In the United States, the Centers for Disease Control and Prevention (CDC) reports that one out of every five adults suffers from a disability with the most common being a mobility limitation (difficulties climbing stairs or serious trouble walking). Nearly 40 million Americans struggle with a physical functioning difficulty, the CDC further publishes. Trouble hearing, seeing, and walking are all physical disabilities. Spinal cord injuries and traumatic brain injury (TBI) are as well.
Individuals who suffer from physical disabilities may be at a higher risk for also abusing substances like drugs or alcohol. The National Rehabilitation Information Center (NARIC) reports that around half of those who suffer from disabilities may also abuse substances while only around 10 percent of the general population does. Individuals struggling with a disability, such as a spinal cord injury, amputation, vision impairment, orthopedic disability, deafness, arthritis, or multiple sclerosis (MS), may be between two and four times more likely to also abuse drugs or be heavy alcohol drinkers, Disabled World reports.
Family history of addiction, emotional trauma, high levels of stress, and biological and environmental factors can all be involved in the onset of addiction and problematic drug and alcohol use. Physical disabilities may present additional risk factors for drug and alcohol abuse, such as:
- Familial and/or societal enabling: Loved ones may allow the person to “have their vices” as a result of their disability and to remain dependent on substances of 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.
- 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.
Drug and alcohol abuse can complicate treatment for a physical disability by interfering with medications and also with rehabilitation, therapy, and counseling sessions. The reverse is also true, as a physical disability may disrupt and complicate addiction treatment and recovery. Addiction treatment for individuals who also suffer from a physical disability should be comprehensive, including specialized services that attend to both the physical and emotional needs of the two co-occurring disorders.
Overcoming Potential Treatment Barriers
There are numerous possible barriers for everyone when it comes to addiction treatment, such as the individual not feeling like they need help for their substance abuse or financial and insurance coverage concerns. Someone who also suffers from physical disability may struggle with additional treatment barriers, including accessibility issues, social stigma, cultural sensitivities, and the lack of necessary programs, educational information, and properly trained staff members. For example, wheelchair-bound individuals require accommodations, such as ramps and elevators, to physically maneuver around a treatment center. Additionally, hallways and doors will need to be wide enough to accommodate a wheelchair, and the floors will need to be even. Those who are sight-impaired will need Braille signs and other navigational features while deaf and hearing-impaired individuals will require an interpreter and TTY options on the phone when they call in.
The American Association on Health and Disability (AAHD) reports that physical accessibility negatively impacts treatment for individuals with disabilities on a regular basis. For instance, a random survey showed that around half of those with TBI or spinal cord injuries who were seeking addiction treatment were turned away from treatment facilities and declined services due to a lack of physical accessibility. Finding a treatment center that is physically accessible is crucial.
Lack of cultural sensitivity and social stigma can make it difficult for individuals with disabilities to receive proper addiction treatment. 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 for like individuals can be highly beneficial to dispelling social isolation and helping to provide a healing environment. It can be very helpful for people who suffer from similar ailments, in addition to addiction, to attend sessions and meetings together as they can relate to each person’s unique set of circumstances and struggles. 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 five inpatient and four outpatient programs that provided specific treatment services for individuals who were deaf and battling addiction. Options for the deaf community in recovery including telehealth treatment services that can connect individuals to specially trained treatment providers, support groups, recovery services, and more, all over the country. 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, support groups, and relapse prevention and aftercare services. When someone also battles a physical disability, there are likely other things that will need to be included, such as vocational rehabilitation (VR), medication management, medical attention, and accommodations for the disability.
While a facility needs to accommodate a physical disability, they should not enable the individual either, the SAMHSA Treatment Improvement Protocols (TIP) publishes. Making proper accommodations simply means that treatment is provided equally for someone with a disability. For instance, they need to be able to get around the facility physically, but they also need to learn how to cope with and manage situations that might not be as easily accessible. VR and therapies can teach effective methods for managing daily life and living with a disability. People who are wheelchair-bound may isolate themselves socially because they are afraid to go places that may not be easily accessible to them. Isolation can be a risk factor for alcohol and drug abuse and relapse.
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 and also how to allow their loved one to become more independent. It can be easy to keep allowing a family member to be dependent on substances when they suffer from a physical disability; however, with therapy and counseling providing during treatment, they can learn new strategies for becoming more self-reliant, which can breed self-confidence and help to minimize drug and alcohol use. Individuals are taught how to draw from their strengths instead of dwelling on any physical inadequacies. Treatment providers seek to better understand what motivates the individual in order to develop an enhanced treatment and recovery plan moving forward.
Depression, anxiety, and other mental health concerns often accompany addiction and physical disability, and 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), which is 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 to alleviate physical pain and discomfort. People with disabilities are often required to take medications on a regular basis, however, and a treatment program will teach them how to use and manage these medications safely.
Medical providers, therapists, counselors, and addiction treatment specialists will all work together to devise and implement a treatment plan that supports addiction recovery and the management of the physical disability at the same time in an integrated fashion. When both addiction and disability are treated simultaneously by trained professionals who are all working together, recovery is enhanced.