The Substance Abuse and Mental Health Services Administration estimates that 4.7 million Amer-ican adults with physical disabilities also have a co-occurring substance use problem. People with disabilities, encompassing a range of conditions that includes deafness, arthritis, and multiple sclerosis, experience substance abuse at two to four times the rate seen in the general population. Among people with spinal cord injuries, orthopedic disabilities, visual impairments, and amputations, about 40 to 50% can be classified as heavy drinkers, according to federal statistics.
Despite the prevalence of substance abuse seen among disabled individuals, addiction treatment centers often struggle in trying to meet the needs of clients with physical disabilities. According to the U.S. Department of Health and Human Services, treatment centers often are inaccessible to people with physical disabilities. Barriers to effective treatment for this population can include cultural insensitivity by healthcare and health promotion entities; limited availability of supports, such as interpreters for deaf or hard-of-hearing individuals; and materials unavailable in formats appropriate for visually impaired people.
SAMHSA has offered guidance in this area for some time through the 29th Treatment Improvement Protocol in that series of written publications: Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities. This guide covers provider-focused topics such as screening for disabilities, individualized treatment planning, counseling techniques, community linkages, and organizational commitment to serving this population. Still, there remains a dearth of programs designed specifically to meet the needs of physically disabled clients.
Dennis Moore, EdD, director of Substance Abuse Resources and Disability Issues (SARDI), a program based in the medical school at Wright State University in Dayton, Ohio, says that in 1991, more than 40 disability-related treatment programs were in operation across the country. “The vast majority of them don't exist now—there are very few that do,” Moore says. He adds that programs that seek to fill this niche in treatment often find such efforts difficult to sustain, partly because of challenges in retaining funding.
SARDI, which receives most of its funding from the regional board that oversees behavioral health services in the Dayton area, is involved with both clinical services and research. SARDI's Consumer Advocacy Model allows consumers to have direct input into their services. CAM started when psychologists at Miami Valley Hospital in Dayton contacted SARDI because a number of people going through their physical rehabilitation program had alcohol or drug problems.
“They didn't seem to be able to connect these individuals with treatment programs that were effective, and in fact most [of these clients] had trouble even getting into the programs because of physical accessibility issues,” says Moore.
SARDI started a program at Miami Valley Hospital in 1994, and within two to three years outgrew the space and relocated it to a community setting. The program serves 300 active consumers in an outpatient setting, with all clients referred from the public system. SARDI also is in the process of opening a residential facility for more severe cases, particularly for individuals with accompanying mental illness.
“You can run a program with that kind of philosophical background and end up with a census that large and have it based in a town no larger than Dayton—that says something about the need,” says Moore. CAM serves people with visual impairments, traumatic brain injury, hearing impairments, orthopedic injury, cognitive injury, and co-occurring mental illness.
SARDI follows several treatment principles that differ from those of most mainstream centers. First, it works to get a patient stable, rather than automatically focusing on immediate sobriety. “We spend a period of time simply engaging with a person to the point where he'll trust us,” says Moore. This is particularly true for people with co-occurring cognitive disabilities or mental illness.
SARDI also believes in less intensity of treatment but a longer duration of treatment; its public funders are aware of this approach and do not see it as problematic in the way a private insurer might. “We only deliver as much treatment as a person can tolerate or the minimal treatment that he needs to keep him at a good place or allow him to make progress,” says Moore. SARDI tries to keep its engagement with clients for up to two years, though the average time is closer to nine months.
The program also provides intensive case management for its clients. It places an emphasis on finding employment for clients, and SARDI is currently working on a clinical trial examining rapid supported employment services. SARDI also works extensively with other community agencies, including social welfare agencies, the Medicaid agency, housing authorities, and criminal justice entities. If clients are referred from one of these systems, SARDI provides monthly updates on their progress, says Moore.
As for treatment accommodations, Moore says the treatment process moves slower for his agency's clients, and fewer written and visual materials are used in treatment. Counselors also spend more individual time with clients before and after group meetings.