alternative ways to alleviate physical pain and discomfort. People with disabilities are often required to take medications regularly, however, and a treatment program will teach them how to use and manage these medications safely.
To create the most robust and dynamic treatment plan, the best approach is for medical providers, therapists, counselors, and addiction treatment specialists to work together. This allows for a plan to be created that both support addiction recovery and addresses the management of the physical disability. When both addiction and disability are treated simultaneously by trained professionals who are all working together, recovery is enhanced.
- Centers for Disease Control and Prevention. (July 30, 2015). CDC: 53 million adults in the US live with a disability.
- Centers for Disease Control and Prevention. (May 3, 2017). Disability and Functioning (Noninstitutionalized Adults Aged 18 and Over).
- Weiss, T. (July 22, 2013). Addiction and Substance Abuse Among Persons with Disabilities. Disabled World.
- Sinha, R. (Oct. 2008). Chronic Stress, Drug Use, and Vulnerability to Addiction. Ann N Y Acad Sci.
- Substance Abuse and Mental Health Services Administration (SAMHSA). (July 2012). TIP 29: Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities.
- SAMHSA. (2005). 5 Strategies for Working With Clients With Co-Occurring Disorders.
- West S, Luck R, Capps C. (2007). Physical inaccessibility negatively impacts the treatment participation of persons with disabilities. Addict Behav. 2007 Jul;32(7):1494-7.
- Office of the Surgeon General; Center for Mental Health Services; National Institute of Mental Health. (2001 ). Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville (MD): Substance Abuse and Mental Health Services Administration; Aug. Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health.
- Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality.
- Center for Substance Abuse Treatment. (1998). Substance Use Disorder Treatment For People With Physical and Cognitive Disabilities. Substance Abuse and Mental Health Services Administration. (Treatment Improvement Protocol (TIP) Series, No. 29.) Chapter 3—Treatment Planning and Service Delivery.