Evaluating an Individual’s Treatment Needs
Substance Abuse Among Physically Disabled Individuals
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:
- Unemployment and poverty
- Increased risk of physical and sexual abuse
- Increased risk of mental illness
- Chronic medical problems and pain
- Easier access to prescription medications
- Social isolation
- Lack of access to education
- Enabling by caregivers
Substances Use among Specific Disability Populations
Naturally, the most commonly used substances among the physically disabled are the ones that reduce pain. These include prescription opioids like Vicodin and OxyContin, alcohol, heroin, and marijuana.
Prescription opioids are often given out by doctors because they work; Vicodin and OxyContin are both very effective at eliminating pain. However, they’re also highly addictive and cause health problems over time. Other substances are often used to self-medicate when physically disabled individuals lack the resources to obtain prescription drugs. The use of marijuana appears to have some benefits over alcohol, heroin, and prescription medications (though medical marijuana is becoming more commonplace), but its long-term effects and addictiveness are still being hotly debated.
According to the former president of the National Association on Alcohol, Drugs, and Disability, one in seven deaf individuals has a drug or alcohol dependency problem. This is significantly higher than the general population. They are at an even greater risk of becoming addicted to narcotics and are very unlikely to seek treatment due to the lack of training among interpreters when it comes to language around illegal drug use. The frustration this creates when they attempt to communicate with medical professionals often causes them to give up early.
People with spinal cord injuries and traumatic brain injuries have a special relationship with substance abuse, particularly alcohol. A whopping 50 percent of people with spinal cord injuries, which can result in paraplegia or quadriplegia, have problems with substance abuse. It’s no surprise that many of these individuals go back to abusing intoxicants after their injuries, especially since the barriers to employment, reduction in mobility, and social isolation all increase the risk of substance abuse.
Many people with paralysis feel hopeless or broken after their injuries, and some may turn to substance abuse as an intentional form of self-harm or a path to suicide. Any doctor or person close to someone with a disability like this needs to be especially watchful for substance abuse.
Amputees are especially vulnerable to becoming addicted to pain medications like opioids from the very beginning of their disability. Having a limb amputated involves an extremely painful recovery. To deal with this, doctors often give patients a patient-controlled analgesia (PCA) pump that lets them control the amount of pain medication in their system. It’s connected to the patient via IV, and a simple push of the button pumps extra doses of opioids into their blood., providing quick relief. The pump, of course, is designed to prevent overdose by only allowing a certain amount of doses for each set period of time, determined by the doctor.
While very effective, this can easily be the start of an addiction, especially since the pain can last for weeks after the surgery and because amputations can be such traumatic experiences. The injury that led to the amputation can also be incredibly traumatic, and the loss of a part of one’s body often creates a sense of grief. It’s just as easy to turn to intoxicants for relief from the emotional pain.
When it comes to people with chronic pain, such as those with arthritis, abuse of and dependence on pain medications, especially opioids, is a constant concern. Although there are other ways to manage pain, medication is a quick, easy, and simple solution. It became such a problem that the U.S. Drug Enforcement Administration (DEA) recently upgraded certain opioids to a Schedule II controlled substance, meaning that their distribution is much more restricted. For those who want to avoid opioids, medicating (including self-medicating) with marijuana is common. However, results and side effects vary significantly.
In a study of health risk behaviors among young adults with spina bifida, a birth defect in which the spinal cord does not develop properly, it was found that individuals with the condition are less likely to use substances overall. However, nearly half reported minor or major depressive symptoms, and those who had major depression had a higher rate of alcohol use. Like others with reduced mobility, they were more sedentary overall and therefore experienced barriers to treatment.
Depression and anxiety are common among those with multiple sclerosis, which in turn increases the chances of substance abuse. According to one study, 6-6.6 percent of the participants who had MS were considered to be dependent on alcohol, based on a questionnaire score. Among the group, 20.6 percent identified as current tobacco smokers.
Strangely enough, a study presented at the International Stroke Conference found that illegal drug use among stroke victims increased nine-fold over a period of 13 years, from 1993 to 2005. Most of these users were under the age of 35. Some of the increase is likely explained by the rise in strokes among young people, but the researchers say that despite this, the increase is not trivial. Use of alcohol and nicotine did not change significantly.
There are both general concerns about substance abuse for those with physical disabilities as well as concerns specific to the type of disability. Those dealing with both of these issues have to contend with the following concerns:
More difficulties accessing medical treatment:
People with physical disabilities likely already find it harder than able-bodied people to get around. Ongoing substance abuse makes it even more difficult to get to the doctor, and it’s been found that drug abuse decreases the chance that a patient will follow medical advice, such as taking medication and going to physical therapy.
Interaction with prescription medications:
For those who use alcohol or illegal substances in addition to medications prescribed by their doctors, whether they are opioids or not, they run the risk of greater damage to the body as well as overdose due to dangerous interactions between substances.
Increased rate of health issues:
Individuals with physical disabilities are already prone to additional health problems like infection and inflammation that can be worsened by the use of certain substances. Becoming intoxicated also typically reduces coordination, increasing the chance of injury.
Increased social and employment issues:
Substance abuse tends to correlate with social and occupational issues. It makes it more difficult to get to work and can drive away family and friends who disapprove of the drug abuse or who can’t handle dealing with someone who has that kind of problem.
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.
Access to Treatment
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.
Due to the unfortunate lack of education among medical professionals when it comes to treating people with physical disabilities for substance abuse, it’s necessary for them to seek out doctors and programs that will treat them right. There are 14,500 specialized drug abuse and dependence treatment facilities in the US alone, and it can be a waste of time and money to attend one that can’t handle your unique needs. Fortunately, there are resources out there to help the physically disabled find programs that will work for them.
Here are some resources that women can turn to if they feel they need help addressing a substance use problem:
Addiction Resource Guide: Special Populations:
This website offers inpatient treatment listings, organized according to both the type of disability and the type of addiction.
The National Directory of Alcohol and Other Drugs Prevention and Treatment Programs Accessible to the Deaf:
This extensive directory is organized by city and state, including full descriptions of each treatment program.
Prevention through Alternative Learning Styles (PALS):
This program offers preventative resources and education to middle school youth in terms of potentially damaging behavior like alcohol and drug abuse. The information is appropriate for those with disabilities.
Substance Abuse Resources & Disability Issues (SARDI):
This program addresses disability and how it relates to behavioral health issues, such as substance abuse.
Resources for Human Development:
This nonprofit organization serves 14 states and is dedicated to helping people with disabilities to lead more rewarding lives. Among other services, they offer help for addiction recovery.
Addiction & Disabilities Education & Resource Guide:
This site features a detailed introductory guide to substance abuse and how it affects people with disabilities. A self-assessment questionnaire, advice on how to neurotypical individuals can interact with disabled individuals, and additional resources are offered.