Physical Disability & Addiction

Physical disability and addiction have an under-researched relationship, even more so when one considers many studies group all disabilities together when discussing drug use. We break down the research and the relationship below. 

The Relationship Between Physical Disability & Addiction

People who have physical disabilities in addition to addiction often must face unique challenges when trying to overcome their substance use disorder (SUD). 

Accessible treatment options can sometimes be substantially more limited depending on the nature of the disability. In addition, disabilities can bring some unique stressors into a person’s life that people who don’t have a disability don’t generally have to deal with or at least experience less frequently.

Some Relevant Statistics 

While the relationship between disability and addiction warrants more research, and it’s especially worth research better distinguishing between physical and mental disabilities, there are still some relevant statistics available to help us understand this relationship.

For example, a 2013 comparative study found that people with disabilities tend to engage in substance abuse at a higher rate than people without disabilities (40 percent versus 34 percent). Interestingly, it was found that the abuse of alcohol was significantly less common among people with disabilities despite the overall higher rate of drug abuse. One potential reason for this is that alcohol can interfere with many different medications.

It’s been estimated that about 4.7 million Americans have a substance abuse problem co-existing with a disability. The substance abuse rates among certain disabilities are vastly higher than the average. Notably, those who have suffered a traumatic brain injury, spinal cord injury, or have certain mental illnesses approaching or exceeding an abuse rate of 50 percent. 

Common Causes of Substance Abuse Among the Physically Disabled

There are common reasons that people, including people with physical disabilities, turn to substance misuse. Some of the most common reasons people abuse substances include the following:

• Curiosity or experimentation
• To cope with stressors or untreated mental health issues
• To fit in with others who are doing drugs
• To feel good
• To gain an advantage in sports or academics

People with physical disabilities vary in the rates they may have to deal with some of these issues, or they may face unique issues not as frequently discussed, depending on their disability. For example, a person who suffers from severe chronic pain may abuse drugs in an effort to reduce their pain to a more tolerable level. 

Generally speaking, addiction is the result of a period of drug abuse. A person’s risk of developing an addiction when they abuse drugs can vary significantly depending on the individual. Common contributors to a person’s risk of addiction include the following:

• Biology: Genetics play a significant role in a person’s risk of addiction.
• Environment: The culture a person grows up in and the people they’re surrounded by can greatly influence if and when they use drugs or alcohol.
• Development: Drug use during important periods of a person’s physical and mental development (notably during puberty) often increases their risk of drug abuse leading to an addiction.

Unique Factors People With Disabilities Face

While none of the contributing factors here are completely unique to those who have a disability, and certainly not everyone with a disability will experience all of these factors, there are still some challenges people with disabilities may encounter much more frequently than those without disabilities.

First, a disability can sometimes cause a person significant stress, especially if they live in an area where their condition is stigmatized and/or it is difficult for them to engage with the outside world due to limited accessibility. In some cases, disabilities can cause a person to feel isolated and limited in what they can do for leisure. 

People with disabilities live full, happy lives, but this is much easier to do when societal safety nets are put in place to support their unique needs and encourage empathy in people who don’t face those same challenges. If a person with a disability doesn’t have these forms of support, they are more likely to struggle.

Second, some people with disabilities may need or greatly benefit from medications that also have abuse potential. What begins as a legitimate prescription meant to help them control their symptoms can unfortunately sometimes evolve into substance abuse if the person and their prescriber aren’t careful to control their risk of drug abuse. We discuss this more below.

Abuse of Pain Medication

Pain medication, specifically opioids, is a common cause of drug abuse and substance use disorders. Many opioids, such as oxycodone and hydrocodone, are prescribed to people who suffer from moderate to severe chronic pain. These medications can help people whose pain is interfering with their quality of life function more easily, although it also inherently increases their risk of abuse as they now have much easier access to potentially addictive drugs.

There isn’t necessarily an easy solution to situations where a person may be at risk of abusing drugs but can also benefit from those same drugs if they are used correctly. Often, a prescriber and the individual just need to carefully balance the risks and benefits of a given substance, and approach its use with significant care if they think a potentially abusable substance is the best option. 

For people at great risk for drug abuse, such as those who have struggled with addiction in the past, it’s often best to first search for pain management alternatives. In some instances, it may be best to have the medication administered by a different, trusted party rather than letting the individual have direct access to their drugs themselves.

Alcohol Abuse Among Those With Disabilities

Again, the overall rate of alcohol abuse is lower among people with disabilities. 

It’s important to acknowledge that this doesn’t mean a person with a disability is less likely to become addicted to alcohol if they choose to abuse it. Physical disabilities rarely change the way a person’s brain fundamentally operates. Their risk of addiction will still be about the same if they engage in alcohol abuse. 

One potential reason for the statistical discrepancy is that many medications explicitly list alcohol as a drug that can interfere with their ability to work or that may mix dangerously with it. Because of the nature of having a disability, many people with disabilities take medications. 

It’s also worth noting the referenced study doesn’t differentiate between physical and mental disability. Mental health issues are very frequently treated with medications that cannot be mixed with alcohol, which may explain at least some of the discrepancy. It’s common for those with physical disabilities to also deal with depression, anxiety, and other mental health issues.

Despite an overall lower alcohol abuse rate, people with disabilities do sometimes turn to alcohol to cope with life’s stressors. 

Can Addiction Be Defined as a Disability?

While many people don’t think of it as such, addiction is a disability under the Americans with Disabilities Act (ADA).

While a person can manage addiction, it is a lifelong condition. Addiction can cause a person to have long-term difficulties engaging in major life activities. They can also face discrimination because of their addiction. 

Generally speaking, the ADA defines something as a disability by its ability to limit major life activities, which include but aren’t limited to the following:

• Walking
• Seeing
• Self-care
• Learning
• Working
• Thinking
• Communicating
• Controlling bodily functions
  

This fact can actually muddy the ability to understand some research papers on drug use, as many papers use the term disability when researching drug use but don’t make it clear if they define addiction as a disability for the purpose of the findings. Many people, even experts, don’t necessarily classify addiction as a disability, but it certainly can interfere with a person’s life enough that the classification is appropriate.

Access to Treatment for Disabled Persons

Treatment access is an important consideration when discussing addiction as it relates to disability. 

Some disabilities, such as those that affect a person’s sight or ability to move, can greatly limit access to care if the appropriate measures aren’t taken. In some cases, tools normally used to screen, diagnose, or treat addiction may need to be modified or simply will not work, depending on a person’s disability.

For example, a 2011 guide from SAMHSA noted that no screening tools had been validated in deaf populations. While this doesn’t mean people who are deaf can’t be diagnosed with an addiction or treated for one, it does complicate treatment. 

It’s difficult to fully discuss treatment access for people with disabilities because of the wide range of limitations a physical disability might cause. What’s important for people who have both an addiction and disability to consider, as well as facilities offering care, is which treatment facilities are available that may best suit their needs. 

In many cases, accessibility for people with disabilities may be legally required. However, a facility may not necessarily be compliant with the law, especially facilities that don’t frequently treat people with disabilities.

Finding Addiction Treatment Options for People With Disabilities

People who have physical disabilities largely have the same addiction treatment options as people without a disability in terms of what treatments may be effective. They just unfortunately may be more limited in the facilities that can treat them or at least treat them effectively. 

When considering a treatment option for you or someone in your life with a disability, it may help to call the facility and discuss any unique needs and problems the person with a disability generally has. Find out what the professionals at the location may be able to do to better facilitate treatment and if any of their usual methods may not work for someone with that disability.

Addiction can range in severity, with a number of evidence-based treatments that can potentially help a person manage their addiction. Often, the best place to start is by talking to a licensed mental health professional who specializes in addiction treatment. You can also talk to a specialist with significant experience helping individuals who have the same or similar disabilities as the one the person seeking treatment has.

Varying Levels of Care

People in crisis, where their addiction has started to greatly impact their health and quality of life, may need to stay at an inpatient (residential) facility. 

At this kind of treatment facility, they will stay multiple weeks. They’ll go through withdrawal, physically and mentally recover, and then learn some key skills to help avoid drug abuse once they leave. Then, the individual will generally transition to more traditional drug treatment counseling.

Oftentimes, people will go to facilities to undergo withdrawal in a safe environment under the care of medical professionals, staying at the facilities for a few days. For some drugs, such as opioids and alcohol, this type of rehab treatment can greatly improve a person’s chances of successfully getting through withdrawal and beginning to avoid drug abuse. 

The level of care a person needs will depend on the severity of their substance use disorder, their medical history, their support system, and the assessment of treatment professionals.

Medication is sometimes used as part of the addiction treatment process. This is called medication-assisted treatment (MAT), and it can often make it much easier for a person to avoid drug abuse. It’s fairly common when treating opioid addiction, where a person may take a substance such as Suboxone or methadone on a set schedule to avoid withdrawal and reduce their cravings. 

Addiction Resources 

If you have a loved one struggling with addiction, check out this guide from the University of Rochester Medical Center to encourage them to get the treatment they need. It covers how to talk to a friend about their problems in a way that’s productive and effective as well as how to avoid some of the common pitfalls non-experts can fall into when trying to help.

For people trying to help themselves or someone else in their life, SAMHSA’s National Helpline can help at 1-800-662-HELP (4357). Free and confidential, this helpline is meant to act as a good starting point for those who want treatment referral and information services related to addiction and mental health services. 

While the availability and value of the resources can vary depending on your region, many states also have pages set up to help people with disabilities learn more about available addiction resources tailored to their needs. 

While physical disabilities can complicate substance abuse treatment, many addiction treatment centers have experience treating people with physical disabilities. These facilities can accommodate individuals with physical disabilities so they can get the life-changing care they need to effectively manage their addictions.