research vol. 6, issue 1: substance abuse and disability › public › research ›...

reSearchA collection of research reviews on rehabilitationtopics from NARIC and other informationresources.

Substance Abuse & Individuals with DisabilitiesVolume 6, Issue 1, January 2011

In this edition of reSearch we explore the prevalence of substance abuse among individuals with disabilities. According to the U.S. Department of Health

& Human Services Office on Disability “SubstanceAbuse and Disability” webpage approximately 54 mil-lion Americans experience some form of disability.Additionally, approximately 15 percent of the generalpopulation experiences substance abuse problems re-lated to alcohol (10 percent) and/or drug abuse (5 per-cent). It is estimated that 4.7 million adults experiencea substance abuse problem in addition to a co-existingdisability (Office of Disability, 2006a, retrieved on De-cember 20, 2010 from http://www.hhs.gov/od/about/fact_sheets/substanceabuse.html). Based on these sta-tistics it appears that approximately 12 percent of thepopulation with disabilities experience issues related tosubstance abuse—only 3 percent less than the generalpopulation.

Individuals with disabilities are disproportionately atgreater risk of substance abuse due to multiple risk fac-tors such as “medication and health problems, societalenabling, a lack of identification of potential problems,and a lack of accessible and appropriate prevention andtreatment services” (Office of Disability, 2006a, re-trieved on December 20, 2010 from http://www.hhs.gov/od/about/fact_sheets/substanceabuse.html). The preva-lence rates of substance abuse among individuals withdisabilities are significant but what is truly staggeringare the substance abuse prevalence rates for individu-als with traumatic brain injury (TBI), spinal cord injuries(SCI), and/or mental illness. Prevalence rates approachor exceed 50 percent for individuals experiencing TBI,SCI, and/or mental illness compared to 10 percent ofthe general population (Office of Disability, 2006a, re-trieved on December 20, 2010 from http://www.hhs.gov/od/about/fact_sheets/substanceabuse.html). Moreover,people with certain conditions such as deafness, arthri-tis, and multiple sclerosis experience substance abuseprevalence rates at least double the general population(Office of Disability, 2006b, Retrieved on December

20, 2010 from http://www.hhs.gov/od/about/fact_sheets/substanceabusech26.html).

In addition to being at higher risk of substance abuseissues individuals with disabilities may experience a lackof or incomplete prevention, intervention, and treatmentservices for substance abuse problems. Issues such asphysical access; lack of appropriate educational materi-als such as materials written for individuals with intel-lectual or learning disabilities, materials available in Braille,and/or materials available in alternative communicationformats); lack of interpreters and/or resources for indi-viduals who are profoundly deaf or hard of hearing; anda lack of culturally sensitivity among service providersmay inhibit individuals with disabilities from seeking andreceiving substance abuse treatment (Office of Disabil-ity, 2006b, retrieved on December 20, 2010 from http://www.hhs.gov/od/about/fact_sheets/substanceabusech26.html).

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Table of Contents

NIDRR Funded Projects ........................page 2NARIC Citations ....................................page 3CIRRIE Citation ................................... page 12ERIC Citations ...................................... page 14NCRTM ................................................ page 20PubMed Citations ................................. page 20Quick Looks .......................................... page 24Search Terms ........................................ page 26

Full-text copies of these documents may be availablethrough NARIC’s document delivery service. To orderany of the documents listed, please note the NARIC Ac-cession Number (starts with a J, O, or R) and call aninformation specialist at 800/346-2742. You may alsoorder online at www.naric.com/services/requestform.cfm.There is a charge of five cents for copying and shippingwith a $5 minimum on all orders. International shippingfees may apply.

NIDRR Funded ProjectsRelated to Substance Abuse &

Individuals with Disabilities

In addition to document searches, we searched ourNIDRR Program Database to locate grantees/projectsrelated to substance abuse and individuals with disabili-ties. The search resulted in one currently funded NIDRRproject and six projects that have completed their re-search activities. Project information and their publica-tions are offered as additional resources for our pa-trons.

A National Assessment of the Rates and Corre-lates of Alcohol and Other Drug Use by CollegeStudents with DisabilitiesProject Number: H133G080123Phone: 804/827-0921

The following projects have completed their researchactivities:

The Impact of Alcohol Use on Outcome and Re-covery after Traumatic Brain InjuryProject Number: H133F060032Phone: 206/616-0371Email: [email protected]

Relation of Substance Abuse to RehabilitationOutcome in Persons with Spinal Cord InjuryProject Number: G008635120

Rehabilitation Research and Training Center onSubstance Abuse, Disability, and EmploymentProject Number: H133B040012Phone: 937/775-1484 (V/TTY)Email: [email protected]/citar/sardi/rrtc_about.html

Substance Abuse as a Barrier to Employment forPersons with Traumatic Brain InjuryProject Number: H133A10014Phone: 312/908-2802Email: [email protected]

Substance Abuse Treatment for Adults withChronic Mental IllnessProject Number: H133F40029Phone: 312/567-3515Email: [email protected]

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This edition of reSearch provides approximately 25year “snapshot” of research on substance abuse andindividuals with disability. This “snapshot” presents re-search related to substance abuse among individuals withdisabilities such as TBI and/or SCI, psychiatric disabili-ties, learning disabilities, and visual impairment/blindness.The combined search terms for this edition of reSearchincluded: prevalence, risk factors, substance abuse, al-cohol use, drug use, and disabilities. A listing of near 70additional descriptor terms between the NARIC,CIRRIE, ERIC, NCRTM, and the PubMed databasescan be found at the end of this document. A search ofthe REHABDATA database resulted in 36 documentspublished between 1986 and 2007. The CIRRIE andERIC database searches resulted in 5 documents be-tween 2002 and 2006 and 21 documents between 1989to 2010; respectively. The NCRTM database searchresulted in two documents from 1993 and 2002. Finally,a search of the PubMed database resulted in 12 docu-ments between 1990 and 2010. The complete citationsare included in this research brief.

Citations:

U.S. Department of Health & Human Services Officeof Disability (2006a). Substance Abuse and Disabil-ity: A Companion to Chapter 26 of Healthy People2010. Retrieved from http://www.hhs.gov/od/about/fact_sheets/substanceabuse.html.

U.S. Department of Health & Human Services Officeof Disability (2006b). Substance Abuse and Disabil-ity: Fact Sheet. Retrieved from http://www.hhs.gov/od/about/fact_sheets/substanceabusech26.html.

Documents from NARIC’s

REHABDATA search listedare listed below:

2007

Holicky, R. (2007). Living well: Alcohol, drugs, anddisabilities. PN/Paraplegia News, 61(4), 16-19.NARIC Accession Number: J52471Project Number: H133N000015ABSTRACT: Article provides information on the preva-lence, causes, and effects of alcohol, drug, and othersubstance abuse among people with disabilities.

Pagulayan, K.F. (2007). The impact of alcohol useon outcome and recovery after traumatic brain in-jury.NARIC Accession Number: O17082Project Number: H133F060032PDF: http://www.naric.com/research/rehab/download.cfm?ID=105368ABSTRACT: Study investigated the prevalence, pre-dictors, and impact of alcohol among 177 adults andadolescents with traumatic brain injury (TBI). All par-ticipants completed the Center for Epidemiological Stud-ies-Depression Scale and the Sickness Impact Profile,and provided information about the quantity and fre-quency of alcohol consumption at 4 time points: 1 month,6 months, 12 months, and 3 to 5 years post injury. At thefirst three follow-ups, participants also completed a bat-tery of neuropsychological tests. Individuals with TBIwere found to have high rates of moderate-to-heavyalcohol consumption pre-injury. Alcohol consumptiondeclined immediately after the injury, but there was astatistically significant increase in the percentage of in-dividuals who started drinking between 1 and 6 monthspost injury. Pre-injury moderate-to-heavy drinking andless severe injuries consistently predicted return to drink-ing at 6 months, 12 months, and 3 to 5 years post injury.There was no significant difference in depressive symp-toms or functional outcome between abstinent/light andmoderate/heavy groups. Neuropsychological perfor-mance at 1 month and at 12 months post injury wassignificantly better for those who drank in the moder-ate-to-heavy range, compared to those who were absti-nent. The results suggest that individuals with a historyof moderate-to-heavy alcohol use and a relatively mildTBI should be target for alcohol interventions within thefirst 6 months after injury.

2004

Blake, K.D., Bombardier, C.H., Ehde, D.M., Gibbons,L.E., Kraft, G.H., & Moore, D. (2004). Alcohol anddrug abuse among persons with multiple sclero-sis. Multiple Sclerosis, 10(1), 35-40.NARIC Accession Number: J53652Project Number: H133B980017ABSTRACT: Article presents the results of the surveyof a large community sample of individuals with mul-tiple sclerosis (MS) regarding alcohol and/or drug abuse.Seven hundred thirty-nine out of 1,374 potential partici-pants (54 percent) returned the survey, while 708 whoreported a medically confirmed diagnosis of MS pro-vided sufficient data for further analysis. Fourteen per-cent of the sample screened positive for possible alco-hol abuse or dependence, and 7.4 percent reportedmisusing illicit drugs or prescription medications withinthe previous month. Possible alcohol abuse and drugmisuse were associated with younger age, less severeMS-related disability, and being employed, as well asgreater self-reported depressive symptomatology. Therelationships between drug misuse and demographic ordisease factors was similar to the pattern found for al-cohol problems. Most respondents with alcohol prob-lems indicated interest in learning more about ways tostop or cut down; however, only 27 percent of thosewho reported medication or drug misuse were inter-ested in stopping or cutting down.

2003

Higgins, C. (2003). Substance abuse. ResearchInformation on Independent Living, 2(1), 1-2.NARIC Accession Number: O15144Project Number: H133A980048PDF: http://www.naric.com/research/rehab/download.cfm?ID=96655ABSTRACT: Paper briefly discusses research findingson substance abuse among individuals with disabilities.Disability-specific risk factors for substance abuse in-clude communication barriers, increased family stress,enabling behaviors of family and friends, therapeuticmedication use, and easy access to prescription drugs.

2002

Koch, D.S., Nelipovich, M., & Sneed, Z. (2002). Al-cohol and other drug abuse as coexisting disabili-ties: Considerations for counselors serving indi-viduals who are blind or visually impaired. RE:view,33(4), 151-159.NARIC Accession Number: J44097ABSTRACT: Article discusses the prevalence and po-tential effects of alcohol and other drug abuse (AODA)among people who are blind or visually impaired. De-scribes barriers to providing service including: attitudestoward AODA, lack of professional preparation, sys-tems barriers, and accessibility of treatment programs.Presents strategies for improving services for peoplewith coexisting blindness or visual impairments andAODA.

2001

(2001). Guide to Substance Abuse & Disability Re-sources Produced by NIDRR Grantees. Second Edi-tion. Southwest Educational Development Lab:Austin, TX.NARIC Accession Number: O14030Project Number: H133A990008PDF: http://www.naric.com/research/rehab/download.cfm?ID=92058ABSTRACT: Second edition of a bibliography ofNIDRR grantees’ publications on disabilities co-exist-ing with substance abuse. Includes a brief descriptionof each publication, with bibliographic references. Alsoincluded is a list of NIDRR grantees that provide sub-stance abuse and disability information, with contact in-formation.

Becker, B., Block, P., Bock, B., & Everhart, S. (2001).Alcohol and substance use by adolescents andyoung adults with recent spinal cord and traumaticbrain injuries. Disability Studies Quarterly, 21(2).NARIC Accession Number: J45412ABSTRACT: Study examines factors supporting alco-hol and substance use among adolescents and youngadults with recent spinal cord injury and traumatic braininjury. Data was collected from observation and inter-views conducted with youth participating in a 5-weekresidential alternative therapy program for physical re-habilitation and recreation. Themes derived from analy-

sis of the data include: family history of drinking, pre-injury drinking behavior, alcohol use at the time of in-jury, social support for drinking, and consequences ofalcohol and substance abuse. Results confirm a highprevalence of excessive alcohol and substance use,which interfered with participants’ goals for physicalrehabilitation and independent living.

Cosden, M. (2001). Risk and resilience for sub-stance abuse among adolescents and adults withLD. Journal of Learning Disabilities, 34(4), 352-358.NARIC Accession Number: J42561ABSTRACT: Article reviewing findings of current re-search on substance abuse among adolescents and adultswith learning disabilities (LD), interpreting findings withina risk and resilience framework that seeks to identifyfactors that increase or decrease the susceptibility ofindividuals with LD to substance abuse. Hypothesesare developed regarding potential risk factors and pro-tective factors. Potential risk factors discussed includea poor understanding of one’s disability, a lack of skillsfor developing peer relationships, and the need for pro-longed family support. Implications for future researchare discussed.

2000

Bombardier, C.H. (2000). Alcohol and traumatic dis-ability. In R. G. Frank & T. R. Elliott (Eds.), Hand-book of rehabilitation psychology (pp. 399-416).Washington, DC: American Psychological AssociationNARIC Accession Number: J42141Project Number: H133N50025ABSTRACT: Book chapter on the role of alcohol inrehabilitation of persons with traumatic brain injury andspinal cord injury, including pre- and post-injury alcoholproblems and intoxication. The prevalence of alcoholabuse and the effects of alcohol-related factors on re-habilitation outcomes are discussed, and methods forscreening, assessment, and intervention are described.This document is included in NCDDR’s Guide to Sub-stance Abuse and Disability Resources Produced byNIDRR Grantees, 2nd edition, number A.1.

1999

(1999). Guide to substance abuse & disability re-sources produced by NIDRR grantees. NationalCenter for the Dissemination of Disability Research:Austin, TX.NARIC Accession Number: O13443Project Number: H133D50016PDF: http://www.naric.com/research/rehab/download.cfm?ID=91493ABSTRACT: Bibliography of NIDRR grantees’ publi-cations on substance abuse by persons with disabilities.Includes a brief description of each publication, withbibliographic references.

1998

Ford, J.A., & Li, L. (1998). Illicit drug use by womenwith disabilities. American Journal of Drug & Al-cohol Abuse, 24(3), 405-418.NARIC Accession Number: J36897ABSTRACT: Study examines the patterns of illicit druguse and risk factors relating to illicit drug use among arandom sample of 900 women with various disabilities.Multiple regression analyses revealed that age, illicit druguse by a best friend, and being a victim of substanceabuse-related violence. Attitudes towards substance useby people with disabilities (i.e., entitlement attitudes)were significantly related to illicit drug use by the studypopulation. Across disability categories, women withchemical dependency as a primary disability reportedthe highest incidence (40%) of illicit drug use in the past12 months. Followed by: those with mental illness (26.3percent), those with medical disabilities (18.4 percent),and those with physical disabilities (18.2 percent).Women with mental retardation or learning disabilitiesreported the lowest rates of illicit drug use (9.6 per-cent). The implications of these findings are discussed.This document is included in NCDDR’s Guide to Sub-stance Abuse and Disability Resources produced byNIDRR Grantees, number D.26. This document is in-cluded in NCDDR’s Guide to Substance Abuse andDisability Resources produced by NIDRR Grantees, 2ndEd, number D.31.

Li, L., & Moore, D. (1998). Prevalence and riskfactors of illicit drug use by people with disabili-ties. American Journal on Addictions, 7(2), 93-102.

NARIC Accession Number: J36903Project Number: H133B970018ABSTRACT: Study examines patterns and risk factorsof illicit drug use among a random sample of 1,876 per-sons actively involved in vocational rehabilitation servicesin three Midwestern States. Respondents with disabilitiesreported higher rates of illicit drug use for nearly everydrug category compared to regional drug use rates fromgeneral population studies. Factors significantly associ-ated with illicit drug use included: level of disability ac-ceptance, best friend’s drug use, attitude of disability en-titlement, self-esteem, and risk taking. Implications fromthese findings for rehabilitation and disability policy arediscussed. This document is included in NCDDR’s Guideto Substance Abuse and Disability Resources Producedby NIDRR Grantees, Number D.38.

1996

Foster-Johnson, L., Greenbaum, P.E., & Petrila, A. (1996).Co-occurring addictive and mental disorders amongadolescents: Prevalence research and future direc-tions. American Journal of Orthopsychiatry, 66(1).NARIC Accession Number: J36892Project Number: H133B40023ABSTRACT: Article proposes the need for epidemio-logical research that documents the pervasive co-occur-rence of addictive and mental disorders in adolescents.Special problems inherent in the assessment of co-occur-rence in this age group are discussed. These involve thelack of available assessment tools that can accuratelymeasure addictive disorders specifically for this age group.The clinical heterogeneity of single terms to refer to co-existing addictive and mental issues can also confoundthe issue, since the label does not identify a homogenousclinical population. Evidence suggesting that the preva-lence of co-occurring disorders in adolescents parallelsthat already documented in adults is reviewed. Futureresearch strategies are delineated. This document is in-cluded in NCDDR’s Guide to Substance Abuse and Dis-ability Resources produced by NIDRR Grantees, num-ber D.18.|This document is included in NCDDR’s Guideto Substance Abuse and Disability Resources producedby NIDRR Grantees, 2nd Ed, number D.21.

Katims, D.S., Yin, Z., & Zapata, J.S. (1996). Riskfactors for substance use by Mexican Americanyouth with and without learning disabilities. Jour-nal of Learning Disabilities, 29(2), 213-219.NARIC Accession Number: J30828ABSTRACT: Study examines substance abuse amongMexican American youth. Drug use among adolescentsand even preadolescents is of great concern. Studieshave given conflicting information on whether learningdisabilities (LD) are seen as a risk factor associatedwith substance abuse. Ethnic status has been corre-lated as an independent variable, but without specificity.This study looks at both the factors of learning disabilityand Mexican American ethnic status in identifying risksfor substance abuse. With age also being an area ofconcern, the study participants were from elementaryand middle schools in a Texas working class environ-ment. The study found that significant differences be-tween Mexican- American students with LD and thosewithout LD did not exist. A majority of both studentgroups reported no substance abuse within the last year.In identifying the factors leading to use of minor drugs,the students with LD more often identified peer influ-ence. The difficulties that students with LD have withsocial inclusion may explain their willingness to conformto group behavior. Stressful life events and the use ofminor drugs had a greater correlation to major drug usewith the students that had LD.

Kreutzer, J.S., Marwitz, J. H., & Witol, A.D. (1996).Alcohol and drug use among young persons withtraumatic brain injury. Journal of Learning Dis-abilities, 29(6), 643-651.NARIC Accession Number: J32693Project Number(s): G0087C0219, H133P20018ABSTRACT: Study examining the pre-injury and post-injury patterns of alcohol and illicit drug use among youngpersons with traumatic brain injury (TBI). Participantswere 87 persons with TBI who were 16 to 20 years ofage. Follow up data were collected at two time inter-vals averaging 8 and 28 months post-injury. A compari-son with large-sample studies indicated that the youngpersons with TBI had pre-injury drinking patterns simi-lar to those in the general population. There was evi-dence of a decline in alcohol use at initial follow up, butpre-injury and second follow up alcohol use patternswere similar. The findings suggest that men, personswith moderate to heavy pre-injury alcohol use, and those

taking prescribed medications are at greatest risk forlong term alcohol abuse post-injury. Post-injury illicit druguse rates remained relatively low, falling below 10 per-cent at both follow up intervals. This document is in-cluded in NCDDR’s Guide to Substance Abuse andDisability Resources Produced by NIDRR Grantees,number D.5. This document is included in NCDDR’sGuide to Substance Abuse and Disability Resourcesproduced by NIDRR Grantees, 2nd Ed, number D.5.

1995

Fuhrer, M.J., Hart, K.A., Rintala, D.H., Rossi, C.D., &Young, M.E. (1995). Alcohol and marijuana use ina community-based sample of persons with spinalcord injury. Archives of Physical Medicine & Re-habilitation, 76(6), 525-532.NARIC Accession Number: J29805Project Number: H133B80020ABSTRACT: Study investigating the prevalence of selfreported alcohol and drug use and alcohol abuse in acommunity based sample (n=123) of persons with spi-nal cord injuries (SCI). Correlates of alcohol and mari-juana use and alcohol abuse also were examined, in-cluding demographic variables, measures of impairment,disability, and handicap, SCI medical complications, andsubjective assessments including depression, perceivedstress, and life satisfaction. Results showed that theprevalence of alcohol use (59 percent) and marijuanause (16 percent) in the subjects with SCI was less thanthat of comparison groups in the general population.However, the prevalence of alcohol abuse (21 percent)exceeded that of general population studies. Subjectswho abused alcohol perceived their overall health asworse, were more depressed, and experienced morestress in their lives than did those who did not abusealcohol. Subjects who used marijuana were younger atthe time of the study and at the time of injury and weremore depressed and more stressed than those who didnot use the drug.

Holicky, R. (1995). Who, me? Drink too much?PN/Paraplegia News, 49(10).NARIC Accession Number: J36914Project Number: H133G30050ABSTRACT: Article reports on alcohol consumptionand aging among individuals with spinal cord injury (SCI).Conditions associated with the combination of alcohol

and SCI include increased muscle spasticity, fractures,heart, liver, and brain damage, pressure sores, malnutri-tion, and urinary-tract infections. Risk factors are iden-tified that can turn alcohol use into alcohol abuse. Defi-nitions provided include: alcohol use, alcohol abuse, de-pendence. Drinking habits can define drinking problemsand may be identified by the CAGE questionnaire: (1)have you ever felt you should cut down, (2) have peopleannoyed you by criticizing your drinking, (3) have youever felt bad or guilty about your habit, and (4) have youever used alcohol as an eye-opener to treat nerves, hang-overs, or morning sleepiness. Enabling environments andcaregivers can encourage alcohol abuse among agingSCI survivors. Other problems are discussed. On theplus side, older problem drinkers and alcoholics have anunusually good chance of recovery, experience fewerwithdrawal symptoms and have good programs avail-able for help. Some resources are provided. This docu-ment is included in NCDDR’s Guide to Substance Abuseand Disability Resources produced by NIDRR Grant-ees, Number E.10. This document is included inNCDDR’s Guide to Substance Abuse and Disability Re-sources produced by NIDRR Grantees, 2nd Ed, num-ber E.11.

1994

(1994). Substance abuse & students with disabili-ties: Little known facts.NARIC Accession Number: O13087ABSTRACT: Pamphlet relates basic information regard-ing substance use in the general population and issuesspecific to students with disabilities. Risk factors re-lated to alcohol, and substance abuse is listed. Amongthese facts are: 40-80 percent of all traumatic brain in-jury patients are injured while intoxicated and 40-80percent of spinal cord injuries are related to intoxicationand substance abuse. Warning signs of substance abuseare described. Physical and psychological red flags arealso identified. Special risks for students with disabili-ties are discussed including the risk for misidentificationof warning signs and enabling attitudes, prescriptionmedications, constrained socialization opportunities, in-creased risk of parental alcoholism, a strong predictorof substance abuse, and physical and attitudinal inac-cessibility. Prevention efforts are described, as well aswhat to do to help someone who is abusing alcohol ordrugs. Telephone numbers are provided for the Alcohol

Abuse Crisis Center, the Drug Abuse Action Helpline,and Children of Alcoholics. This document is includedin NCDDR’s Guide to Substance Abuse and DisabilityResources produced by NIDRR Grantees, Number B.9.This document is included in NCDDR’s Guide to Sub-stance Abuse and Disability Resources Produced byNIDRR Grantees, 2nd Ed., number B.10. This docu-ment is included in NCDDR’s Guide to Resources Pro-duced by NIDRR Grantees: Infants, Children, and Youthwith Disabilities as G.22.

Li, L., & Moore, D. (1994). Alcohol use and drink-ing-related consequences among consumers ofdisability services. Rehabilitation Counseling Bul-letin (ARCA), 38(2).NARIC Accession Number: J36889Project Number: H133B30050ABSTRACT: Study reports on patterns of alcohol useand consequences of abuse among 916 individuals withdisabilities. Patterns of alcohol use were analyzed inrelation to demographics, disability groupings, and vari-ous consequences of abuse. Specific self-reported con-sequences of abuse were examined as they related tohealth, family relationships, legal involvements, and workproblems. Respondents with disabilities used alcohol asmuch as or more than the general population despiteadditional risk factors such as medication and healthproblems. A number of negative consequences of alco-hol use were reported by respondents. Negative conse-quences discussed include high rates for alcohol-relatedarrests, health problems, family dysfunctions, and dis-turbingly high rates for attending work or school whileunder the influence of alcohol and other drugs. Recom-mendations for rehabilitation counselors in light of thesefindings are presented. This document is included inNCDDR’s Guide to Substance Abuse and DisabilityResources produced by NIDRR Grantees, numberD.14. This document is included in NCDDR’s Guide toSubstance Abuse and Disability Resources producedby NIDRR Grantees, 2nd Ed, number D.15.

1993

Cottrol, C., & Frances, R. (1993). Substance abuse,comorbid psychiatric disorder, and repeated trau-matic injuries. Hospital & Community Psychiatry,44(8), 715-716.NARIC Accession Number: J25852

ABSTRACT: Study examining the relationship betweenrepeated traumatic injuries and substance abuse andcomorbid psychiatric disorders. Subjects were 58 pa-tients admitted to a level I trauma center. Data werecollected on 249 variables using a demographic ques-tionnaire and the Structured Clinical Interview for DSM-III-R. Fifty-eight percent of the sample reported theyhad abused substances in the past three months includ-ing the date of injury. Forty-seven percent reported ahistory of traumatic injury. A significantly larger propor-tion of the patients with a history of trauma reportedrecent substance abuse than did patients without a his-tory of trauma. In addition, there was a high prevalenceof psychiatric disorders among patients who reportedsubstance abuse, including generalized anxiety disorder(40 percent), bipolar disorder, manic type (37 percent),and posttraumatic stress disorder (30 percent). The au-thors suggest that the high rate of re-injury among pa-tients with substance abuse problems could be reducedby improved screening for and treatment of underlyingpsychiatric disorders.

1991

(1991). An overview of alcohol and other drugabuse prevention and disability. Resource Centeron Substance Abuse Prevention and Disability:Washington, D.C.NARIC Accession Number: R06905ABSTRACT: Overview of the risk for alcohol and otherdrug abuse prevention among persons with disabilities.The first section describes and provides examples ofthe factors placing persons with disabilities at higherrisk for substance abuse. These factors include medi-cation use, health concerns, chronic pain, peer groupdifferences, fewer social supports, and enabling of al-cohol and other drug use. The second section discussesthe disability categories which have been identified asat risk for alcohol and other drug abuse. The third sec-tion discusses what is needed to address these prob-lems, including additional research, access to appropri-ate prevention information, early identification of prob-lems, and access to appropriate treatment. The fourthsection suggests specific activities for consumers, fam-ily members, and advocates. Definitions of key termsand a list of related resource materials are included.

Armstrong, K.J., Doll, M.D., Heinemann, A.W., Schnoll,S., & Yarkony, G.M. (1991). Substance use and re-ceipt of treatment by persons with long-term spi-nal cord injuries. Archives of Physical Medicine &Rehabilitation, 72(7), 482-487.NARIC Accession Number: J20399ABSTRACT: Study assessing the extent of substanceuse, consequent problems, recognition of problems, andreceipt of treatment by persons with long-term spinalcord injury (SCI). Subjects were 86 individuals with SCI,aged 13 to 65 years; 69 percent were male. The meantime from injury to study entry was 13.1 years. Sub-jects were interviewed on two occasions, 12 monthsapart, to obtain information for four time periods cover-ing the six months before injury up to the time of thesecond interview. All subjects reported the use of oneor more substances with abuse potential during theirlives. The most frequent use occurred during the periodfrom time of injury to six months before the first inter-view; the duration of this period ranged from 18 monthsto 43 years. Seventy percent of the subjects reportedproblems resulting from substance use. Sixteen percentbelieved they needed treatment at some time, but only 7percent received treatment. This document is includedin NCDDR’s Guide to Substance Abuse and DisabilityResources produced by NIDRR Grantees, 2nd Ed, num-ber D.57.

Breakey, W.R., & Fischer, P.J. (1991). The epidemi-ology of alcohol, drug, and mental disorders amonghomeless persons. American Psychologist, 46(11),1115-1128.NARIC Accession Number: J21451ABSTRACT: Discusses research on prevalence of al-cohol, drug and mental (ADM) disorders among indi-viduals who are homeless: (1) prevalence of ADM dis-orders; (2) methodological issues in estimating the preva-lence of ADM disorders (definitions of homelessness,sampling, and methods of case ascertainment); and (3)epidemiology of ADM disorders (alcohol use disorders,other drug use disorders, and mental disorders). Re-search evidence supports the high prevalence of ADMdisorders in today’s population of homeless persons.Homeless substance abusers and those with mental ill-ness are characterized by severe poverty, isolation fromfamily, friends, and other support networks,underutilization of public entitlements, poor generalhealth, and frequent contact with correctional agencies.

There are still gaps in the knowledge of this subject thatmust be addressed by research. Knowledge of the sub-ject can be used to advocate for better services to sup-port those who are homeless and prevent furtherhomelessness.

Corthell, D.W., Ed. (1991). Substance abuse as acoexisting disability: Report from the study group,Eighteenth Institute on Rehabilitation Issues, Oct.1991.NARIC Accession Number: O10681Project Number: H133B80049PDF: http://www.naric.com/research/rehab/download.cfm?ID=13496ABSTRACT: Report from the Eighteenth Institute onRehabilitation Issues (IRI) Study Group on SubstanceAbuse as a Coexisting Disability. The report is intendedas a training document for rehabilitation counselors.Seven chapters address the following topics: (1) an over-view of the problem of substance abuse as a coexistingdisability; (2) the medical aspects of substance abuseincluding the classification and pharmacology of sub-stances, major effects of substances on the central ner-vous system, and the interaction of substances with com-monly encountered physical, cognitive, and emotionaldisabilities; (3) assessment of substance abuse as a co-existing disability, with a focus on the diagnostic inter-view; (4) the treatment process, including the need forfamily involvement and interagency cooperation; (5) therole of the rehabilitation counselor in treating substanceabusing clients; (6) model programs and program com-ponents; and (7) special issues in job placement for cli-ents with a coexisting substance abuse disability. Addi-tional resource materials are contained in appendices.

Driscol, C., Getson, P.R., Glasgow, A.M., Hicks, J.M.,O’Donnell, R.M., Schwartz, R., Turek, J., & Tynan, D.(1991). Alcohol and drug use in teenagers withdiabetes mellitus. Journal of Adolescent Health,12(1), 11-14.NARIC Accession Number: J19292ABSTRACT: Examines the prevalence of drug use in apopulation of 101 adolescents with diabetes mellitus andthe relationship between drug abuse and poor control ofthe disease. Subjects completed a questionnaire con-cerning drug use and were tested for glycohemoglobinand urine drug metabolites of marijuana, phencyclidine(PCP), and cocaine. About 50 percent of the subjects

reported trying alcohol and 25 percent report ongoinguse. Almost 25 percent have tried drugs and 5 percentreport ongoing use. Only one urine was positive formarijuana, while none was positive for cocaine or PCP.Those individuals indicating drug use tended to be inpoor control of the diabetes mellitus.

Friedman, R.M., Greenbaum, P.E., Prange, M.E., &Silver, S.E. (1991). Substance abuse prevalenceand comorbidity with other psychiatric disordersamong adolescents with severe emotional distur-bances. Journal of the American Academy of Childand Adolescent Psychiatry, 30(4), 575-583.NARIC Accession Number: J36907Project Number: H133B90004ABSTRACT: Study assesses the prevalence of DSM-III substance use disorders (i.e., alcohol and marijuanaabuse/dependence) and comorbidity with DSM-III AxisI disorders among 547 adolescents with serious emo-tional disturbances, ages 12 to 18. Additionally, age, sex,state location and type of treatment program factorswere examined. Significant factors (p<0.05) associatedwith severe alcohol or marijuana abuse/dependency in-cluded: (1) residential mental health treatment program,2.37 odds ratio (OR); (2) conduct disorder diagnosis,2.18 OR; (3) depression diagnosis, 1.75 OR; (4) states,1.43 OR; (5) age 1.29 OR; and (6) depression X facilityintervention 1.91 OR. Changes from DSM-III to DSM-III-R classifications are described and implications forpractitioners are discussed. This document is includedin NCDDR’s Guide to Substance Abuse and DisabilityResources produced by NIDRR Grantees, NumberD.45. This document is included in NCDDR’s Guide toSubstance Abuse and Disability Resources producedby NIDRR Grantees, 2nd Ed, number D.54.

Hesselbrock, V.M., Kranzler, H.R., Lane, T.J., Manu,P., & Matthews, D.A. (1991). Substance use disor-ders in patients with chronic fatigue. Hospital &Community Psychiatry, 42(9), 924-928.NARIC Accession Number: J20976ABSTRACT: Researchers examined prevalence andseverity of substance use disorders in a previously stud-ied sample of 100 individuals with chronic fatigue (CF).Study hypothesized that prevalence of substance usedisorders in people with CF would exceed prevalenceof substance use disorders in general population. Alsohypothesized that number and severity of mood disor-

der symptoms would be greater in people with CF andlifetime diagnoses of substance use disorders than inpeople with CF and no history of substance abuse. Re-searchers conducted medical evaluations and collectedinformation on fatigue history. They administered theDiagnostic Interview Schedule which provides currentand lifetime psychiatric diagnoses. Subjects also com-pleted Brief Michigan Alcoholism Screening Test andBeck Depression Inventory. Data analysis indicated 28subjects had lifetime diagnosis of substance abuse ordependence, and 10 of the 28 had a current diagnosis.Total of 49 subjects had no history of substance abuseor psychiatric illness. There were no differences in de-mographic characteristics or in features of CF amongthose with lifetime diagnoses of substance use disor-ders, without lifetime diagnoses of substance use disor-ders but with other lifetime psychiatric diagnoses, andthose with no lifetime history of psychiatric illness. Thosewith lifetime history of substance use reported morelifetime depressive symptoms and were more likely tohave tried or thought about suicide.

1990

Austin, G., de Miranda, J., & Prendergast, M. (1990).Substance abuse among youth with disabilities.Prevention Research Update, No. 7, Summer 1990.NARIC Accession Number: O10996ABSTRACT: Review of recent research on alcohol andother drug (AOD) abuse among youth with disabilities.The first section addresses the limits of the research-based information that is available. The second sectionreviews the nature and extent of the problem amongpersons with disabilities in general and among youth withdevelopmental, learning, hearing, visual, and mobilityimpairments. The third section examines correlates ofAOD use and risk factors for the disabled population ingeneral and for the specific disability groups. The finalsection discusses issues and factors to be considered inprevention and intervention efforts with youth with dis-abilities. The review includes references, abstracts ofselected publications, and lists of other information re-sources.

Bellack, A.S., Kee, K., Levinson, D.F., Morrison, R.L.,Mueser, K.T., Singh, H., Yadalam, K.G., & Yarnold, P.R.(1990). Prevalence of substance abuse in schizo-phrenia: Demographic and clinical correlates.Schizophrenia Bulletin, 16(1).

NARIC Accession Number: J16479ABSTRACT: A report of findings from a study under-taken to determine the relationship of substance abuseamong schizophrenics with demographics, diagnosis,history of illness, and symptoms. The report of the studyand findings is preceded by a lengthy review of the cur-rent state of knowledge. For the study, the authors re-viewed the cases of 149 patients with schizophrenia(101), schizoaffective (42), or schizophreniform disor-der (6), for abuse and demographic data. Among thefindings were: likelihood of abuse was greatest for al-cohol, followed by cannabis, stimulants, and hallucino-gens; and demographic variables strongly predictedabuse, especially age, race, and socioeconomic status.Also found was that stimulant abusers tended to havetheir first hospitalization at a younger age and were morelikely to have been diagnosed as schizophrenic, whilecannabis abusers had fewer symptoms and prior hospi-talizations. (For other papers addressing the issue ofschizophrenia and substance abuse, see AN XJ16479through AN XJ16485).

Greer, B.G., Jenkins, W.M., & Roberts, R. (1990). Sub-stance abuse among clients with other primary dis-abilities: Curricular implications for rehabilitationeducation. Rehabilitation Education, 4(1), 33-44.NARIC Accession Number: J16628ABSTRACT: Examines substance abuse among per-sons with other primary disabilities. Topics include: (1)a definition of substance abuse and the prevalence inthe general population; (2) a review of research reveal-ing wide variations in estimates of the prevalence ofsubstance abuse among persons with physical and/ormental disabilities; (3) factors predisposing persons withdisabilities to the abuse of alcohol and/or drugs (includ-ing easy access to prescription drugs for real medicalneeds, excessive levels of frustration related to the dis-ability, oppression and alienation in society, and ill-ad-vised medical intervention); (4) the critical need for moresubstance abuse treatment programs which address thespecial needs of disabled persons; (5) the critical needfor adequately trained personnel; and (6) the implica-tions for the education and training of rehabilitation coun-selors.

Leal, A. (1990). Hispanics and substance abuse:Implications for rehabilitation counselors. Jour-nal of Applied Rehabilitation Counseling, 21(3), 52-54.NARIC Accession Number: J18214

ABSTRACT: Discusses factors to be considered byrehabilitation counselors in considering the Hispanic cli-ent, especially the Mexican American, who may be us-ing or abusing substances. Addressed are the Hispaniclabel, ethnic identity, the use of Spanish language, sub-stance abuse patterns and prevalence in this population,and treatment of members of this group. Rehabilitationcounselors must remain aware of the Hispanic client’sindividual self-identification as well as sociocultural andhistorical aspects of this heritage.

1989

Bjorgen, D. (1989). Removing barriers: A guide toproviding substance abuse services to those with de-velopmental disabilities.NARIC Accession Number: O10723ABSTRACT: Guide to implementing the ADAPTmodel—A Differential Approach to Prevention andTreatment of Substance Abuse among Persons withDevelopmental Disabilities. Part I describes commu-nity approaches to developing substance abuse servicesfor persons with developmental disabilities: identifyingresources, determining community needs, identifyingbarriers, developing service agreements, and coordinat-ing and providing cross-training between disability andsubstance abuse professionals. Part II addresses pro-fessionals interested in working directly with personswho have developmental disabilities and substance abuseproblems. This part describes risk factors for substanceabuse, provides several screening and assessment in-struments, describes eight sessions suggested for a sub-stance abuse support group with individuals who havedevelopmental disabilities, and discusses the importanceof offering recreational activities as alternatives to abus-ing substances. The guide also contains a list of addi-tional resources and a bibliography.

Lane, K.E. (1989). Substance abuse among thedeaf population: An overview of current strategies,programs & barriers to recovery. JADARA, 22(4),79-85.NARIC Accession Number: J12705ABSTRACT: A discussion of substance abuse amongdeaf people. The author begins by noting that deaf peopleprobably have the same rate of dependency as the nor-mal hearing population. Among the causes of abuse are:advertising, easy availability, high levels of anxiety and

frustration, the relieving of “oppressed minority” anxi-ety and resentment, and residual effects from medicalrehabilitation. Among the barriers to recovery the au-thor identifies are: lack of specialized services, wide dis-persal of deaf alcoholics, labeling among deaf persons,the suspicions of hearing people harbored by the deaf,and the unsuitability of Alcoholics Anonymous for deafpersons. The author concludes his discussion with briefdescriptions of ten substance abuse centers tailored forthe deaf; these include: Project AID (Ohio), CCAIRU(Cape Cod, MA), SAISD (New York), the KansasSchool for the Deaf, among others. The author urgesfederal funding for the training of counselors to treatthe deaf substance abuser.

1988

Donohue, R., Heinemann, A.W., Keen, M., & Schnoll,S. (1988). Alcohol use by persons with recent spi-nal cord injury. Archives of Physical Medicine &Rehabilitation, 69(8).NARIC Accession Number: J42146Project Number: G008635120ABSTRACT: Study examining drinking history, preva-lence of alcohol abuse, and consequences of alcoholuse in 103 persons with spinal cord injury (SCI). Re-sults suggest that a significant number of individuals withrecent SCI have histories of heavy drinking and experi-ence behavioral problems resulting from alcohol use.The Michigan Alcoholism Screening Test proved to bean efficient method of assessing alcohol-related prob-lems among participants. Treatment and policy implica-tions are discussed. This document is included inNCDDR’s Guide to Substance Abuse and DisabilityResources Produced by NIDRR Grantees, 2nd edition,number D.17.

Germanson, T., Glaser, F.B., & Ross, H.E. (1988). Theprevalence of psychiatric disorders in patients withalcohol and other drug problems. Archives of Gen-eral Psychiatry, 45(11), 1023-1031.NARIC Accession Number: J09295ABSTRACT: Survey of the lifetime and current preva-lence of psychiatric disorders in patients with alcoholand other drug problems. The study subjects were 501patients who had sought help at an alcohol and drugtreatment facility. Information was gathered in inter-views, using the National Institute of Mental Health

Documents from the Centerfor InternationalRehabilitation ResearchInformation and Exchange

(CIRRIE-2) search at cirrie.buffalo.edu arelisted below:

Diagnostic Interview Schedule (DIS). Lifetime and cur-rent diagnoses were generated by computer, based onDSM-III criteria. The results show that 84 percent ofthe patients had a DIS lifetime psychiatric disorder inaddition to substance abuse, and 68 percent had a DIScurrent psychiatric disorder. Even when generalizedanxiety is excluded, 78 percent had a lifetime DIS diag-nosis and 65 percent had a current DIS diagnosis inaddition to substance abuse. The most frequent lifetimedisorders were antisocial personality disorder, phobias,psychosexual dysfunctions, major depression, and dys-thymia. Patients who met DIS current criteria for bothalcohol and other drug abuse had a much higher preva-lence of lifetime psychiatric disorders than did otherpatients. These and other findings are discussed; dataare included.

1986

Greer, B.G. (1986). Substance abuse among peoplewith disabilities: A problem of too much accessi-bility. Journal of Rehabilitation (JAN-FEB-MAR),34-38.NARIC Accession Number: J05915ABSTRACT: Explores the problem of substance abuseamong persons with disabilities. Reviews the literatureon the prevalence of alcohol and drug abuse amongpersons with disabilities. Examines some possible fac-tors leading to such abuse and suggests interventionstrategies. Includes 20 references.

2006

Anstey, K.J., Christensen, H., & Low, L.F. (2006).Prevalence, risk factors and treatment for sub-stance abuse in older adults. Current Opinion inPsychiatry, 19(19), 587-592.No abstract is available.

Ebner, N., Sachs, G., Thau, K., & Winklbaur, B., et al.(2006). Substance abuse in patients with schizo-phrenia. Dialogues in Clinical Neuroscience, 8(8),37-43.ABSTRACT: The comorbidity of schizophrenia andsubstance abuse has attracted increasing attention inthe past years, with multiple potential links, includinggenetic vulnerability, neurobiological aspects, side ef-fects of medications, and psychosocial factors beingunder discussion. The link between the use of substancesand the development of psychoses is demonstrated bythe high prevalence of substance abuse in schizophre-nia. Apart from alcohol misuse, substances commonlyabused in this patient group include nicotine, cocaine,and cannabis. In particular, heavy cannabis abuse hasbeen reported to be a stressor eliciting relapse in schizo-phrenic patients. In general, substance use in psychosisis associated with poorer outcomes, including increasedpsychotic symptoms and poorer treatment compliance.Since both disorders have been observed to be closelyinterdependent, a particular treatment for schizophrenicpatients with comorbidity of substance abuse is neededin order to provide more effective care. In this article,we discuss various potential modes of interaction andinterdependence, and the possibility of embarking onnew therapeutic paths for treating this particular popu-lation. (PubMed Abstract)

Gill, K., Margolese, H.C., Negrete, J.C., & Tempier, R.(2006). A 12-month prospective follow-up study ofpatients with schizophrenia-spectrum disordersand substance abuse: Changes in psychiatric symp-toms and substance use. Schizophrenia Research,83(83), 65-75.

ABSTRACT: While it is widely known that patientswith schizophrenia-spectrum psychoses and co-occur-ring substance use disorders are more difficult to man-age, there is limited data on the course of their psychiat-ric symptoms when they remain in treatment over time.This prospective 12-month study evaluated changes inpsychiatric symptoms and substance use to ascertain ifthe co-existence of substance use disorders influencesratings of psychiatric symptoms at follow-up. 147 out-patients in a continuing care program were assessed atintake and followed prospectively for 12 months. Psy-chiatric symptoms were measured at baseline and 12-month follow-up using the Positive and Negative Syn-drome Scale (PANSS) and Hamilton Depression Rat-ing Scale (HAM-D). Subjective psychological distresswas rated with the Brief Symptom Inventory (BSI) andquality of life by the Satisfaction with Life Domains Scale(SDLS). Drug and alcohol use was measured with theAddiction Severity Index (ASI). 50.3 percent of patientswere diagnosed with dual disorders (DD) (current andlifetime). The most common primary substances of abusewere alcohol (35.6 percent) and cannabis (35.1 percent).DD subjects had higher baseline PANSS positive scoresbut experienced a greater reduction at 12 months com-pared to single diagnosis (SD) patients. Severity of sub-stance abuse as measured by ASI composite scores didnot decrease significantly between baseline and 12months. DD patients with schizophrenia and relatedpsychoses treated for their psychiatric illness showed areduction in PANSS scores over 12 months, even whentheir substance use remained largely unchanged. How-ever, co-morbidity cases continued to show higher de-pression and anxiety ratings. Ongoing substance abuseappears to be related to levels of depression as 62.5percent of DD-current versus 34.7 percent of SD pa-tients had HAM-D scores in the depressed range at 12-month follow-up. Implications for treatment are dis-cussed. (PubMed Abstract)

2005

Cividanes, G., Laranjeira, R., & Ribeiro, M. (2005).Transtorno Bipolar Do Humor E Uso Indevido DeSubstancias Psicoativas [Bipolar disorder and sub-stance abuse]. Revista de Psiquiatria Clinica,32(32), 78-88.ABSTRACT: This article describes the available scien-tific evidences concerning the epidemiology, etiology,

clincial evolution, diagnosis, and pharmacological andpsychosocial approaches designed for bipolar disor-der and substance abuse comorbidity. (CIRRIE Ab-stract)

2002

Chong, S.A., Kua, E.H., Subramaniam, M., & Verma,S.K. (2002). Substance abuse in schizophrenia:A Singapore perspective. Social Psychiatry andPsychiatric Epidemiology, 37(37), 326-328.ABSTRACT: BACKGROUND: Most of the infor-mation on the prevalence and patterns of substanceabuse in patients with schizophrenia has been fromstudies conducted in North America and Europe anddata from Asian countries are conspicuously lacking.This study was undertaken with the aim to identify theprevalence and patterns of substance abuse amongpatients with first-episode schizophrenia in the city-state of Singapore. METHODS: All new patients witha diagnosis of first-episode schizophrenia orschizophreniform disorder who were seen in one cal-endar year in the only state mental institute in Singaporeand its affiliated outpatient clinics were evaluated fora lifetime history of substance use. RESULTS: In asample of 272 patients, 201 (73.6 percent) were ab-stainers, 43 (15.8 percent) had “mild” substance useand 28 (10.3 percent) had “heavy” use patterns. Al-cohol was the most frequently abused substance. Thesubstance users were more likely to be males and weremore likely to have a criminal record than abstainers.CONCLUSIONS: To our knowledge, this is the firststudy that examines the co-morbidity of substanceabuse in schizophrenia in an Asian population. Our find-ings once again highlight the fact that patients withschizophrenia are at a high risk for substance abuse.

Documents from the EducationResource Information Center(ERIC) search at www.eric.ed.govare listed below:

2010

Janusis, G.M., & Weyandt, L.L. (2010). An explor-atory study of substance use and misuse amongcollege students with and without ADHD and otherdisabilities. Journal of Attention Disorders, 14(3),205-215.ERIC #: EJ903064ABSTRACT: Objective: The present study investigatedpotential differences between college students with andwithout disabilities (including ADHD, Asperger’s syn-drome, executive functioning disorder, and learning, men-tal health, vision, hearing, and physical/chronic disabili-ties) regarding self-reported substance use and misuse,perceived stress, and sensation seeking. Method: Stu-dents responded to a Stimulant Survey Questionnaire(SSQ), Perceived Stress Scale (PSS), Sensation-Seek-ing Scale (SSS), and items from the National CollegeHealth Assessment (NCHA). Results: The hypotheseswere part supported as MANOVA results revealed thatstudents with disabilities provided significantly lowerratings on the SSS and also reported lower alcohol andmarijuana use. Students with ADHD were more likelyto use or misuse prescription stimulant medication butwere less likely to use alcohol than did students withoutADHD. Conclusion: Students with disabilities comparedto those without disabilities differed on levels of sensa-tion seeking and alcohol and marijuana use. (Contains 2tables.)

2008

Huang, T., Newman, L., & Yu, J. (2008). Substanceuse among young adults with disabilities. Facts fromNLTS2. National Center for Special Education Re-search: Washington, D.C.ERIC #: ED501318ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED501318ABSTRACT: The report uses data from the NationalLongitudinal Transition Study-2 (NLTS2) to answerquestions about the use of alcohol, cigarettes and illegal

drugs such as marijuana, cocaine, and LSD among youngadults with disabilities. The report compares substanceuse among this population with substance use in thegeneral population, and compares different disabilitycategories and demographic groups in substance useand in the receipt of substance abuse prevention edu-cation and services. The NLTS2 is funded by the Na-tional Center for Special Education Research at the In-stitute of Education Sciences, U.S. Department of Edu-cation. NLTS2 was initiated in 2001 and has a nation-ally-representative sample of more than 11,000 studentswith disabilities. The study found that adults with dis-abilities were less likely than those in the general popu-lation to report drinking alcohol and using any illegaldrugs. Young adults with emotional disturbances weremore likely than those in almost all other disability cat-egories to report smoking cigarettes, drinking, and usingmarijuana or other illegal drugs. Young adults with learn-ing disabilities were also more likely than those in manyother disability categories to report smoking, drinking,and marijuana use. (Contains 2 tables, 3 figures, and 23notes.)

2005

Hollar, D. (2005). Risk behaviors for varying cat-egories of disability in NELS:88. Journal of SchoolHealth, 75(9), 350.ERIC #: EJ725343ABSTRACT: A large body of research shows that youthwith disabilities, who comprise about 13 percent of thecountry’s school-aged population, report comparable tohigher incidence rates of alcohol, tobacco, and otherdrug (ATOD) use than their peers. Furthermore, youthwith disabilities who reported ATOD use or who en-gaged in binge drinking had significantly more negativeeducational outcomes and engaged in sexual activity ata younger age than nonusers. This study describes riskfactors for substance use, personal characteristics, as-pects of the attitudinal environment, and educational,employment, and social outcomes among youth across6 categories of disability. Data came from the NationalCenter for Education Statistics’ National EducationLongitudinal Study of 1988-2000 (NELS:88). The find-ings indicate that (a) youth with varying types of dis-abilities are relatively homogeneous with respect to riskbehaviors, personal characteristics, and outcomes; (b)youth with emotional, learning, or multiple disabilities

may be at heightened risk for binge drinking and mari-juana use; and (c) youth with emotional and multipledisabilities may be less likely to graduate from high schoolor its equivalent 8 years beyond the 12th grade. Basedon these results and limitations of the NELS samplingstrategy, appropriate interventions are discussed as wellas the need for more definitive operational definitionsfor disabilities, specifically the biopsychosocial approachused by the International Classification of Functioning,Disability, and Health.

2004

Lorber, C., & Moore, D. (2004). Clinical character-istics and staff training needs of two substance usedisorder treatment programs specialized for per-sons with disabilities. Journal of Teaching in theAddictions, 3(1), 3-20.ERIC #: EJ843904ABSTRACT: The clinical aspects and staff trainingneeds for two substance use disorder (SUD) treatmentprograms that serve persons with co-existing disabili-ties are described. The article addresses SUD preva-lence among persons with disabilities and the corre-sponding specialized treatment needs and accommoda-tions that may be necessary. The philosophical orienta-tions, demographic profiles, and treatment outcome dataare presented. Considerations about staff training arereviewed, and strategies for implementing a compre-hensive staff training program are discussed. (Contains3 figures and 3 tables.)

2002

McCombs, K., & Moore, D. (2002). Substance abuseprevention and intervention for students with dis-abilities: A call to educators. ERIC Digest.ERIC #: ED469441ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED469441ABSTRACT: This digest summarizes basic informa-tion on substance abuse prevention and intervention forstudents with disabilities. It identifies risks associatedwith specific disabilities including mental retardation/developmental disability, emotional disturbance (at high-est risk for substance abuse), attention deficit hyperac-tivity disorder, blindness, and deafness. The digest points

out that as many as 50 percent of spinal cord injuriesand traumatic brain injuries occur as a direct result ofalcohol or drug abuse. Guidelines for prevention effortsinclude more comprehensive research-based school pro-grams, community and family involvement, training forspecial education teachers and counselors in substanceabuse education for this population, and increased ad-vocacy efforts for appropriate prevention and treatmentoptions. (Contains 10 references.)

2000

Guthmann, D. (2000). Identifying and assessing sub-stance abuse problems with deaf, deafened, andhard of hearing individuals.ERIC #: ED452650ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED452650ABSTRACT: This report provides an overview ofchemical dependency, communication barriers, and as-sessment/treatment considerations for individuals whoare deaf or have hearing impairments and have drug oralcohol problems. Following a discussion of the patternof substance abuse, risk factors, and signs and symp-toms, the report describes a model treatment program:the Minnesota Chemical Dependency Program for Deafand Hard of Hearing Individuals. The following recom-mendations for treatment are made: (1) accessibleTwelve Step groups are needed; (2) education/preven-tion services should be provided to individuals who aredeaf or hard of hearing of all ages; (3) there is a needfor accessible outpatient, inpatient, and after care ser-vices; (4) training opportunities about specialized treat-ment considerations should be offered to professionalsworking in the field of chemical dependency; (5) moreinterpreter training programs are needed that offer spe-cialized training in the area of chemical dependency;(6) more chemical dependency counselors are neededwho are fluent in American Sign Language; (7) addi-tional research is needed in the prevalence of chemicaldependency within the Deaf community; and (8) voca-tional rehabilitation counselors are needed to workclosely with chemical dependency treatment programs.(Contains 13 references.)

1994

Bachman, S.S., Drainoni, M., & Tobias, C. (2004).Medicaid managed care, substance abuse treat-ment and people with disabilities: Review of theliterature. Health & Social Work, 29(3), 189.ERIC #: EJ696494ABSTRACT: Most states enroll individuals with dis-abilities who receive Supplemental Security Income inMedicaid managed care plans. The impact of managedcare on these individuals, especially those with substanceabuse disorders, is not well understood. A review of theliterature related to substance abuse, disability, andMedicaid managed care suggests that substance abuseis a serious issue for individuals with disabilities. Moreresearch is needed to determine how the substance abusetreatment needs of individuals with disabilities can bemet through Medicaid managed care. The authors iden-tified topics for a research agenda on the needs of indi-viduals with disabilities who also experience co-occur-ring substance abuse disorders. Implications for socialwork policy and practice are discussed.

Backer, T.E., & Newman, S.S. (1994). Organiza-tional linkage and information dissemination: Strat-egies to integrate the substance abuse and dis-abilities field. Rehabilitation Counseling Bulletin,38(2), 93-107.ERIC #: EJ506257ABSTRACT: Reviews current activities in the fields ofboth substance abuse and disability, and discusses newefforts to take advantage of advances in electronic com-munications and systems change approaches. The workof federal agencies in these areas is highlighted, andlinkages of these agencies with the private sector areadvocated.

Helwig, A.A., & Holicky, R. (1994). Substance abusein persons with disabilities: Treatment consider-ations. Journal of Counseling and Development,72(3), 227-33.ERIC #: EJ478936ABSTRACT: Examines issues and needs of individualswho are physically disabled and have substance abuseproblems. Explores reasons for high rate of substanceabuse among individuals who are physically disabled.Addresses treatment considerations for such individu-als, including individual, family, and educational coun-

seling. Examines prevention issues and assesses im-portance of Americans with Disabilities Act.

McMahon, B.T., et.al. (1994). Prologue to the spe-cial issue on drugs and alcohol: resource centeron substance abuse prevention and disability—bridging the gap. Rehabilitation Counseling Bulle-tin, 38(2), 84-92.ERIC #: EJ506256ABSTRACT: Reports on attempts to bridge the gapbetween the alcohol and drug abuse community and thedisability and rehabilitation community through the cre-ation of the Resource Center on Substance Abuse Pre-vention and Disability in Washington, DC. The higherprevalence of substance abuse among the disabled com-munity identifies them as a high-risk group. Describesproject development and implementation.

1993

Zuckerman, K., Ed. (1993). People with disabili-ties: Alcohol, tobacco, and other drugs resourceguide. Drug free by the year 2000. National Clear-inghouse for Alcohol and Drug Information:Rockville, MD.ERIC #: ED380930ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED380930ABSTRACT: This resource guide provides informationfor counselors, physical therapists, and mental healthprofessionals about alcohol and other drug problems ofindividuals with physical disabilities. The guide beginswith 26 listings of prevention materials, including bro-chures, videotapes, classroom materials, and other items.Information provided for each listing includes publica-tion or production date, length, target audience, setting,readability, availability, and a paragraph-length annota-tion. The guide then presents annotations for nine gov-ernment publications and journal articles and six otherpublications dealing with drug abuse. The guide con-cludes with a list of 16 groups, organizations, and pro-grams dealing with people who have disabilities.

1992

(1992). Understanding a need: Alcohol and otherdrug abuse prevention for people with disabilities.Resource Center on Substance Abuse, Prevention,and Disability: Washington, D.C.ERIC #: ED358613ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED358613ABSTRACT: This booklet provides an overview of al-cohol and other drug abuse prevention, disability, andthe relationship between the two issues. It cites the in-cidence of alcohol and other drug abuse among peoplewith disabilities. It looks at alcohol and other drug abuserisk factors that are disability related, such as medica-tion use, chronic pain, increased stress, adjustment prob-lems, fewer social supports, isolation, unemployment,financial concerns, and limited access to drug abuseeducation. The booklet separates myths from facts andoutlines prevention strategies. Prevention strategies in-clude providing information, developing critical life skills,creating alternatives to drug abuse, involving and train-ing impactors, and influencing policy.

1991

(1991). Americans with disabilities: A look at alco-hol and other drug abuse prevention. ResourceCenter on Substance Abuse Prevention and Disabil-ity: Washington, D.C.ERIC #: ED346638ABSTRACT: This guide to alcohol and other drug abuseprevention for individuals with disabilities begins with adiscussion of Congressional intent in enacting the Ameri-cans with Disabilities Act of 1990 (ADA), the stressfuldemands experienced by Americans with disabilities,and the ways in which these stresses may predisposepeople with disabilities to choose an escape through theuse of alcohol or other drugs. The impact of the ADAon alcohol and drug prevention programs and profes-sionals is outlined. The guide also examines the defini-tion of a person with a disability, architectural and com-munication barriers, discrimination, suggestions to im-prove access and positive interactions, five commonlyheld myths about individuals with disabilities and the factsthat dispel them, and language guidelines regardingpeople with disabilities. The guide concludes with a listof 13 organizational resources and 18 references.

(1991). Disability and enabling: A look at alcoholand other drug abuse prevention. Resource Cen-ter on Substance Abuse Prevention and Disability:Washington, D.C.ERIC #: ED346645ABSTRACT: This leaflet examines how family mem-bers, friends, and professionals sometimes enable indi-viduals with disabilities to abuse alcohol and other drugs.The leaflet points out: that this enabling occurs becauseof overcompensation for the disability by others or be-cause of others’ feeling that the individual with a dis-ability is entitled to use drugs; that the enabling problemcan best be addressed through education and self-evalu-ation; and that the same criteria for reacting to alcoholand other drug abuse should be used for everyone, re-gardless of whether or not someone has a disability.Four commonly held myths about people with disabili-ties and drug use are dispelled with factual information.Three training materials, a videotape, and three printreferences are listed as sources of more information.

(1991). Disability and health implications: A lookat alcohol and other drug abuse prevention. Re-source Center on Substance Abuse Prevention andDisability: Washington, D.C.ERIC #: ED346646ABSTRACT: This leaflet examines the impact of alco-hol and other drug use in creating an unhealthy lifestylefor individuals with disabilities and placing them at riskfor health and medical problems. The negative effectsof even moderate amounts of alcohol are noted, and thehindering of rehabilitation efforts when a person with adisability is using alcohol or other drugs is pointed out.Behaviors associated with disabilities that are similar tothe consequences of alcohol and other drug abuse islisted. A section titled “Did You Know That...” cites theimpact of certain medications on the body’s processingof alcohol and notes specific examples of the impact ofalcohol in causing arthritis, bedsores, and fetal alcoholsyndrome. Three organizational resources, a videotape,three training materials, and three references are listedas sources for more information.

(1991). Disability and the family: A look at alcoholand other drug abuse prevention. Resource Cen-ter on Substance Abuse Prevention and Disability:Washington: D.C.ERIC #: ED346644

ABSTRACT: This leaflet examines alcohol and otherdrug abuse prevention in individuals with disabilities andthe influence of the family. It points out the family’spotential negative reactions to a disability and reasonswhy a person with a disability uses alcohol or other drugs.Prevention guidelines for families are provided, such asexpressing concerns in a caring but firm way and en-couraging the child with a disability to become involvedwith a peer group. Four commonly held myths aboutindividuals with disabilities and their families and theimpact of drug use are noted and dispelled with factualinformation. Six organizational resources and three ref-erences are listed as sources of more information.

Leone, P.E. (1991). Alcohol and other drug use byadolescents with disabilities. ERIC Digest #E506.Council for Exceptional Children: Reston, VA.ERIC #: ED340150ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED340150ABSTRACT: This digest, based on a longer documenttitled “Alcohol and Other Drugs: Use, Abuse, and Dis-abilities” by Peter E. Leone, addresses the followingquestions: (1) “Are students with disabling conditionsmore likely to use or abuse alcohol or other drugs thantheir peers?” (usually a “no” response); (2) “Are stu-dents with problems of alcohol and drug dependencyentitled to special education and related services?” (notunder the Individuals with Disabilities Act or Section504 of the Rehabilitation Act of 1973); (3) “How shouldschools respond to students enrolled in special educa-tion programs who use drugs and/or alcohol?” (developawareness and prevention activities and referral to treat-ment efforts); and (4) “How can schools and educatorsdeter students enrolled in special education programsfrom using drugs and alcohol?” (despite the lack of ef-fectiveness data on school-based prevention programs,there is some evidence that schools can provide qualityeducational services and coordinate with other agen-cies). Includes 10 references and a list of 4 additionalresources.

1990

(1990). Substance use by youth with disabilities andchronic illnesses, Second edition. National Centerfor Youth with Disabilities: Minneapolis, MN.

ERIC #: ED329069ABSTRACT: This annotated bibliography on substanceuse by youth with disabilities and chronic illnesses listsreferences published since 1980 that directly addressthe special developmental needs of adolescents andyoung adults. The bibliography’s scope includes all dis-abilities and the use or abuse of a wide range of drugs—alcohol, illicit drugs, nicotine, and non-medicinal use ofprescribed drugs. The approximately 80 books and jour-nal articles listed are arranged into a general sectionand a section on training materials. The general sectionis subdivided by disability type: mental retardation; learn-ing disabilities and attention deficit disorders; mental ill-ness and emotional disturbances; sensory disabilities;other physical disabilities; chronic illnesses; and mul-tiple disability groups. The training materials sectiondescribes approximately 20 curricula, booklets, Braillematerials, and videotapes. A treatment selection check-list concludes the resource guide. The checklist listsquestions to ask in selecting a treatment program, basedon its philosophy and program structure, treatment com-ponents, educational services, aftercare, family involve-ment, staff, and finances.

Moore, D. (1990). Research in substance abuse anddisabilities: The implications for prevention andtreatment.ERIC #: ED337955ABSTRACT: This paper reviews literature related tosubstance abuse and persons with disabilities. The pa-per distinguishes between congenital disability andtrauma-generated conditions and the impact on drug use.Drug use patterns are also differentiated by type andseverity of disability categories including mental illness,orthopedic and physical disability, learning disability, hear-ing impairment and deafness, visual impairment, anddevelopmental disability or mental retardation. Specialproblems when studying substance abuse among thedisabled include low awareness of the problem amongfamily members, friends, and professionals; samplingproblems in substance abuse research; and limited re-sources for research. Substance abuse risk factors thatare unique to individuals with disabilities include soci-etal entitlement of drug use by individuals with disabili-ties, physical health problems, long-term use of medica-tion, atypical childhood experiences, sexuality, andchronic pain. Persons with disabilities may need spe-

cialized or additional services for chemical dependencytreatment. Development of these services requires con-sideration of such issues as use of a treatment modelother than the disease model, use of therapeutic drugsin the form of prescribed medications, use of “handi-capped” behaviors by clients, involvement of significantothers, and aftercare. Future directions are discussed.(Includes 27 references)

1989

(1989). Chemical abuse among older women, olderadults and disabled people. Final grant report.Hazelden Foundation: Center City, MN.ERIC #: ED330159ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED330159ABSTRACT: This one-year project identified severalgoals to increase the awareness of chemical abuseamong older women, older adults, and disabled people.The goals included: develop an assessment instrument;identify chemical health service providers; develop aprocess to coordinate outreach and case-finding; de-velop a guide for chemical health service providers; pro-vide a training conference; and convene an advisorycommittee. Project activities carried out to achieve thesegoals are described. Recommendations are offered con-cerning the development of a screening tool, trainingneeds, and distribution of the project’s products. Ap-pendixes, which make up the bulk of the report, contain:(1) a literature review titled “Screening for ChemicalAbuse in Three Populations: Older Adults, People withSevere and Persistent Mental Illness, People with Physi-cal Disabilities” and descriptions of ten screening andassessment instruments; (2) a report titled “HazeldenScreening Study: Report of Instrument Analysis” whichexamines the item analysis, reliability, validity, and se-lection of cut score for instruments designed by projectstaff to screen for chemical problems; (3) training ma-terials on behavioral symptoms of chemical dependency,impact of chemical dependency on special populations,interviewing techniques, participant consent, and coor-dinated service delivery; and (4) copies of the project-designed screening tools and questionnaires to gatherdemographic information on participants.

Allison, K.W., & Richardson, K.A., comps. and eds.(1989). Annotated bibliography of substance abuseamong handicapped, disabled and high risk indi-viduals [and] prevention and treatment resourcesfor the handicapped or disabled substance abuser.University of Maryland: College Park, MDERIC #: ED312799ERIC Full-Text: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED312799ABSTRACT: The bibliography lists English-languagejournal articles, book sections, a dissertation, and an of-ficial State of Wisconsin report, addressing the topic ofsubstance abuse among handicapped and high-risk indi-viduals. The entries are arranged in five sections ac-cording to handicapping condition and provide basic bib-liographic information and a paragraph-length annota-tion. Included are seven citations on substance abuseamong persons with physical and sensory impairments,seven citations concerning persons with mental retar-dation, 19 citations concerning individuals with emotionaland behavioral disorders, six citations concerning juve-nile delinquents, and eight citations concerning individu-als with learning problems and individuals in high-riskgroups. The bibliography is followed by a separate listof prevention and treatment resources for the handi-capped or disabled substance abuser in which organiza-tional resources that offer information, workshops, andprevention programs are briefly described.

Documents from theNational Clearinghouse ofRehabilitation TrainingMaterials (NCRTM) search

at ncrtm.org are listed below:

2002

Burganowski, D.F., Kauppi, D.R., Larson, D.M., &Stewart, E. (2002). Substance abuse and adoles-cents with disabilities. Rehabilitation ContinuingEducation Program, State University of New York atBuffalo.PDF: http://library.ncrtm.org/pdf/331.002.pdfABSTRACT: This training module is directed towardsan audience of rehabilitation counselors working withyouth (14-18 years old) with the disability of psychoac-tive substance abuse or dependence concurrent withsome other disabling condition. Information in this train-ing module is also appropriate for supervisors, as wellas for administrators employed in a vocational rehabili-tation setting.

1993

Goodwin Jr., L.R. (1993). A bibliography of selectedsubstance abuse readings on dual disorders, voca-tional rehabilitation, and general substance abusethemes in the rehabilitation literature. SubstanceAbuse Counselor Education Program, East Caro-lina University: Greenville, NC.PDF: http://library.ncrtm.org/pdf/331.068.pdfABSTRACT: This bibliography is divided into four sec-tions: 1) Substance Abuse and General, which includesjournal articles, monographs, books, and chapters frombooks in the rehabilitation literature; 2) Dual Diagnosis:Substance Abuse and Mental Disorders; 3) Dual Diag-nosis: Substance Abuse and Physical Disabilities; and4) Substance Abuse and Vocational Rehabilitation.

Documents from the NationalLibrary of Medicine PubMedsearch at www.pubmed.com are

listed below:

2010

Ebener, D., & Smedema, S.M. (2010). Substanceabuse and psychosocial adaptation to physical dis-ability: Analysis of the literature and future direc-tions. Disability & Rehabilitation, 32(16), 1311-9.PMID #: 20156048ABSTRACT: PURPOSE: To analyze the current stateof the literature with respect to substance abuse andpsychosocial adjustment in persons with disabilities.METHOD: The two primary databases containing theliterature related to rehabilitation and disability issues(PsychINFO and MedLine) were searched to identifyarticles addressing the psychosocial impact of substanceabuse in persons with disabilities. Eleven empirical ar-ticles specifically measuring the strength of the rela-tionship between substance use and psychosocial out-comes in persons with disabilities were selected foranalysis. RESULTS: Of the studies identified, five wererelated to spinal cord injury, three were related to trau-matic brain injury, one was related to chronic back pain,one was related to HIV/AIDS, and one was related topersons with any type of disability. Each of the studiesused different methodologies, measured substance abusein different ways, and examined different psychosocialoutcome variables. Examination of trends suggested thatpre-injury substance abuse appears to be unrelated toacceptance of disability in persons with spinal cord in-jury and negatively associated with satisfaction in per-sons with traumatic brain injury. Recent substance abusetends to have a detrimental effect on psychosocial out-comes across all disability groups. CONCLUSIONS:Future research, combined with appropriate pre-serviceand continuing education related to substance abuse anddisability for rehabilitation practitioners, has the poten-tial to lead to improved psychosocial outcomes in per-sons with disabilities.

Slayter, E.M. (2010). Disparities in access to sub-stance abuse treatment among people with intel-lectual disabilities and serious mental illness.Health & Social Work, 35(1), 49-59.PMID #: 20218453

ABSTRACT: People with intellectual disabilities (ID)have experienced increasing levels of community par-ticipation since deinstitutionalization. This freedom hasfacilitated community inclusion, access to alcohol anddrugs, and the potential for developing substance abuse(SA) disorders. People with ID, who are known to havehigh rates of co-occurring serious mental illness (SMI),may be especially vulnerable to the consequences ofthis disease and less likely to use SA treatment. Usingstandardized performance measures for SA treatmentaccess (initiation, engagement), rates were examinedretrospectively for Medicaid beneficiaries with ID/SA/SMI ages 12 to 99 (N = 5,099) and their counterpartswith no ID/SA/SMI (N = 221,875). Guided by thesociobehavioral model of health care utilization, age-adjusted odds ratios and logistic regression models wereconducted. People with ID/SA/SMI were less likelythan their counterparts to access treatment. Factorsassociated with initiation included being nonwhite, livingin a rural area, and not being dually eligible for Medi-care; factors associated with engagement included allof the same and having a fee-for-service plan, a chronicSA-related disorder, or both. Social work policy and prac-tice implications for improving the health of people withID/SA/SMI through policy change, cross-system col-laboration, and the use of integrated treatment ap-proaches are discussed.

2007

Capps, C.F., Luck, R.S., & West, S.L. Physical inac-cessibility negatively impacts the treatment par-ticipation of persons with disabilities. AddictiveBehaviors, 32(7), 1494-7.PMID #: 17258869ABSTRACT: This research assessed the impact thatphysical inaccessibility of provider locations has on thesubstance abuse treatment participation of two groupsof persons with disabilities. A random sample of treat-ment providers in the Mid-Atlantic region were surveyedand asked if they had declined services to persons withspinal cord (SCI) or traumatic brain (TBI) injuries dueto the inaccessibility of their practices. Over half ofthose who had been approached by persons with SCIand nearly half of those approached by persons withTBI were unable to provide services due to physicalbarriers. The inability to serve such individuals was notrelated to practice affiliation (public or private) or prac-

tice type (hospital based, non-medical residential, or out-patient). These findings support earlier research indi-cating the treatment participation of persons with dis-abilities is negatively affected by physical accessibilityconcerns.

Deck, D., Farrell, N., Gabriel, R., & Krahn, G. (2007).A population-based study on substance abusetreatment for adults with disabilities: access, utili-zation, and treatment outcomes. The AmericanJournal of Drug & Alcohol Abuse, 33(6), 791-8.PMID #: 17994475ABSTRACT: AIMS: To examine potential disparitiesin access to substance abuse treatment services forMedicaid-eligible adults with disabilities, and compareutilization rates and outcomes in outpatient programs.DESIGN: Population-based multi-year cross-sectionalstudy. SETTING: State-wide examination of substance-abuse treatment, particularly outpatient. PARTICI-PANTS: Medicaid enrollees aged 18-64. MEASURES:Treatment access and utilization; outcome measures ofretention, completion, readmission, and abstinence de-rived from state treatment and Medicaid databases.FINDINGS: Access and utilization rates for adults withdisabilities were about half others’ rates; treatment out-comes were generally equivalent across groups. CON-CLUSIONS: Adults with disabilities are underutilizingsubstance abuse treatment, suggesting barriers to ac-cessing treatment.

West, S.L. (2007). The accessibility of substanceabuse treatment facilities in the United States forpersons with disabilities. Journal of SubstanceAbuse Treatment, 33(1), 1-5.PMID #: 17499956ABSTRACT: This study assessed the accessibility ofa nationally representative sample of substance abusetreatment facilities in the United States for persons withdisabilities (PWDs). A stratified random sample of 159substance abuse treatment facilities in 40 states com-pleted a survey regarding physical accessibility and theprovision of services that could enhance the ability toserve individuals with disabilities. Most responding fa-cilities self-reported a variety of barriers to physicalaccessibility, as well as the lack of services and physi-cal accommodations for persons with sensory limita-tions. Such widespread inaccessibility may be a factorthat promotes the low representation of PWDs in thetreatment population.

2006

Deck, D., Farrell, N., Gabriel, R., & Krahn, G. (2006).Access barriers to substance abuse treatment forpersons with disabilities: An exploratory study.Journal of Substance Abuse Treatment, 31(4), 375-84.PMID #: 17084791ABSTRACT: Research in substance abuse (SA) treat-ment has demonstrated that persons with disabilities(PWDs) are at substantially higher risk for SA than per-sons without disabilities. Despite their higher risk, PWDsaccess SA treatment at a much lower rate than personswithout disabilities. Using the Behavioral Model for Vul-nerable Populations as a research framework, we iden-tified reasons for differences in access to SA treatmentfor Medicaid-eligible adults with disabilities in Oregonthrough a multiphase study. Analyses of demographicand referral source data, along with interviews with keystate agency representatives, adults with disabilities, andtreatment program personnel, helped identify barriersto SA treatment access. These barriers are reflected asattributes of PWDs, contextual variables that enable orimpede access, recognition of the need for SA treat-ment, and characteristics of treatment services. The find-ings suggest needed policy and practice changes to in-crease access rates for PWDs. They provide directionfor future research.

2004

Bachman, S.S., Drainoni, M.L., & Tobias, C. (2004).Medicaid managed care, substance abuse treat-ment, and people with disabilities: Review of theliterature. Health & Social Work, 29(3), 189-96.PMID #: 15453057ABSTRACT: Most states enroll individuals with dis-abilities who receive Supplemental Security Income (SSI)in Medicaid managed care plans. The impact of man-aged care on these individuals, especially those withsubstance abuse disorders, is not well understood. Areview of the literature related to substance abuse, dis-ability, and Medicaid managed care suggests that sub-stance abuse is a serious issue for individuals with dis-abilities. More research is needed to determine how thesubstance abuse treatment needs of individuals with dis-abilities can be met through Medicaid managed care.The authors identified topics for a research agenda onthe needs of individuals with disabilities who also expe-

rience co-occurring substance abuse disorders. Impli-cations for social work policy and practice are discussed.

2003

Crowley, M.O. (2003). Latino access to mentalhealth, developmental disabilities, and substanceabuse services in North Carolina. North CarolinaMedical Journal, 64(3), 127-8.PMID #: 12854308No abstract is available.

Janekoviæ, K. (2003). Comparative research onsubstance abuse and self-perception among ado-lescents with physical handicap. CollegiumAntropologicum, 27(2), 479-89.PMID #: 14746134ABSTRACT: The research on substance (alcohol, to-bacco and drug) abuse and on self-perception was doneby comparing a test group of physically disabled ado-lescents and a test group of non-disabled adolescents.The respondents of the experimental group were stu-dents of the only special high school for physically handi-capped persons in Croatia, Zagreb. The respondents ofthe control group were the students of two regular highschools in the capital of Croatia. The instrument used inthis research was a self-reported, anonymous question-naire. The respondents completed the questionnaire inthe classroom. The data analysis regarding alcohol abuseindicated that physically disabled adolescents drink moreoften and out of quite different motives than their non-disabled peers. Regarding the prevalence, frequency,quantity and motives for smoking, no statistically sig-nificant difference has been found between the testedgroups. On the contrary, significant differences betweenhandicapped and non-disabled adolescents were evi-dent regarding drug abuse. Only one physically disabledexaminee used a drug—marijuana, only a few times ayear. On the other hand, almost one quarter of the non-disabled adolescents use at least one, five at the most,type of drug sometimes or often. The results on theself-perception scale show that adolescent with physi-cal disabilities have a much more negative attitude to-ward themselves than non-disabled controls. Their self-esteem and self-confidence are seriously diminished.Described findings could have a mighty impact on waysof preventing substance abuse, and on ways of increas-ing self-esteem among disabled and non-disabled ado-lescents.

2001

Cosden, M. (2001). Risk and resilience for sub-stance abuse among adolescents and adults withLD. Journal of Learning Disabilities, 34(4), 352-8.PMID #: 15503579ABSTRACT: Substance abuse is a major problem af-fecting the health and well-being of many people in oursociety. Although anecdotal evidence concerning link-ages between learning disabilities (LD) and substanceabuse has been common, this association is not welldocumented or understood. This article reviews the cur-rent research on substance abuse for adolescents andadults with LD, interpreting findings within a risk andresilience framework. Integrating these studies with thebroader literatures on substance abuse and the needs ofindividuals with LD, the author develops hypothesesregarding specific risk and protective factors that couldaffect the occurrence of substance abuse for adoles-cents and adults with LD. Potential risk factors includea poor understanding of one’s disability, a lack of skillsfor developing peer relationships, and the need for pro-longed family support. Future directions for research inrelation to prevention of and intervention regarding sub-stance abuse among individuals with LD are discussed.

1993

Rush, B., & Tyas, S. (1993). The treatment of dis-abled persons with alcohol and drug problems:Results of a survey of addiction services. Journalof Studies on Alcohol, 54(3), 275-82.PMID #: 8387615ABSTRACT: This report provides information on dis-abled clients that was collected as a supplement to the1989 Addiction Research Foundation survey of alcohol/drug services in Ontario. The estimated prevalence ofdisabled clients in the treatment population was highestfor those with psychiatric disorders (10.3 percent), fol-lowed by physical disabilities (mobility, 3.7 percent; vi-sion, 1.5 percent; hearing, 1.4 percent; other impairments,0.1 percent) and developmental handicaps (2.3 percent).There were, however, relatively few agencies reportingservices tailored specifically for the disabled. Respon-dents generally felt that clients with psychiatric disor-ders or developmental handicaps would be better servedby specialized programs with additional staff training,while the physically disabled could be adequately served

in “mainstream” services. Resources for physically dis-abled clients were not available in many addiction pro-grams. Not all agencies desired these resources, how-ever, even if funding were to be made available. Otherfactors were also important, such as the architecturalfeasibility of wheelchair accessibility, or the perceptionamong the agencies that outreach capacity was beyondthe role of their program. Implications of various meth-ods of service delivery for the disabled are discussed.

1990

Brillhart, B.A., & Kircus, E. (1990). Dealing withsubstance abuse among people with disabilities.Rehabilitation Nursing, 15(5), 250-3.PMID #: 2399359ABSTRACT: Many persons with physical disability havea hidden disability: substance abuse involving alcoholand/or psychotropic drugs. Patterns of substance abusebehavior vary according to use before disability, follow-ing the onset of disability, or both before and followingthe onset of disability. Substance abuse has a negativeimpact on a person’s vocation, academic performance,family life, and social life, as well as on physical health.Rehabilitation nurses need assessment skills and inter-ventions specifically aimed at dealing with substanceabuse.

The following excerpt is referenced from the Chris-topher & Dana Reeve Foundation, Paralysis ResourceCenter information sheet on Substance Abuse and Dis-ability featuring information from theU.S. Departmentof Health and Human Services, Office on Disability FactSheets on Subtance Abuse (http://www.hhs.gov/od/about/fact_sheets/substanceabusech26.html).

Substance use disorders occur more often in personswith disabilities than in the general population. Thisincludes problems related to the abuse of prescriptionmedications as well as illicit drugs. In the generalpopulation, alcoholism affects 10% of individuals and5% are addicted to drugs.

Moore (2002) estimates that as many as 1.5 millionindividuals with disabilities may need treatment forsubstance use disorders in any given year. TheSubstance Abuse and Mental Health Servicesadministration (SAMHSA) (2002) estimates thatapproximately 4.7 million American adults with adisability have a cooccurring substance abuseproblem.

Persons with any type of disability experiencesubstance abuse at rates 2 to 4 times that of thegeneral population. Substance abuse prevalencerates approach or exceed 50% for persons withtraumatic brain injuries, spinal cord injuries, ormental illness.

Conditions such as deafness, arthritis, and multiplesclerosis have shown substance abuse rates of atleast double the general population estimates.

Where persons with spinal cord injuries, orthopedicdisabilities, vision impairment, and amputationsconsume alcoholic beverages, approximately 40-50% and be classified as heavy drinkers.

Data indicates that rates of substance abuse varywidely across disabilities. Spinal cord and traumaticbrain injury populations have been found to havesubstantially higher rates of substance abuse disordersthan the general population.

Online Resources Related to Substance Abuseand Individuals with Disabilities

Advance for Directors of RehabilitationArticle on Substance Abuse and Disabilityrehabilitation-director.advanceweb.com/common/editorial/editorial.aspx?CC=8066

Craig Hospital article on Alcohol Abuse and SCIAs people age, their bodies become less able tohandle alcohol. As a result, they can become problemdrinkers without increasing their consumption.Alcohol can cause serious health and safetyproblems for all older people. SCI survivors are evenmore at risk because their systems are alreadycompromised and they tend to take more medications.www.craighospital.org/SCI/METS/alcoholAbuse.asp

National Association on Alcohol, Drugs andDisability (NAADD)The National Association on Alcohol, Drugs andDisability Inc., (NAADD) promotes awareness andeducation about substance abuse among people withco-existing disabilities. The mission of NAADD is tocreate public awareness of issues related toalcoholism, drug addiction, and substance abusefaced by persons with other co-existing disabilities,and to provide a peer approach to enhance accessto services, information, education and preventionthrough the collaborative efforts of interestedindividuals and organizations nationwide.Phone: 651/578-8047www.naadd.org

Ohio Valley Center for Brain Injury Preventionand Rehabilitation: Substance Abuse and BrainInjuriesProvides information on programs, research andtraining on the issues of substance abuse and TBI.www.ohiovalley.org/abuse/index.html

Quick Looks

Oregon Brain Injury Resource NetworkProvides a bibliography on substance abuse.www.multnomah.or.networkofcare.org/aging/resource/agencydetail.cfm?pid=MCAG0329AA_247_1_0

Substance Abuse Resources and Disability Issues(SARDI)The SARDI Program at the Wright State University inDayton, Ohio seeks to improve the quality of life forpersons with disabilities, including those who areconcurrently affected by behavioral health issues. TheSARDI Program achieves its objective by conductingcollaborative and participatory research; developingintervention approaches; and training; and disseminatingrelated information.Phone: 937/775-1484www.med.wright.edu/citar/sardi

Synapshots: Substance Abuse and TBIPresents information on topics such as how commonthe problem is, the effects of substance abuse, andtreatment for substance abuse.www.synapshots.org

U.S. Dept of Health and Human ServicesOffice of Disability: Substance Abuse and Disabilitywww.hhs.gov/od/about/fact_sheets/substanceabusech26.html

U.S. DHHS’s Substance Abuse and Mental HealthServices Administration’s National Clearinghousefor Alcohol and Drug InformationToll Free: 800/729-6686ncadi.samhsa.gov

Publications

Exploring Substance Abuse among MinoritiesWith Disabilities and its Associations with theirExperiences in Vocational Rehabilitation. HowardUniversity Monograph: Washington, D.C.w w w. m e d . w r i g h t . e d u / c i t a r / s a r d i / f i l e s /pdf_monograph.pdf

Guide to Substance Abuse and Disability ResourcesAvailable in print and online. Funded by NIDDR.

(2001). http://www.naric.com/research/rehab/download.cfm?ID=92058

(1999). http://www.naric.com/research/rehab/download.cfm?ID=91493

SARDI Materialswww.med.wright.edu/citar/sardi/products.html#additionalresources

University of Washington: Northwest RegionalSpinal Cord Injury System: Alcohol and Your Health

After SCI (Spring 2003)http://sci.washington.edu/info/newsletters/articles/03sp_alcohol.asp

Alcohol Abuse and SCI (Summer 1996)http://sci.washington.edu/info/newsletters/articles/96su_alcohol_abuse.asp

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