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COMMENTARY

Getting Clean from Old Attitudes

PART II

By Leslie Underwood

Editor’s note: Leslie Underwood is a blind woman who was addicted to drugs and alcohol. Part I of her story illustrated the difficulty she faced breaking down barriers to treatment. Part II deals with drug and alcohol abuse within the disability community and its relationship to the general population.

Researchers generally agree that the frequency of drug and alcohol use within the disability community is about twice that of the general population. A number of studies have addressed the following questions:

Why is drug and alcohol abuse so much higher among people with disabilities than within the general population?
Who, within the disability community, is more prone to chemical abuse and why?
Which disability groups are more vulnerable to addictive behavior and why?
What are the barriers to treatment programs and how can they be overcome?
How are rehabilitation outcomes affected by drug and alcohol abuse?
Does disability rights legislation such as the ADA and Section 504 of the Rehabilitation Act of 1973 address compliance issues related to the identification and treatment of drug and alcohol abuse within the disability community?
Who are the major players concerned with this issue and how are they acting as agents for change?
Can we expect positive changes systemically now and in the future? If not, why not, and if so, who can do it and what can they do?

As mentioned in Part I of this series, society leans toward condoning the use and abuse of illicit drugs and alcohol among people with disabilities. Ignorant empathy sets the tone. The prevailing thought appears to be: It’s OK. After all, what else does he or she have to look forward to?

If drug use and-or alcoholism exist within a family system, there is frequently familywide denial. How much more so if one of the family members happens to be a person with a disability?

Vocational rehabilitation state agencies are not monitoring the potential of drug and alcohol abuse as being a deterrent to successful outcomes. If identified, however, a rehab counselor is seldom equipped to help the client handle the problem.

Treatment programs traditionally have not been receptive to admitting and treating people with disabilities. The usual reasons offered for refusing entry into a given program are that the staff is not equipped to understand the needs of people with disabilities, the facility lacks physical access, insurance rates will skyrocket if a person with a disability has an accident, and physical and program access are too expensive.

Certain disability groups and minorities are more likely to experience susceptibility to drug and alcohol abuse. The Rehabilitation Services Administration conducted a study in 1998 to determine the incidences of drug and alcohol abuse within minority groups. According to the results: Among black Americans, the percentage using drugs and alcohol was 24%; among Native Americans, 23%; among Hispanic Americans, 11%; among Asians, 6%.

Surprisingly enough, rehabilitation agencies reported that even though consumers were actively involved in various addictions, all four minority groups were more likely to be competitively employed. They more frequently reported their primary income as being earned rather than from entitlements.

Access Unlimited Substance Abuse Services, a program sponsored through Wright State University, published a national perspective indicating that one out of every two people with traumatic brain and spinal-cord injuries experiences severe drug and alcohol abuse. Chances are that drunk driving or other types of accidents produced their head or spinal-cord injuries in the first place.

After an accident or injury, drug and alcohol use prevails at a rate as high as 60%. People with visual impairments experience addictions at a rate of 40-50%. And those with psychiatric disabilities are addicted at levels comparable to those two groups. One out of every five people who are deaf and those who have arthritis or other mobility impairments demonstrates addictive behavior. Self-medicating for stress reduction and pain control are common reasons for drinking and using pain-management medications.

In the 16 years since the passage of the Americans with Disabilities Act, awareness of drug and alcohol use among people with disabilities has greatly increased. There are several established academic and research-oriented projects that have, since the late ‘80s, studied this issue extensively.

The Rehabilitation Services Administration is the federal agency that oversees and establishes policy for the state rehabilitation entities throughout the U.S. The Substance Abuse Resources and Disability Issues program, funded by the National Institute on Disability and Rehabilitation Research, conducts extensive research activities widely disseminated on the Internet. The National Association on Alcohol, Drugs and Disability is a national network of people with disabilities and concomitant organizations whose purpose is to disseminate information about substance abuse and disability. It also develops policy and conducts extensive research.

The latest research data is available only through 2001. It appears that funding for the aforementioned programs is lacking. This, in my opinion, is why we need to be more proactive with respect to fund-raising and coming up with solutions to mitigate these often-overlooked issues.

It is obvious, through national survey results sponsored by the above-mentioned initiatives, that ADA and the Rehabilitation Act have a responsibility to monitor compliance to program access. Many of the programs cited are woefully lacking in all types of access and training. Therefore, vigilance and funding are needed to remedy the situation. Acknowledging that the rate of drug abuse and alcoholism is approximately 10% within the general population, it is obvious that the percentages within the disability community are alarming and in need of immediate attention.

A 1998 survey conducted in the San Francisco Bay area showed that among the facilities surveyed, only 47% had any means of physical access, 33% provided interpreters for the deaf, and 10% of the facilities provided materials in large print or Braille for people with visual impairments. Of the 21,000 people served in the last year (those participating in drug rehab programs), only 1.6% were people with disabilities. Of the facilities surveyed, however, 90% indicated they would be interested in learning more about how to assist people with disabilities in their recovery efforts.

With this type of disparity, it seems to me that programs that receive public funds should develop and implement uniform standards of practice. I believe that a significant portion of the application process should consist of set-asides (money earmarked for a subset of the larger group) when applying for grants and other means of financing.

Because of the gap in services, independent living centers have a golden opportunity here. Peer advocates can develop and implement programs of intervention and educate the consumer and the treatment facilities. They should make sure that management information systems are designed to include assessment tools and recording mechanisms for people with disabilities, and they should train the trainer within treatment program settings.

Although Arizona, Ohio, California and Massachusetts have been ahead of the curve in improving program access, other states have not been as progressive. ADA monitors should notify treatment facilities that barring non-ambulatory individuals is discriminatory. If noncompliance continues after a warning, federal funds should be withdrawn.

Barriers of previous generations continue to be eliminated. Alcoholics Anonymous and Narcotics Anonymous meetings are, for the most part, accessible. Alcoholics Anonymous, often referred to as the "Big Book,” has been published in Braille and recording for years. In addition, interpreters are available at designated meetings.

What this means is that people with disabilities need to become educated about the realities of drug and alcohol abuse in order to help bring about change for the better.

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