Academic journal article The Journal of Rehabilitation

The Functional Limitations of Clients with Coexisting Disabilities

Academic journal article The Journal of Rehabilitation

The Functional Limitations of Clients with Coexisting Disabilities

Article excerpt

As a group, people with disabilities have a higher rate of alcohol and drug use problems when compared to the general population (Heinemann, Goranson, Ginsburg, & Schnoll, 1989; Moore & Li, 1998; Stern, Byard, Tomashefski, & Doershuk, 1987). A report by the National Association on Alcohol, Drugs, and Disability (NAADD) estimated that up to six million people with disabilities also have co-existing substance abuse problems and that these disabilities may present obstacles to recovery (de Miranda, 1998). Nelipovich and Buss (1991) estimated that between 15-30% of the disabled population abuse alcohol or drugs--a rate of about two times found in the general population. The incidence of alcohol and/or drug problems appears to vary by disability type; traumatic brain injury and spinal cord injury (50-75%) and mental illness (50%), tend to have the highest rates of abuse/addiction, while people with mental retardation (10%) have been found to have a rate comparable to that of the non-disabled population (Rehabilitation Research and Training Center (RRTC), 1996).

In a study regarding current alcohol use, Moore and Li (1994) reported that 71.5% of people with spinal cord injuries drank, followed by hearing impairment (60.9%) and visual impairment (57.5%). Drinking was cause for concern in this sample because 51% of the respondents were also taking prescription medication and still others had medical/health concerns that could create problems with even minimal amounts of alcohol. These complicating factors makes it more likely that even relatively low levels of alcohol or drug use may become problematic (i.e., abuse) for people with disabilities.

A pattern of more pervasive substance abuse problems is maintained for people enrolled in state vocational rehabilitation programs as well. A survey of almost 2000 people with disabilities receiving vocational rehabilitation services in three Midwestern states found that illicit drug use of every major type was much higher in this sample when compared to the general population (RRTC, 1996). It was reported that marijuana and cocaine use in the past month was almost double the rate of the general population and crack cocaine use in the past year and in the past month was estimated to be about five times higher. Overall, the study estimated that about 25% of consumers receiving vocational rehabilitation services experienced substance abuse problems, most of which were unknown to the individuals' vocational rehabilitation counselors.

As indicated earlier, people with disabilities appear to be at greater risk for abuse alcohol or drugs because of the presence of physical, emotional, or cognitive problems that, in part, are attributed to their disabilities.

   Like the general population, persons with disabilities face a
   variety of situations that may encourage illicit drug use. However,
   there are some drug abuse risk factors that are more frequently
   associated with disability.... problems of personal adjustment and
   unemployment, as well as the experienced medical and health
   difficulties. (Li & Moore, 2001, p. 5)

Further, social isolation and unstructured free-time also place people with disabilities at greater risk to develop problems with alcohol or drugs (Nelipovich & Buss, 1989). Within both the general and disability populations, drinking to cope with life's stress is viewed as a powerful predictor of alcohol abuse and drug problems (Cooper, Russell, & George, 1988; Heinemann, Schmidt, & Semik, 1994).

Given the prevalence rates of use and abuse, it seems certain that a sizable percentage of people with disabilities have problems with alcohol or drug use to such an extent as to require treatment. However, it is uncertain how many such people seek, obtain, and complete treatment. Importantly, it is also unclear how their disabilities and functional limitations affect treatment process and outcome. …

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