A federal advisory from the Substance Abuse and Mental Health Services Administration, or SAMHSA, reports that people with physical and cognitive disabilities have a higher prevalence of serious mental illness and substance use disorders, and lower treatment rates for both, than people without these disabilities. The advisory notes several paths into substance use: some people begin using to cope with chronic pain, isolation, stigma or trauma, including physical or sexual abuse. Unemployment and impulsivity are also risk factors. For others, substance use came first and contributed to the injury that caused a disability.
The same advisory lists barriers that come from treatment programs themselves: inaccessible parking, entrances and rooms; policies that exclude people with disabilities, such as a rule that clients must be able to evacuate a building unassisted; counseling that is not adapted for people with cognitive disabilities; no materials in Braille, large print or electronic formats; and staff who do not know how to communicate with people who are deaf. It also describes a pattern familiar to many case managers: disability departments saying people with serious mental illness are not their responsibility, and mental health departments saying the same about people with disabilities. Providers may also overestimate how accessible they are.
Some disabilities are not obvious. SAMHSA cautions that behavior linked to cognitive disabilities can be mistaken for willful nonadherence or lack of motivation. Reduced stamina can look like laziness, memory problems can look like not caring, and impaired judgment can look like rebellion. A person may also say they understand more than they do, to avoid embarrassment. When a person with a disability keeps missing appointments or breaking program rules, ask whether the program fits them before concluding they are not ready.
Disability services staff are well placed to notice these gaps. You do not diagnose substance use disorders, and you do not decide whether someone needs treatment. You can notice when substance use is affecting a person's goals, ask whether they want help, and make sure that when they seek treatment, their disability is part of the conversation from the first call. Treat evidence on prevalence as a reason to be alert, not as a prediction about any one person.
