Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 15 Persons with Disabilities and Substance-Related and Addictive Disorders Updated by Melinda Haley, Walden University

The Disability Community Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Estimated 58 million people Largest and most diverse minority group Substance abuse & addiction problems Prevalence twice as high as that of the general population Often seen as secondary to other disability or not recognized Less likely to enter or complete treatment Other addictions Eating disorders, gambling, sexual addictions

Persons with Disabilities and Addictions Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Disabilities categorized by type, need for assistance, and severity Reasons for abuse may include Coping with adjustment to disability More prescriptions may increase opportunity Isolation, depression, and financial issues

Societal Barriers to Treatment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Societal beliefs about PWDs Don’t abuse substances Should receive identical treatment Should be allowed to engage in substances Require extreme efforts to serve Those with cognitive disabilities are not capable of learning to stay sober Counselor perception as fragile, helpless, sick, or abnormal Labels of social deviance

Risks of Addiction for PWDs Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Health and medical Medication can interact with substance Decreased tolerance Chronic pain medication Psychological Enabling as family’s response to guilt, etc. Stresses in family Denial, anger, depression, embarrassment, etc.

Risks of Addiction for PWDs, (continued) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Social Social isolation Excess free time More likely victim of crime Economic and employment Higher bills for treatment, etc. Greater unemployment Access to treatment Physically inaccessible Accommodation often necessary

Risks of Addiction for PWDs, (continued) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Four cultural perspectives on risk factors Sociocultural Physiological Psychological Developmental

Types of Treatment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Stages of care Detoxification, rehabilitation, and aftercare Medical intervention may be required Number of venues Inpatient, outpatient, or partial hospitalization Array of techniques Integrated and inclusive

Levels of Care Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved American Society of Addiction Medicine (ASAM) Patient placement criteria in six categories Five levels of client care Assessment for PWDs must be Culturally-specific Flexible Holistic manner

Rehabilitations Settings Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Halfway or Transition Houses VA Hospitals General Hospitals Clinical Settings Programs for the Homeless Prisons and Jails Substance Abuse Programs

Considerations for Treatment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved PWD’s life problems raise likelihood of relapse May need to include opportunities to: Learn activities of daily living Develop prevocational skills Learn social skills, healthy recreation Obtain financial benefits Develop parenting and childcare skills Build new peer networks Have information and services presented in simple language or in sign language

Questions to Aid Assessment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Do you feel you have a disability, or has anyone ever told you that you have one? Have you ever seen a doctor for a long period of time, more frequently than just one visit or for routine check-ups? Do you take any kind of medication (prescription and over-the- counter)? Have you ever incurred any type of injury? If so, what type? What were the outcomes? Also ask about employment, hobbies, family and social life Consider cultural needs, cross addictions, gender

Treatment for PWDs Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Strengthen resiliency skills – psychosocial, emotional, mental, physical Promote healthy lifestyle changes and skills training Provide psychoeducation – decision-making, assertiveness, stress management, etc. Organize 12-step programs in accessible spaces already used by PWDs Locate or establish peer-support programs hidden disabilities and ethnic minorities

Location of Treatment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Clients often treated for disabilities in one facility, addiction in another Sequential or parallel treatment Parallel, unified, and comprehensive treatment best for PWDs Collaborative efforts across agencies needed Independent Living Centers

Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Academy of Addiction Psychiatry (AAAP) National Institute on Alcohol Abuse and Alcoholism