Substance Abuse and Disabilities

According to one report, alcohol and other drug abuse, or AODA, disorders tend to increase as functional limitation becomes more severe among women with disabilities.

There is considerable information about the relation between alcohol abuse and the onset of a disability due to accidents and injuries while under the influence. For example, alcohol consumption is a well-known strong predisposing factor in traumatic brain injury, or and it has been well documented with high pre-injury prevalence rates for people with spinal cord injuries. However, less research has focused on AODA among people who are already living with disabilities caused by other factors.

It has been suggested in the literature that people with disabilities may be more at risk for substance abuse related to the following factors:

• Medical issues such as overmedication, long-term medication usage, including difficulty managing medication for chronic pain;
• Psychosocial issues such as low self-esteem, depression, and anxiety; and
• Sensation-seeking (rebelliousness) and vicarious experiences.

People who have abused alcohol and other drugs tend to continue to do so after their injury, and substance abuse among people with TBI and SCI is three to six times higher than in the general population. Moreover, when people are abusing these substances at the time of injury, they tend to have poorer short-term functional outcomes in rehabilitation and more severe impairment.

One study conducted on a sample of 242 people (20 percent women) attending a Weekend Intervention Program (a three-day intervention for convicted substance impaired drivers) identified 32.2 percent of this sample as having a disability, as defined by the Association on Dr. One third of these individuals had a traumatic brain injury, followed by mental illness, or back or spinal cord injury resulting in functional impairment, while a smaller percentage had learning disabilities and hearing or visual impairments. These findings suggest that persons with disabilities disproportionately incur arrests for "driving under the influence." However, the study did not identify how many of these disabilities were related to previous substance-related accidents.

Another cross-disability study of 900 women with disabilities examined the patterns of drug use and associated risk factors. Findings suggested that age, drug use by best friend, and being a victim of substance abuse-related violence were risk factors for personal drug abuse.

One study conducted on 140 people with multiple sclerosis found severity of depression, alcohol abuse, and social isolation to predict suicidal intent with 85 percent accuracy. One third of the participants reporting suicidal intent had not received psychological help, and two-thirds of those reporting suicidal intent and major depression had not received antidepressant medications. Suicidal intent is a potentially treatable cause of morbidity and mortality in MS.

Substance abuse may be more likely to be harmful for a woman's health if she has a disability than for a woman who is non-disabled. People with disabilities may experience more damaging health problems attributed to substance abuse than people in the general population. Researchers have identified several potential reasons for this.

• Alcohol consumption may directly and immediately negatively impact some types of disabilities, even at light or moderate levels. For example, a woman with multiple sclerosis may find herself experiencing more rapid vision impairment, instability, and so forth due to substance use.
• Substance use has been found to increase vulnerability for secondary conditions among people with disabilities (i.e., pressure sores and bladder infections).
• People with disabilities are often prescribed medications that can be harmful when combined with alcohol or street drugs. The potential for dangerous health outcomes when mixing alcohol and prescription drugs is substantial and particularly hazardous for people with disabilities.
• As with all women, substance abuse may make women with disabilities more vulnerable to substance abuse-related violence.

Women with disabilities face many barriers to treatment for alcohol and drug abuse. The Pacific Research and Training Alliance's Alcohol and Drug and Disability Technical Assistance Project addresses these problems and makes suggestions for programs to improve accessibility.