Rehab 4 Addiction

In the UK, there are over 11 million people living with some form of disability. [1]

Not only is disability prevalent among the general population, rates of disability are also high among those going for drug and alcohol treatment. The proportion of people going in for drug or alcohol treatment in the UK in 2016 citing at least one disability was 18%. [2]

The issue of addiction among the disabled population is a complex one. For some disabilities, such as intellectual and developmental disabilities, the rates of substance abuse disorder (SUD) are higher than in the general population. [3] For other disabilities, such as physical disabilities, there seems to be less of a link with addiction.

In this page, we discuss the topic of addiction treatment for those suffering from a disability. We will also look at risk factors which might push a disabled person towards substance abuse. Finally, we will discuss ways in which alcohol and drug rehabs can cater for disabled people, who make up a sizeable proportion of their patients.

What is a disability?

The UK government defines a disability as a physical or mental impairment which has a substantial and long-term negative effect on your ability to do normal daily activities. [4]

Progressive conditions are conditions that get worse over time. They can be classed as a disability. Addiction to drugs or alcohol is not classed as a disability.

Some examples of impairments which can qualify as a disability include:

  • Auto-immune conditions
  • Conditions related to specific organs, such as asthma, heart disease and cardiovascular diseases
  • Developmental diseases such as autism
  • Fluctuating conditions such as arthritis, depression and epilepsy
  • Impaired eyesight or hearing
  • Impairments caused by injury to the body, including the brain
  • Learning disabilities
  • Mental health conditions that cause anxiety, panic attacks, self-harm and other symptoms
  • Mental illnesses such as schizophrenia
  • Progressive conditions such as motor neurone disease [5]

Mental illness and disability

As shown by this list, severe mental illnesses are now considered disabilities in the UK. However, the link between mental illness and disability does not stop there.

Learning disabilities and mental illness

What is a learning disability? It is a disability that limits three aspects of normal functioning. These include social skills (interacting with others), conceptual skills (reading and writing) and practical ability (to do normal daily tasks, such as getting dressed or washing). [6]

People with learning disabilities frequently suffer from some form of co-occurring mental health problem. One survey found that people with lower intellectual ability were more likely to have a mental health problem (25%) compared with those of average IQ (17.2%). [7]

One of the problems with linking intellectual and learning disabilities with mental illness is that doctors frequently fail to diagnose mental health problems in the intellectually disabled population. They may mistake symptoms of mental health problems with symptoms of a learning disability. [8]

Physical disabilities and mental illness

More than 15 million people in the UK live with a long-term physical condition. Of these, 4 million have some form of mental health problem. [9]

There is clearly a link between physical disability and mental illness. This link runs both ways. People with physical disabilities are more likely to develop mental health problems; people with mental health problems are more likely to get physical health problems.

The 2014 Adult Psychiatric Morbidity Survey (APMS) found that more than a third (37.6%) of people with severe symptoms of mental illness had some form of long-term physical condition. Around a quarter (25.3%) of those with no symptoms of mental illness had a long-term physical condition.

This suggests a massive correlation between mental and physical ill-health, which should come as no surprise. Scientists have long been aware of the link between mental and physical health.

Poor mental and physical health are also major risk factors in the development of a SUD. Substance use is often a cause and a symptom of poor health.

Substance use disorders and disability

As mentioned above, around 18% of people admitted to treatment for a drug or alcohol disorder in the UK suffer from a disability. The real figure could even be higher as some disabilities are undiagnosed.

What is the reason for this link between disability and SUDs? Why is it that people with disabilities turn to substances?

The answer to that question is a complex one. In order to do it justice, we will need to look at a few different kinds of disability in more detail.

However, we can make a few broader statements about the link between disability and SUDs.

Disabilities, as we have seen, are heavily linked with mental illness. Not only do many mental illnesses qualify as disabilities in their own right, they can also lead to physical disabilities, and be caused by physical disabilities.

The link between mental illness and addiction has been well-established. Mental illness provides one clue as to the relationship between disability and SUDs.

It may also be the case that people with physical disabilities are more likely to turn to drugs or alcohol, especially if they are less mobile and spend more time confined in their house.

Intellectual disabilities and substance use disorders

Studies have shown that a relatively small number of those with intellectual disabilities drink alcohol or misuse substances. However, for those who do use substances, they have a higher risk of developing a SUD. [10] [11]

Another interesting feature of these studies is that they found greater levels of substance abuse among people with intellectual disabilities (ID) who were on the milder end of the spectrum. In other words, someone with relatively mild ID was more likely to have a substance use disorder than someone with a more severe ID.

One factor that might explain this is the greater freedom and independence enjoyed by those with milder IDs. Greater freedom equates to an increased ability to buy alcohol and drugs. Therefore, greater freedom could lead to a higher risk of developing a SUD.

Why might disabled people be at risk of developing a substance use disorder?

We’ve touched upon a few risk factors that could cause a person with a disability to develop a SUD, such as decreased mobility.

There are several other risk factors involved. These factors make it more likely that a disabled person who has the ability to access alcohol or drugs will develop a SUD.

They also make disabled people more difficult to treat, since their conditions are often more complex and feature co-occurring mental and physical health problems.

Of course, disabled people should have the exact same access to treatment as able-bodied people but rehab centres need to be aware that their treatment needs may be more complex.

Here is a list of some of the risk factors which disabled people face:

  • Chronic medical problems and pain
  • Easier access to prescription medications
  • Enabling by caregivers
  • Increased risk of mental illness
  • Increased risk of physical and sexual abuse
  • Lack of access to education
  • Social isolation
  • Unemployment and poverty

Substance use disorders in specific disability populations

Physically disabled people who suffer from pain are more likely to use drugs that provide some sort of pain relief. That includes cannabis, heroin, alcohol and prescription opioids like Vicodin (hydrocodone) and OxyContin (oxycodone).

Physically disabled people will often be prescribed pain-relief drugs such as Vicodin and OxyContin. Although they are very effective, they are also very addictive.

They can also lead to heroin use. One study found that 80 per cent of people who used heroin first misused prescription opioids. [12]

There is a perception that cannabis is a lot less dangerous than the other drugs mentioned above (heroin, alcohol, prescription opioids).

However, this is still contested, and there is a worrying correlation between cannabis usage and developing certain mental illnesses such as schizophrenia.

Given the already elevated risk of disabled people suffering from a mental illness, it could be argued that cannabis presents a major risk to this population.

Substance use disorders among the deaf population are also common. For instance, this study found that alcohol and drug use among young deaf and hard of hearing people was similar to in the hearing population; however, among those who did drink or use drugs, they were much more likely to have a SUD. [13] This seems to be a general trend among those with disabilities.

In people with spinal cord injuries in the US, the rates of substance use are very high. One study found that as many as 50% of people with spinal cord injuries have problems with alcohol. [14]

This could be caused by a range of things. One is the lack of mobility associated with spinal cord injuries, including paraplegia and quadriplegia. Another is the lack of employment options. A third reason is the social alienation caused by a spinal injury.

Issues surrounding health

There are several issues to do with health among the disabled population. This includes issues tied to substance abuse, as well as other issues related to treatment and social problems.

Problems getting medical treatment. Those with disabilities tend to be less mobile. They may also be other barriers to treatment, such as a deaf person struggling to find a doctor who knows sign language.

Substance use also makes it less likely that a disabled person will seek out treatment, and follow a doctor’s advice. There is therefore a danger that someone with a lot of pain self-medicates with alcohol or drugs rather than seeking proper help.

Prescription medication. Many physically disabled people who suffer from debilitating pain have no choice but to use prescription medication in order to manage this pain. That creates a danger, since prescription opioids especially are addictive.

Physical health problems. Disabled people, whether they have a physical or mental disability, have a higher risk of developing a physical health problem. Intoxication further raises the risk of injury.

Social issues and difficult getting a job. Disability can make it harder to meet people. It can also lower your employment opportunities. These factors can lead to alienation and impoverishment, which in turn leads to a higher risk of substance abuse and mental illness.

There are also health issues to do with alcohol that are specific to certain disabilities. One example is rheumatoid arthritis. Many take opioid pain medications for this condition, or other medications that are designed for arthritis.

Both kinds exert pressure on the liver. When this is combined with an alcohol use disorder, it can significantly raise the chances of developing a liver disease like cirrhosis.

Another example is Parkinson’s disease. Recent studies have suggested that there might be a link between Parkinson’s and neurotoxicity, which is damage to the nerve system due to the use of substances. [15]

Scientists have posited that the abuse of amphetamine (speed) could lead to the development of Parkinson’s. That may also mean that drug use could accelerate the progress of Parkinson’s disease, which would be another risk to this disabled population.

Getting treatment

One of the main problems for disabled people who have SUDs is getting treatment. There are several barriers that can make it difficult for disabled people to get treatment.

A lack of mobility is one obvious barrier that can prevent physically disabled people from accessing treatment. Disabled people need to be able to get to a hospital or a clinic, and that can be difficult if they are unable to walk or drive.

Another problem is a lack of knowledge among medical staff, who may not know enough about a person’s disability to provide them with adequate care.

Communications barriers, such as those faced by a deaf or mute people, add another potential difficulty.

Finally, some hospitals and clinics simply are not well-designed for disabled people. They may not have adequate ramps for people with wheelchairs, for example. It is worth noting, however, that infrastructure for disabled people has improved a lot in the UK in recent years. [16]

SAMHSA recommendations for treating disabled people with SUDs

SAMHSA (Substance Abuse & Mental Health Service Administration) created a protocol for treating disabled people with SUDs. [17] It offers several ideas for how best to cater to disabled people.

Here are some of the main ones:

  • Staff training is crucial. One of the biggest barriers is staff not understanding the disabilities of their patients. Training staff to deal with these disabilities makes a huge difference
  • Integrating disabled people into existing services is the best policy. Where this is not possible, you may have to come up with a specialized service
  • For the blind or visually impaired, make sure avenues and corridors are clear of obstacles. Use braille where possible and large font for signs. Finally, use oral announcements as well as bulletin board. This caters to blind and hard of hearing people
  • Treatment staff should give the blind and visually impaired a walking tour of their new environment when they first arrive. This will help them to orientate themselves

Final thoughts

Treating people with disabilities presents lots of challenges, but we should treat these as opportunities for developing and improving accessibility rather than a chore.

The fact of the matter is that there are a huge number of disabled people, and many of them suffer from SUDs. The sooner treatment facilities become accessible and teach their staff how to deal with this section of the population, the better.

If you or a loved one is considered disabled and you wish to learn about treatment options, please get in touch today on 0800 140 4690.You can learn more about team here.

References

[1] https://www.gov.uk/government/publications/disability-facts-and-figures/disability-facts-and-figures#fnref:7

[2] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/658056/Adult-statistics-from-the-national-drug-treatment-monitoring-system-2016-2017.pdf

[3] https://bmjopen.bmj.com/content/6/9/e011638.full

[4] https://www.gov.uk/definition-of-disability-under-equality-act-2010

[5] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/570382/Equality_Act_2010-disability_definition.pdf

[6] https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-about-mental-health-2016.pdf

[7] Raj, D., Stansfeld, S., Weich, S., Stewart, R., McBride, O., Brugha, T., … & Papp, M. (2016). Chapter 13: Comorbidity in mental and physical illness. In S. McManus, P. Bebbington, R. Jenkins, & T. Brugha (Eds.), Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.

[8] https://www.mentalhealth.org.uk/sites/default/files/fundamental-facts-about-mental-health-2016.pdf

[9] Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossy, M., & Galea, A. (2012). Long-term conditions and mental health – The cost of co-morbidities

[10] https://pubmed.ncbi.nlm.nih.gov/16867066/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328139/

[12] https://pubmed.ncbi.nlm.nih.gov/28582659/

[13] https://pubmed.ncbi.nlm.nih.gov/29452067/

[14] https://web.archive.org/web/20120813025045/http://www.christopherreeve.org:80/atf/cf/%7B173bca02-3665-49ab-9378-be009c58a5d3%7D/SUBSTANCE%20ABUSE%20AND%20DISABILITY%208-10.PDF

[15] https://pubmed.ncbi.nlm.nih.gov/21375485/

[16] https://www.theramppeople.co.uk/blog/improving-accessibility-in-the-uk/

[17] https://web.archive.org/web/20210325101748/https://store.samhsa.gov/product/TIP-29-Substance-Use-Disorder-Treatment-for-People-With-Physical-and-Cognitive-Disabilities/SMA12-4078?referer=from_search_result