Office on Disability
Substance Abuse and Disability
Healthy People 2010 Chapter and Challenges for Persons with Disability:
The burdens that alcohol, tobacco, and other drug problems pose are compounded when the individual is one of the estimated 54 million Americans who have one or more physical or mental disabilities. For these individuals, the process of recovery is made more difficult by barriers that do not exist for others. For this reason, a companion document for the Healthy People 2010 Chapter, Substance Abuse, is necessary for understanding substance abuse in the context of persons with disabilities.
Adverse Consequences of Substance Use and Abuse:
- Recent estimates indicate that this problem costs the American economy in excess of $220 billion per year, and it directly impacts a large segment of our population. However, it is less understood that Americans with disabilities are at a disproportionately greater risk for encountering these problems.
- People with disabilities experience a number of risks that increase their chances for substance abuse to adversely impact their lives. These risks include: medication and health problems, societal enabling, a lack of identification of potential problems, and a lack of accessible and appropriate prevention and treatment services.
Substance Use and Abuse:
- In some cases, the prevalence rates for substance abuse among persons with disabilities are very alarming. Substance abuse prevalence rates approach or exceed 50% for persons with traumatic brain injuries, spinal cord injuries, or mental illness. This is in striking contrast to 10% of the general population.
- Persons with spinal cord injuries, orthopedic disabilities, vision impairment, and amputations can be classified as heavy drinkers in approximately 40-50% of cases.
- Persons with disabilities experience substance abuse rates at 2 - 4 times that of the general population.
- Conditions such as deafness, arthritis, or multiple sclerosis have shown substance abuse rates of at least double the general population estimates.
- The major causes for disability in the U.S. are changing from medical to social and behaviorally-related conditions, increasingly involving complications such as substance abuse, violence, and poor mental health.
Why is this a dilemma?
- Substance abuse prevention, intervention and treatment services are not physically, attitudinally, cognitively, or financially accessible to persons with disabilities for many reasons.
- Many persons with disabilities struggle with recurring substance abuse problems, frustrating efforts at rehabilitation, employment, and successful integration into society.
- The economic costs associated with this situation are enormous when considering governmental obligations in medical and vocational rehabilitation, education, job development, social security, and public assistance.
Risk of Substance Use and Abuse:
- Approximately 54 million Americans experience a disability.
- It is generally accepted that approximately 10% of the general population experiences alcoholism, while another 5% are addicted to drugs.
- It is important to note that research indicates that rates of substance abuse problems vary widely across disability. Spinal cord and traumatic head injury populations are known to have substantially higher rates of substance abuse problems than the general population, while persons with mental retardation tend to have lower rates. That said, people with disabilities have many more risk factors than the general population which probably makes the estimates conservative.
- According to SAMHSA, in 2002, there were 33.2 million adults aged 18 or older with Serious Mental Illness or a substance use disorder. Of these adults, 13.4 million (40.4 percent) had only SMI, 15.7 million (47.4 percent) had only a substance use disorder, and 4.0 million (12.2 percent) had SMI and a substance use disorder.
- A conservative estimate of the number of adult individuals with a substance abuse problem and a co-existing disability is approximated at 4.7 million Americans.
Estimating Population in Need of Services
|Population of the U.S. 1998 Estimate||Number of individuals with Disabling Condition||Number of Individuals with Disabling Condition and Co-existing Substance Abuse Problem|
*Table taken from www.naadd.org/resources/accesslimited.html
Treatment for Substance Abuse:
- Education: There are over 5 million students in special education programs in this country, yet there are few substance abuse prevention programs to address these students' learning needs.
- Employment: It is estimated that 68% of adults with disabilities are not in the workforce, even though most would like to be. Substance abuse plays a significant role in this figure. It is estimated that approximately 25% of persons with disabilities in vocational rehabilitation programs experience a significant secondary problem with substance abuse.
- Health Care Costs: Hospital and other medical health care costs are very high for persons with disabilities. On average, untreated alcoholics incur general health care costs at least double those of non-alcoholics, and this disparity can exist for more than 10 years before they enter into treatment. The rates and costs of alcohol-related hospitalizations among persons with disabilities are much greater than those for the general population.
- Chemical Dependency Treatment: Persons with hidden disabilities such as mental illness, attention deficit hyperactivity disorder, and learning disabilities represent a substantial sub-population of persons with disabilities, and these conditions have been linked to higher rates of substance abuse. Sensitivity to disabilities within the chemical dependency treatment community would increase treatment effectiveness and better address the needs of current clients. 
To Learn More….
The National Association on Alcohol, Drugs and Disability Inc., (NAADD): http://www.naadd.org/
The Office on Disability: http://www.hhs.gov/od/