Chapter 19: Substance Use and Disability The chapter on Substance Use and Disability in the Marini and Stebnicki textbook was a brief discussion of the various drugs categories and the comorbidity of drug use and mental/physical disability. The occurrence of two separate clinical diagnoses is referred to as “dual diagnosis”. As used in this chapter, the term dual-diagnosis includes the occurrence of a physical, mental, or intellectual disability along with the presence of a substance use disorder (Marini & Stebnick, 2012).
There are several different categories of substances and they all have different effects on the body. Stimulants such as cocaine, amphetamines, and methamphetamines effect the central nervous system and often have behavioral effects such as mood elevations and euphoria. Hallucinogens such as MDMA, LSD, and psilocybin can have hallucinogenic effects on a person’s perception, mood, and state of mind. Marijuana is described as a drug that effects the central nervous system and can cause a euphoric high, heightened sensory perceptions, and hallucinations in higher doses. Depressants consist of psychoactive drugs such as barbituaties, sleeping pills, and alcohol. These substances depress the central nervous system and can result in decreased motor activity and a sedating effect (Marini & Stebnick, 2012, pgs. 295-99).
Opiates include substances such as heroin, morphine, hydrocodone, oxycodone, and codeine. These drugs have an effect on the brain with feelings of a euphoric high and can be psychologically and physiologically addicting. Inhalants are another class of abused substances which can be solvents, glue, paint, gasoline, and other chemicals that are sniffed, huffed, or inhaled into the lungs. Benzodiazepines and sedative hypnotics have a tranquilizing effect or anxiety reducing effect on the central nervous system (Marini & Stebnick, 2012, pgs. 299-301).

According to the Marini textbook, substance use disorders among people with disabilities occurs at a much higher rate than that of the general population. Depending on the type of disability, substance abuse prevalence among people with disabilities range from 12% up to 60% (Marini & Stebnick, 2012, p. 292). A report by the U.S. Surgeon General in 2005 indicated that each year an estimated 1.5 million people with disabilities need substance abuse treatment. The Surgeon General’s report also stated that people with disabilities have a greater likelihood of substance use than people from the general population (Surgeon General, 2005). Substance abuse rates among people with spinal cord injuries, traumatic brain injuries, or forms of mental illness is estimated to approach or exceed 50%. This is compared to the 10% rate for people in the general population, which illustrates the wide disparity (Gilson et al, 1996).
The use of illicit substances among the disabled population only adds to the challenges that people with disabilities have to face. Substance use disorders in people with disabilities can impair self-care activities, increase medical complications, and can result in overall poorer physical health. This often has a negative impact on vocational rehabilitation outcomes by creating additional difficulties in adapting to disability and recovering from a substance use disorder (Ebener & Smedema, 2011). Studies have indicated that many people began substance use as a way to cope with their physical or mental disability. The numbing effects of alcohol or illicit drugs are often used as a way try to cope with physical pain or emotional stress during the initial onset of the disability. However this results in poor psychosocial adaptation to the disability and also results in poor vocational outcomes in vocational rehabilitation cases (Ebener & Smedema, 2011). A 1996 study by Gilson, et al found that the type of drugs used varies based on the age group. The study found that “younger people with disabilities were more likely to have used crack or heroin than their nondisabled peers, but among older subjects (35 and older), the use of non-medically prescribed sedatives or tranquilizers was more prevalent among disabled than nondisabled respondents” (Gilson et al, 1996). Furthermore, the study by Gilson et al, (1996) also found that people with more severe physical disabilities reported a higher use of non-medically prescribed tranquilizers and sedatives than those with less severe disabilities or with no disability. Tranquilizers and sedatives are sometimes used to treat anxiety and other disorders but the medications are highly addictive and can lead to prescription abuse. These medications start out being prescribed for medical reasons but after it becomes addictive, the person needs more and more of the medication in order for it to have the same effect. Substance abuse counseling and treatment for people with a disability can have its own set of challenges because of issues in adapting to their disability as well as disability-related functional limitations. Treatment of a person with a disability often takes the approach from a quality of life standpoint to address issues such as problems with social, family, employment, and financial areas of life. Addressing the issue of denial is also important in successful recovery from a substance abuse disorder. It is suggested by some researchers that as the level of adaptation to disability increases, the individual’s level of denial will likely decrease and lead to a more successful recovery for the substance user (Ebener & Smedema, 2011) .

References
Ebener, D. J., & Smedema, S. M. (2011). Physical Disability and Substance Use Disorders: A
Convergence of Adaptation and Recovery. Rehabilitation Counseling Bulletin, 54(3), 131-141. doi:10.1177/0034355210394873
Gilson, S.F., Chilcoat, H.D., & Stapleton, J.M. (1996). Illicit drug use by persons with disabilities: Insights from the National Household Survey on Drug Abuse.
American Journal of Public Health, 86(11), 1613-1615.
Marini, I. & Stebnicki, M. (2012). The psychological and social impact of illness and disability. 6th ed. New York: NY: Springer Publishing Company.
Surgeon General: Substance abuse problems affect 87% of the disabled. (2005). Alcoholism &
Drug Abuse Weekly, 17(31), 3-4.