Evaluating an Individual’s Treatment Needs
Substance Abuse Among Mentally Disabled Individuals
In the 2012 United States census, it was found that 1.2 million adults in the country are living with an intellectual disability. This number is on the rise, in part because of more research and understanding into the nature of these disabilities, which makes accurate diagnosis easier.
Among the total population of those living with intellectual disabilities, 85 percent of them are considered to be only mildly disabled. These individuals can, for the most part, function in day-to-day life, integrate into the greater population, and blend in. They experience the same kind of successes and failures, strengths and weaknesses, and triumphs and pitfalls as anyone else. That includes the possibility of abusing substances and becoming dependent or addicted.
What Is an Intellectual Disability?
An intellectual disability is defined by the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) as a condition that impairs the individual’s general mental abilities and impacts adaptive functioning. These people have significant trouble in intellectual domains like reading, math, and memory, have impaired social skills, and struggle with everyday self-care that is necessary to maintain an independent lifestyle.
How Substance Abuse Factors In
None of these factors make it impossible to abuse substances. People with intellectual disabilities have a lower rate of substance use in general, but there are special circumstances related to their impairments that can make them vulnerable to abuse and addiction that would not present in neurotypical (non-intellectually disabled) individuals.
Part of the reason that the rates of substance use among this population are lower than average is that many of them live with family or are regularly seen by caretakers who can keep an eye out for destructive behaviors. Reviews of Medicaid healthcare billings suggest that the number of intellectually disabled people with substance use disorder is about 2.6 percent. However, among those who have access to and regularly use intoxicating substances, there’s a higher risk of abuse and addiction. When there are multiple diagnoses of intellectual disabilities or of comorbid mental illnesses, that risk increases substantially.
Tragically, people with intellectual disabilities are disproportionately vulnerable to physical, emotional, and sexual abuse. Abusive people often target these individuals because they see them as vulnerable and easy to manipulate, and the disabled person may have trouble communicating what happened to them. Neurotypical people may also be less likely to take reports of abuse from intellectually disabled individuals seriously. Plus, young people with intellectual disabilities often don’t receive any education about abuse or what to do if someone is hurting them. There is a strong connection between a history of being abused, mental illness, and substance abuse.
One of the biggest differences between substance abuse among people with intellectual disabilities and among those who are neurotypical is access to treatment. Research on the subject is lacking, and many medical professionals and treatment centers are not equipped with the education and mentality to handle intellectually disabled patients. They may even refuse to take such patients on in the mistaken belief that it would be unreasonably difficult to accommodate them. At the same time, standard 12-Step programs often include environments that could make people with intellectual disabilities uncomfortable and concepts that they often have trouble with.
Substances Use among Specific Disability Populations
Each intellectual disability is quite different, but people with these disabilities tend to share the same life problems. They disproportionately suffer from poverty in the US due to the high cost of medical care mixed with low employment rates due to discrimination and lack of accommodations in many workplaces. Widespread lack of education about these disabilities among the general population means that many neurotypical people don’t know how to properly socialize with those with intellectual disabilities in a way that won’t make them feel uncomfortable or left out, leading to a greater rate of social isolation.
Poverty, lack of employment, and isolation all increase the chance that any individual will come to abuse drugs and become dependent or addicted. This is made worse by the fact that those with intellectual disabilities have a greater risk of mental illness.
Research on substance abuse among those with autism is tricky due to the fact that each case of autism can look very different from another, depending on severity and environment. This has led researchers to begin discussing autism in terms of a spectrum, often referring to autism spectrum disorder, with those on the milder side of the spectrum typically being diagnosed with Asperger’s syndrome. Interestingly, one study conducted on Australian twins published in the Journal of Studies on Alcohol and Drugs found that among those who had symptoms of being on the autism spectrum but had not been diagnosed with the disorder, those surveyed were more likely to abuse nicotine, alcohol, and marijuana than the general population. At the same time, those who were diagnosed with autism – the ones on the more severe side of the spectrum – were less likely to abuse these substances.
This may be, again, because those with milder symptoms are more likely to be able to live independently instead of needing caretakers, and they are able to go out, make friends, go to parties, and take part in what is often considered a normal part of life. However, once they begin to abuse a substance, it’s harder for them to stop. This is not only because of their issues with employment and socializing, but because one of the symptoms of autism is the tendency to repeat enjoyed behaviors over and over. They may also be more prone to impulsive behaviors.
For those with learning disabilities, prescription medication abuse and addiction are special concerns. People with attention deficit hyperactivity disorder (ADHD) are often prescribed stimulants that help them focus, organize their thoughts, and accomplish tasks. When taken as prescribed, these medications can be very effective. However, drugs like Ritalin and Adderall have addictive properties and can lead to dependence if taken in a manner that is not recommended by a medical professional. Because of this, there has been a rise in an illegal market for these drugs, and rates of abuse have skyrocketed, especially among young people in school. This is made easier by the fact that the number of Adderall prescriptions given out by doctors more than doubled from 2007 to 2011.
People with low-level fetal alcohol syndrome, also sometimes referred to as fetal alcohol spectrum disorders (FASD), are often misdiagnosed as merely having a mental illness. Fetal alcohol syndrome often co-occurs with a number of other disorders, including mental illnesses and other disabilities, increasing the risk of substance abuse. If misdiagnosed, the individual is very likely to be improperly treated by medical professionals, resulting in worsening issues, frustration, and despair. People who experience this may then turn to substance use to self-medicate or simply to deal with the pain of hopelessness.
People with intellectual disabilities have a lot to worry about when it comes to substance abuse. Some of these disabilities are the result of or come along with developmental of physical issues that can make them more prone to certain illnesses, and many substances make the risk of health problems worse. For example, heavy alcohol consumption increases the chance of infection. They’re also more likely to be on medication to help them function, and many medications interact with intoxicating substances in ways that can damage the body and/or brain and even cause medical emergencies and death.
People with ADHD and other disabilities who are medicated with stimulants and amphetamines should avoid any substance use due to the many dangers associated with mixing drugs. Using additional stimulants like cocaine increases the risk of severe side effects and overdose.
There have been a few isolated cases of young people on medications like Adderall suffering sudden heart failure resulting in death. Though the likelihood of this happening is extremely low, adverse affects on the heart would be twice as likely with twice the stimulants in the body. When it comes to the use of alcohol, barbiturates, and other substances that depress the nervous system, stimulants can mask symptoms of overdose, cause other complications, and increase the risk of seizures.
Many intoxicating substances also cause reduced inhibitions, impulsive or destructive behavior, and sudden mood changes, especially if the individual is dependent on the drug. These side effects can exacerbate existing issues that many people with intellectual disabilities have. People on the autism spectrum, for example, are often easily disturbed by certain kinds of noises and bodily sensations. The unpleasant sensations associated with “coming down” from a high or from withdrawal can be especially distressing for these individuals, making it much harder to stop using the drug.
Difficulty communicating can cause frustration and the temptation to lash out. Confusion and poor coordination are also typically worsened by substances like alcohol, increasing the chance of injury.
Increased social issues are also a concern when an intellectually disabled person is engaging in substance abuse. The results of this behavior can make it even more difficult to get to medical appointments, therapy and group counseling sessions, and social or family events. Drug abuse may strain relationships between individuals and caretakers, leading to a greater risk of isolation, depression, and anxiety.
Treatment Options and Barriers
Programs dedicated to treating substance abuse in people with intellectual disabilities are very hard to find, which is a massive problem due to the fact that many of the standard programs don’t work well for these individuals. According to a report published in the U.S. National Library of Medicine, there are only two known publications that provide medical professionals with information on how to assess and treat substance use disorders in intellectually disabled patients. Without this information, they are very likely to come up against a number of problems when trying to help these patients and will not know how to deal with them properly. They may even mistake a patient’s inability to do a certain kind of therapy or forgetting to take medications as noncompliance.
Problems are also more likely to appear in group treatment settings. Twelve-Step programs have been found to have little success with intellectually disabled persons due to multiple factors. Having to sit quietly in one space and pay attention to others for long periods of time can be excessively difficult, and their inability to do so can create resentment among the neurotypical members of the group who are unlikely to be educated on the different needs that these disabilities create. Being required to speak on their own experiences can be difficult and create unnecessary stress, and being paired with a neurotypical sponsor is a problem since that sponsor will not be able to fully empathize with the disabled individual.
Certain spiritual concepts also may not work for them, and the concept of accepting powerlessness is often ineffective. Addiction treatment professionals have found it more effective to stress with people with intellectual disabilities that they have the power to stop using a substance and recover.
Inability to work and general poverty among people with intellectual disabilities go beyond the basic fact that they may not be able to afford treatment, medication, or transportation. Due to widespread unemployment among this group, most have Medicaid as their primary insurance provider, which often does not cover private substance abuse treatment. This is unfortunate, seeing as private treatment is much more likely to be successful with these individuals. Plus, public programs tend to have long waiting lists and are less likely to be successful even with neurotypical clients.
This can leave these individuals in an impossible situation – they need money to pay for doctors and private programs that are trained to deal with intellectual disabilities so the treatment can be effective, but they’re much more likely to live in poverty because of their disabilities. This explains why so few of them receive or even seek out treatment.
The need for free or low-cost government programs is clear, as is the need for more research and training among medical professionals. However, despite the fact that this was called for over three decades agoand the fact that studies continue to be published showing that the need still exists, little has been done.
According to a survey, 52 percent of medical school deans and 56 percent of students described graduates of their programs as “not competent” in terms of treating patients with intellectual disabilities. Due to the fact that so many medical professionals and addiction programs are woefully uneducated and unequipped to properly treat these individuals, it’s extremely helpful and necessary for those looking for substance abuse treatment to search for resources that will help them get the kind of care they need. There are a few organizations that are dedicated to the intersection of intellectual disability and substance use disorders. These include:
Though finding the right kind of treatment may be a challenge, it’s not out of reach. Contacting organizations dedicated to helping people with disabilities is one of the most effective ways to find properly equipped medical professionals and programs, and it can be the first step toward recovery.
- Addiction Resource Guide: Special Populations: This simple website provides inpatient treatment listings according to both the type of addiction and the type of disability.
- Prevention through Alternative Learning Styles (PALS): This program is designed to give preventative resources and education to middle school youth, including those with disabilities, in terms of risky behavior like alcohol and drug abuse.
- Substance Abuse Resources & Disability Issues (SARDI): This program focuses on both disability and how it interacts with behavioral health issues, including substance abuse. They conduct research and provide free information to anyone looking for help.
- Resources for Human Development: A nonprofit organization serving 14 states that is devoted to helping people with disabilities lead more fulfilling lives. Their services include addiction recovery.
- The Alliance of Community Service Providers: A professional society consisting of 90 specialized agencies, many of them nonprofit. They focus on providing support for people with intellectual disabilities, mental illnesses, and substance use disorders.
- Addiction & Disabilities Education & Resource Guide: This is an in-depth introductory guide into substance abuse and how it impacts people with disabilities. It includes a self-assessment questionnaire, tips on how to interact with disabled persons for able-bodied and neurotypical individuals, and additional resources.