Substance abuse can be found among all groups of people. When it comes to physically disabled individuals, there may be special circumstances around their abuse of a drug related to their disability, especially if chronic pain is involved. These circumstances require special consideration from anyone looking to treat one of these individuals for a substance use disorder.
There is some debate over the rate of substance abuse among the physically disabled. Some studies have found that they are more likely to abuse intoxicants than the able-bodied population, while others have found that they actually abuse drugs less. What we do know is that that the U.S. Department of Health and Human Services Office on Disability found that 74.6 million people in the US have some kind of disability, and that 4.7 million adults in the US have both a substances use disorder and a disability.
It can be difficult to determine rates of substance abuse since the population of physically disabled persons is so much smaller than the general population. Also, these individuals are prescribed medications that are often used at a much higher rate due to pain, mobility issues, and mental health issues. When you need these medications to function, and when your functioning looks different than that of the able-bodied majority, it can be hard to determine where the line between simple use and abuse is located.
Risk factors also depend on the type of disability involved. Some disabled individuals have low mobility resulting in social isolation, and others are able to get around but must rely on prescription opioids to deal with their chronic pain.
All of these factors can also serve as barriers to getting treatment and increase the chance of relapse. One of the biggest barriers is simply a lack of information – for both the physically disabled and for medical professionals who treat substance use disorders. However, since most people with physical disabilities already see health professionals on a regular basis, some simple education can help them recognize the signs of substance abuse in their patients and even implement preventative tactics.
Whether or not they have a higher rate of substance use disorders, people with physical disabilities have unique or increased risk factors for drug abuse and addiction. Some of these include:
For people with rheumatoid arthritis, it’s especially dangerous to mix their medications with alcohol, whether they take opioids for the pain or just take medications that directly address the condition. Both are hard on the liver and increase the risk of liver disease – something made much worse when alcohol is in the mix. There’s also evidence that heavy alcohol use reduces bone density, and there are studies linking nicotine and worsened arthritis.
People with disabilities that impair their coordination such as multiple sclerosis and cerebral palsy sometimes report that a single drink of alcohol significantly impairs coordination and balance. This, in addition to undeveloped muscle and bone or deteriorating nerve tissue, significantly increases the risk of severe injury.
Recently, researchers have begun to consider the link between neurotoxicity – the damaging of the nervous system by artificial or intoxicating substances – and Parkinson’s disease. Nothing conclusive has been found, but if a link exists, then potentially any substance use could make the condition worse for anyone with this disability. The specific substances being tested include cocaine, methamphetamine, and alcohol. It should comes as no surprise that these drugs have also been found to increase the risk of stroke, and stroke victims should avoid any kind of substance abuse.
One of the biggest concerns for those with substance use disorders who also have a physical disability is their ability to access treatment. When mobility is an issue, simply getting to a doctor or inside a treatment center can be difficult, and a large percentage of those who treat substance abuse and addiction are not equipped to deal with physical disability. According to a study published by the American Association on Health and Disability, around half of the medical professionals approached were unable to provide services to physically disabled persons due to physical barriers.
Perhaps the biggest barrier to treatment for those with any disabilities is a lack of education among healthcare professionals. The less doctors know and understand about a physical disability, the less able they will be to give a person who has that disability the necessary care. In fact, the less medical professionals know about physical disabilities, the less likely it is that they’ll be willing to treat patients with these issues simply because they think the disability requires more accommodation than is actually necessary.
Furthermore, not all physical disabilities are visible. People with arthritis, for example, may be able to walk into a doctor’s office just fine, but are dealing with chronic pain and issues in other parts of their bodies. Many medical professionals have likely treated a physically disabled person without even knowing it. However, people with hidden or invisible disabilities still need special consideration for any treatment, including for substance abuse problems.
When it comes to people with multiple sclerosis, individuals may appear fine when sitting in a doctor’s office. In reality, they may have had to get someone to drive them to that appointment because they are unable to drive themselves. They may have serious fatigue issues and chronic pain that makes any trip a significant undertaking, so an additional trip to a pharmacy can be unreasonable to ask of them.
Unfortunately, some people with less visible disabilities feel compelled to hide their issues from others, including doctors, due to stigma and lack of education among the general population. These individuals may even fear that their doctors will refuse to see them if they discover a physical disability is involved. This exposes them to even greater harm, as the ignorance of medical professionals can lead to treatment plans that can be impossible or even harmful for patients. This makes education about physical disabilities even more important, so medical professionals can spot the signs of disability without patients having to explicitly tell them about it.
Participating in rehab and support groups is more difficult for people with disabilities, particularly for blind and/or deaf individuals. Only 27 percent of opioid treatment facilities featured interpretation services for people with impaired hearing, according to a national survey. This makes the vast majority of rehabilitation centers for this addiction inaccessible for the deaf unless they are able to pay for their own interpreters.
A serious issue pertaining specifically to substance abuse treatment is enabling. Family, friends, caretakers, and even doctors of those with physical disabilities may hold beliefs that lead them to tolerate substance abuse and addiction in these individuals in a way they never would with able-bodied persons. Whether it’s pity, fear of broaching the subject, or believing that the disabled person isn’t capable enough to overcome substance abuse, people have a greater tendency to allow destructive behaviors involving drugs to go on if the person abusing the substances has a disability.
Enabling an addicted individual can involve pretending you don’t notice the problem, covering when substance abuse disrupts the person’s life, or even obtaining the drug for that person. Most people do these things in the belief that they are helping, but they are actually making the problem worse and propelling the addicted individual to greater health and life issues. Unchecked enabling will eventually destroy a person.
Education for the general population, not just doctors, will help people to realize that individuals with physical disabilities are just as capable of recovering from a substance use disorder as an able-bodied person. The only thing standing in the way of those with physical disabilities is the ignorance that creates enabling behaviors and leads medical professionals to give them treatment plans designed for the able-bodied.
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