“Issues Linking Developmental Disabilities and

Substance Abuse Services”

Debbie Aidelman, MS, CPSCerebral Palsy of New Jersey

Director of Substance Abuse Prevention • To preventsubstanceabuse amongpeople with alltypes ofdisabilities

• To increase access to substance abuse services statewide

Substance Abuse and Co-existing

Disabilities

GOALFor disability service providers:• understand the difference between

alcohol/drug use, abuse and addiction• be better observers of behavior in your client/consumer group• utilize early identification and referral strategies.

For substance abuse prevention & treatment service providers:• acknowledge cultural sensitivity toward people with disabilities• compliance with ADA• modify approaches and techniques to meet the needs of a diverse community.

Barriers

• Physical/Architectural

• Sensory

• Cognitive/Hidden Disabilities

NATIONAL RESEARCH

• People with disabilities are at higher risk for problems associated with substance abuse than the general population

• There are 54 million Americans with disabilities

• At least 10% or 5.4 million also experience a problem with alcohol and/or drug use

Disability Statistics• Abuse of drugs and alcohol:

– persons with disabilities 25-30%

– general population 8-10%

• Incidence of substance abuse by disability category:

– TBI and SCI 50-75%

– severe mental illness 50%

– hearing loss 20%

– mental retardation 10%

• Other disabilities with high incidence of substance abuse:

– learning disabilities/ADHD, blindness and visual impairment, burn victims

Substance Abuse Precedes a Co-existing Disability: “Type 1”

• Factors contributing to risk for acquiring other disabilities:

• Disinhibition; thrill-seeking behavior

• Impaired judgement

• Neglect of health

• May occur by:

»direct relationship

» indirect relationship

Substance Abuse Follows a Co-existing Disability: “Type 2”

• Factors contributing to risk of substance abuse:– substances are used to cope or fit in – drugs often used to manage disability

symptoms, chronic pain, or depression– easy access to prescription medication– social isolation & excess free time– difficulty managing stress related to a

disability– enabling by well-meaning family, friends

and professionals

What is FASD? Fetal Alcohol Spectrum Disorders

FAS Fetal Alcohol SyndromeARBD Alcohol Related Birth DefectsFAE Fetal Alcohol EffectsARND Alcohol Related Neuro-developmental

Disorders

The mild & subtle problems are often misdiagnosed. Rather than receiving educational & behavioral supports needed to compensate for the disabilities, individuals may exhibit poor frustration tolerance, depression and low self-esteem. As result, they may experiment with alcohol/drugs and get into trouble with the law at an early age.

Top Ten List: Reasons Substance Abuse and Disability are not Addressed in Treatment

1. People with disabilities should not be treated any differently.

2. Nobody with a disability ever shows up.3. There’s another agency that deals specifically

with this situation.4. It’s hopeless anyway.5. I don’t have training in this.6. People with disabilities don’t have substance abuse

problems anyway.7. People with disabilities have a right to medicate

themselves.(I’d do it too in that same situation.)8. Jerry Lewis told me not to!9. I’ll get sued if the person with a disability gets hurt.10. We can’t address the medical or medication needs here.

(D. Moore & J.A. Ford: RRTC on Drugs & Disability)

Americans with Disabilities Act (ADA)1. Employment

2. Transportation

3. Public Accommodations

4. State and Local Government

5. Telecommunications

(Federal legislation passed in 1990)

ADA Provides Protection

from Discrimination for Substance

Abusers

Attitudinal vs.

Architectural Barriers

Understanding Patterns of Use and Abuse

–Abuse

–Use

–Dependence

NCADD/ASAM revised definition of Alcoholism

• “Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.”

Caseworker Questionnaire• 1. Do you worry about your client’s drinking or drug use?• 2. Do you spend more that the average amount of time

managing the client’s case?• 3. Have you tried to assist the client in locating new housing

or employment because of drinking behavior?• 4. Has your client experienced any problems while drinking

or drugging?• 5. Is your client defensive about drinking/drug use?• 6. Does your client brag about substance abuse?• 7. Do you try to control your client’s use?• 8. Are other people concerned about your client’s use?• 9. Is client taking prescribed medication?

• 10. Has your client been accused of or arrested for a criminal offense?

Initial ScreeningASSESS ALCOHOL USE HISTORY• C -Have you ever tried to

control drinking?

• A -Are you annoyed when people stop you from drinking?

• G -Any guilty feelings about drinking?

• E - Ever drink as an eye-opener in the

early A.M.?

Initial Screening• H -How do you use alcohol?

• E -Ever use alcohol to excess?

• A -Anyone thought you drank too much?

• T -Any trouble as a result?

For people who are addicted to nicotine, alcohol, drugs, gambling and food, the signs and symptoms of addictions are the same. Some include:

• continued use despite clear evidence of harm or negative consequences

• compulsion to use and loss of control over use• increased tolerance and physiological

dependence which results in discomfort and illness when substance is withdrawn

• use and recovery from bad effects of use consume an excessive amount of time

• recurrent pattern of use and problems caused by use.

Moderate drinking: 1 - 4 drinks daily

Heavy drinking: 4 - 6 drinks daily

Binge drinking: 5 or more at a time ranging from 2 X per week to 2 -3 X per month

Addiction: significant impact on one’s life; loss of control, harmful results start to become long range. The amount of alcohol one consumes is not an important as the consequences.

Drinking Patterns

ENABLING: A Conspiracy of Silence

• An environment of well-meaning family, friends and professionals who inadvertently support the use or abuse of alcohol/drugs. Not talking about the issues, covering up or making excuses for another person’s behavior, protecting loved ones from the natural consequences of their behavior, pressuring the person to “join the crowd to fit in”, or doing for someone what they can be reasonably expected to do for themselves are all examples of actions that support the unwanted behavior.

Information-Referral Contact Numbers

Call for Alcohol/Drug Assessment, Out-patient/In-patient Treatment Programs, & 12-Step/Support Groups: *NJ Substance Abuse Hotline: 800-238-2333 www.njdrughotline.org

*NJ Prevention Network: 866-367-6576

*Alcoholics Anonymous: 800-245-1377

Relapse Triggers: Work Related

• Receiving cash tips

• Transportation issues

• Too much free time

• Working two jobs

• Too much pressure on the job

• Job dissatisfaction or boredom

• Required business meetings, dinners and parties

• Active drinking or drugging by other employees

• Pay day

• Working a rotating, graveyard, or night shift

• Seasonal work

• Lack of supervision

• Working excessive overtime

• Dealers near the job

• Access to marketable goods or petty cash

Risk Factors for Substance Abuse Among People with Disabilities• Prescription medication use• Chronic pain• Increased stress on family life• Fewer social/recreational opportunities• Inadvertent enabling by well-meaning

friends and family• Lack of access to prevention and

treatment programs and services

Spinal Cord Injury and Traumatic Brain Injury

1. Half follow alcohol or drug use

2. Intoxication rates range from 29% to 58% at time of injury

3. Alcohol abuse histories range from 25% to 68%

4. Substance abuse directly contributes to incidence of physical disabilities:

• abuse prior to accident

• caused accident

• hampers rehabilitation

Persons with TBI Face Additional Challenges when Seeking Substance Abuse Treatment

• cognitive impairments may affect a person’s learning style

• misinterpretation of memory problems as resistance to treatment

• damage to the frontal lobe affects executive thinking skills

• environmental cues may not be perceived• easy to interpret behavior as intentionally

disruptive• alcohol and other drug consumption hamper

the rehabilitation process

Eight reasons those with brain injury should consider about drinking or drug use

People who use alcohol or other drugs after a brain injury don’t recover as much or as fast.

Brain injuries cause problems in balance, walking or talking that get worse when a person uses drugs.

People who have had a brain injury often say or do things without thinking first, a problem made worse by using.

Brain injuries cause problems with thinking, like concentration or memory and using makes these worse.

After an injury, alcohol and other drugs have a more powerful effect.

Depression is common; drinking alcohol should be avoided.

Substance abuse can cause a seizure.

More likely to have another brain injury.Ohio Valley Center for Brain Injury Prevention and Rehabilitation,

2001

Mental Retardation vs. Mental Illness

Mental Retardation Mental I llnessOccurs at birth or during

developmental yearsOccurs at any age, of tenadolescence or adulthood

I ntellectual problems,learning problems

Behavioral or emotionalproblems

Lif e-long, irreversible May be temporary andreversible, may re-occur

Not curable Treatment withmedication,psycho-

therapy, etc.

Mild Mental Retardation• Describes 89%; only a small percent have

moderate, severe or profound MR• A hidden disability without an IQ score• Lack of A/D education and prevention info

during high school• Influenced by distorted media ad

campaigns• Difficulty comprehending abstract concepts• Restructure sessions and modify treatment• Use modified vocabulary 12-Steps • 12-Step pictorial representation• 12-Step Addictive Disorders workbook

The Twelve Steps of Alcoholics Anonymous

1. We admitted we were powerless over alcohol - that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care to God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people whenever possible, except when to do so would injure them or others.

10. Continued to take personnel inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awaking as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

Twelve Ideas for Improvement1. I believe that when I drink I cannot control my life.

2. I must begin to believe in a God that will help me become well.

3. I must decide that I will allow God to help guide me in my life work and my relationships with other people.

4. I must search my past life and search life now to see what is good and what still must be changed.

5. With God’s help I am able to share my past, both good and bad things, with another person I trust.

6. I am ready to change the things I must change.

7. I ask God to help me change my life now.

8. I am ready to say I am sorry to the people I hurt during the time I drank too much.

9. I will go to the people I hurt before and show with my present actions that I am truly sorry.

10. I will always look for my mistakes and quickly admit any wrong things that I do.

11. Each day, I will think how God will help me become a better person.

12. Now that I have a new life, I will gladly search for other persons who drink too much and together we will follow these twelve ideas one day at a time.

“Prevention-Education” Small Group Discussion Topics

Session 1: Alcohol and Other Drugs: The effect on the human body

and behaviorSession 2: Alternatives to Substance

Abuse: Fun without AlcoholSession 3: Peer Pressure and Self-EsteemSession 4: Alcohol, Prescription

Medications & O-T-C Drugs: A lethal combinationSession 5: Tobacco and Nicotine

Crossing Organizational Boundaries• alcohol and other drug prevention &

treatment services• disability services• mental health agencies• criminal justice systems• legal services• general health care services• child and adult protective services• vocational rehabilitation programs• housing agencies• educational services• HIV/AIDS prevention/treatment

Overlapping Areas• Mentally ill - chemical abuser (MICA)• Increased incidence of spinal cord injuries

and traumatic brain injuries• Prevalence factors and prevention issues for

adolescents with learning disabilities and attention deficit/hyperactivity disorder(ADHD)

• FAS and alcohol-related birth defects • HIV/AIDS• Division of Vocational Rehabilitation Services• ADA provides protection from discrimination

for substance abusers

Action Steps1. Participate in the advocacy movement of the NJ Coalition on Disabilities and Addictions.

2. Arrange in-service training sessions for agency staff/colleagues.

3. Consider the lifelong effects of alcohol-related

birth defects and FASD.

4. Utilize specialized ATOD materials, brochures,

manuals and videos.

5. Urge special educators and schools to integrate

A/D prevention curricula for classified students in “transition from school to adult life”.

6. Increase accessible AA/NA meeting sites.

Action Steps, cont.

7. Utilize S.O.S. or NJ Division of Deaf & H/H

“Interpreter Referral Service”.

8. Consider the ADA when planning ATOD prevention activities/events and publicize accessibility features.

9. Acknowledge attitudinal, architectural and programmatic barriers when accessing services.

10. Increase cultural sensitivity toward persons with disabilities. Encourage “People First” language.

11. Disability Specialists: *Need to increase early identification and referral of substance abusers.

12. Addictions Specialists: *Need to modify techniques in compliance with the ADA.

13. Cross-pollinate ideas, cross organizational boundaries.