Despite the fact that more than 5 million Americans have developmental disabilities (generally regarded to include most forms of mental retardation, cerebral palsy, autism, and epilepsy), mainstream addiction prevention, treatment and recovery services are largely inaccessible for this population. In 2011 the National Council on Disability, an independent federal agency that focuses on national disability policy, issued a report titled Rising Expectations: The Developmental Disabilities Act Revisited. The document reaffirmed principles, guiding policies and services aimed at the full inclusion of persons with developmental disabilities in American life, and their rights to:
- Make informed choices and decisions about their lives;
- Live in homes and communities in which they can exercise their full rights and responsibilities as citizens;
- Pursue meaningful and productive lives;
- Contribute to their families, their communities, their states, and the nation;
- Live free of abuse, neglect, financial or sexual exploitation, and violations of their legal and human rights; and
- Achieve full integration and inclusion in society as individuals, consistent with their unique strengths, resources, priorities, concerns, abilities and capabilities.
Addiction treatment and recovery programs, just like restaurants, government services and movie theaters, are obligated to accommodate people with cognitive and intellectual disabilities under the Americans with Disabilities Act (ADA) and other federal/state laws and regulations.
Few addiction treatment programs have taken the time or expended the resources necessary to modify their services to ensure cognitive accessibility. Addiction prevention, treatment and recovery services tend to rely heavily on abstract terminology laden with nuanced meaning. Terms such as “denial,” “enabling,” “tolerance” and “abstinence” can present significant barriers to understanding for someone with mild mental retardation.
One of the byproducts of cognitive adaptation is that by lowering the intellectual threshold for understanding basic treatment concepts, other groups benefit. This is specifically true for those with limited English language proficiency or low educational attainment.
For example, Step 4 of most 12-Step programs reads: “Made a searching and fearless moral inventory,”an exhortation that links several abstractions into a behavior unfamiliar to most. Contrast that statement with this one modified for easier understanding: “Made a list of things good and bad about myself.”
In addition to concept simplification (see box below on suggested modification of 12-Step language), it is also true that in order to be effective, services for people with cognitive and learning impairments need to include repetition reinforcement strategies as well as graphics/images.
12 Steps of Alcoholics Anonymous
Traditional language vs. modified for easier understanding