Academic journal article The Journal of Rehabilitation

Emotional Factors Involved in Substance Abuse in a Sample of Rehabilitation Clients

Academic journal article The Journal of Rehabilitation

Emotional Factors Involved in Substance Abuse in a Sample of Rehabilitation Clients

Article excerpt

Substance abuse among rehabilitation clients who had other (not substance abuse) primary disabilities has received considerable attention in recent years (Buss & Cramer, 1989; Greer, Roberts, & Jenkins, 1990; Hienemann, Goranson, Ginsberg, & Schnoll, 1989; Moore, Greer, & Li, 1994). For example, Buss and Cramer (1989) reported that 40 to 50 percent of persons with disabilities indicated moderate to heavy drinking. Hienemann et al. (1989) found that 39 percent of their spinal cord injured sample were intoxicated at the time of injury and reported an average of 2.5 alcohol-related incidents six months following injury. Greer (1986) reviewed research on the incidence of alcohol and drug abuse among people for whom substance abuse was not the primary disability. For some disability groups (e.g., amputees, clients with spinal cord injuries, and psychiatric patients), abuse was dramatically higher than for the general population.

Until recently, such writings have focussed primarily on the incidence of substance abuse problems. Little has been published on mediating factors associated with such problems. Moore et al. (1994) investigated attitudes associated with alcohol abuse. They found positive relationships between problematic drinking and attitudes toward entitlement and risk-taking behaviors. Thus, rehabilitation clients who drank excessively were more prone to see themselves as deserving breaks and represented themselves as high risk takers.

Sociological factors associated with drug abuse by persons with disabilities were reviewed by Alston, Harley, and Lenhoff (1995). Those authors proposed that predisposing factors such as isolation are operative in the dynamics of disability and drugs much as they are in youth, delinquency, and drugs. Phrases such as "compensation for guilt," "ease the pain," "excessive frustration," "choosing an escape," "oppressed minority," "relief from oppression," "placatory behaviors," "hostile encounters," "stressful demands," "feelings of helplessness," "stigmatized and dependent," and "isolation and loneliness" are found in literature that seeks rationale for substance abuse and leads toward intervention strategies.

Emotional factors associated with adjustment to disability have been discussed by Vash (1981), Deloach and Greer (1981), Marshak and Seligman (1993), and Ferguson, Dodds, Craig, Flannigan, and Yates (1994). Much of such discussion centers around anxiety, anger, and depression. For example, Ferguson et al. (1994) found anxiety and depression impacted feelings of self-worth. Although rehabilitation personnel may view anger outbursts as an indicator of hostility, Marshak and Seligman (1993) discussed the need for rehabilitation personnel to allow clients to express anger more freely. Such outbursts may be attempts to compensate for a perceived loss of control over their lives. Anxiety, according to Deloach and Greer (1981), is a result of the uncertainty of the individual in coming to terms with disability and the future. Both Deloach and Greer (1981) and Vash (1981) saw the use of alcohol as one way to deal with anxiety. Marshak and Seligman (1993) stated that depression is another stage or phase of adjustment to disability. Depression includes feelings of worthlessness, self blame, and suicidal thoughts. In addition to potential relationships of anxiety, anger, and depression to substance abuse, a measure of bizarre thoughts was included in the present research. Little is written regarding bizarre thoughts in relation to substance abuse or adjustment to disability, except in relation to psychiatric conditions per se.

Most of the prior work reported in the literature either has involved the study of incidence of abuse or has been theoretical as opposed to empirical. The present study was undertaken as a preliminary investigation of emotional factors associated with substance abuse among persons with disabilities. The purpose was to identify emotional factors related to alcohol abuse and/or drug abuse for this population. …

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