RESEARCH INFORMATION ON INDEPENDENT LIVING
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Volume 2, Issue 1

Substance Abuse

Often people with this dual diagnosis (in which each disorder complicates the other) spend disability checks to buy drugs or alcohol. Known as "social iatrogenesis," this can cause the unintentional aggravation of a disease by an economic policy intended to promote well-being.

When an individual’s occasional use of drugs or alcohol becomes regular, intense, or "binging,” that person enters the second stage of consumption: abuse.

Compulsive and addictive behavior constitutes "dependence," the third stage. Both the second and third stages are classified as treatable illness by diagnostic medical manuals.

Reports consistently show that substance abuse is a problem in the disabled population. Some studies indicate that up to 30% of the disabled population abuses alcohol.

According to a 1994  survey of 1,876 VR consumers marijuana was the No. 1 drug of choice for individuals receiving vocational rehabilitation services. The consumers with disabilities also used illicit drugs more than the general population, especially marijuana and cocaine (twice the general rate). Findings also showed:

• VR consumers used crack cocaine five times higher than the general population.

• Men used more drugs than females.

• The highest drug rate was reported by consumers 25 to 34 years old.

• Respondents in supported, sheltered, or temporary employment reported lower illicit drug use than those working full- or part-time.

• 17.2% reported binge drinking.

• 32% said they drank alcohol while taking prescription drugs.

 Researchers suspect that people with disabilities may be vulnerable to substance abuse because of peer pressure and desire for acceptance. The addiction also may provide relief, excitement, numbness to discrimination, and a release from tensions not eliminated through physical means.

Disability-specific risk factors for substance abuse include communication barriers, increased family stress, enabling behaviors of family and friends, therapeutic medication use, and easy access to prescription drugs.  

Reginald Alston, a professor at the University of Illinois at Urbana-Champaign, thinks abuse may be explained by social control theory, which states that people get involved in delinquent behavior when their bond to society is weakened.

A societal bond has four elements: attachment (for instance, to friends or church); commitment (how much time, energy, and resources go into an attachment); involvement; and belief in shared values and norms.

• Attachment: People who feel devalued or shunned may chose social isolation, which can lead to depression and loneliness, and subsequently alcohol and drug abuse.
• Commitment: If a person thinks "I don’t have much to lose anyway" he or she may make deviant choices such as drug and alcohol abuse.
• Involvement: Too much free time can lead a person with a disability to look for sensation-seeking activities.
• Belief: Families may change or soften beliefs because of pity or guilt after disability. Family and friends may think it is okay for a person with a disability to use drugs because of loss associated with disability.

To get out of the downward spiral of substance abuse, studies suggest increasing  attachment with drug-free family and friends. One way to surround oneself with supportive friends is to join a mutual support group. Group feedback and structured activities can also keep people from deviant behavior.

At the Center for Independent Living in Berkeley, consumers are screened for substance abuse problems and linked with peer support, weekly support groups, and individual counseling. 

The American With Disabilities Act protects individuals with alcohol or (past) drug problems in employment discrimination. Accommodations for recovering employees vary depending on job requirements and recovery time length. 

―  Cindy Higgins, The Research and Training Center on Independent Living, The University of Kansas. This project funded by National Institute on Disability Rehabilitation Research grant  #H133A980048.

Information for this review came from the interactive Research Information on Independent Living (RIIL) database at www.GetRiil.org, which contains research summaries related to independent living with disabilities. A special effort has been made to include information that independent leaders in the field said they wanted, namely topics regarding accessible, affordable housing, effective advocacy for rural areas, effective transition from schools and nursing homes, accessible, affordable transportation, reaching underserved populations, policies that impede independent living, rural health care services, and Medicaid/Medicare regulations for durable equipment.