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Substance Abuse & Mental Health Services Administration
Center for Substance Abuse Treatment

For Immediate Release	Contact: Leah Young
January 13, 1998	301-443-5052

The document, number 29 in CSAT's series of Treatment Improvement Protocols (TIPs), presents simple and straightforward guidelines on how to overcome barriers and provide effective treatment to people with disabilities. It emphasizes that treatment programs have a "legal and ethical responsibility" under the Americans with Disabilities Act to insure appropriate treatment for all clients.

The consensus panel that created the document cites 1997 statistics showing that of 248,679 clients served by licensed substance abuse facilities in New York State, 55,719 (22.4 percent) were reported to the Office of Alcoholism and Substance Abuse Services as having a coexisting physical or mental disability. Of those clients with disabilities, almost 60 percent suffered from physical disabilities such as mobility impairment, visual impairment, or deafness.

Since other disorders, such as traumatic brain injury, would not be obvious to treatment staff personnel, the consensus document emphasizes that "coexisting disabilities may actually affect up to 40 percent of all clients served by substance use disorder treatment programs."

"Our treatment programs have a legal and ethical obligation to ensure appropriate treatment for all clients, said SAMHSA Administrator, Nelba Chavez, Ph.D. "It is the Federal role to help providers deliver appropriate and relevant services. This new TIP also reinforces the part that treatment can play in helping people live not only drug-free lives, but productive lives."

"Some people with disabilities use substance in response to an injury. Others may suffer injury as a result of using alcohol and drugs," said. CSAT director H. Westley Clark, M.D., J.D., M.P.H. "Both groups are at great risk of denying their drug and alcohol problems as their disabilities become their principle focus. There are also hidden disabilities such as cognitive impairment that may make it difficult for individuals to realize they have a substance abuse problem."

Dr. Chavez added that "it has been estimated that 60-70% of people with disabilities are either underemployed or unemployed. A good treatment plan can make full-time, part-time, or volunteer work part of the protocol, opening doors to people who have been stigmatized and shut out of mainstream life. It also supports the goal of the Presidential Task Force on Employment of Adults with Disabilities to create a coordinated and aggressive national policy to bring adults with disabilities into gainful employment."

The TIP is designed to provide treatment screening and planning information to substance abuse treatment professionals with little or no experience in treating people with physical, cognitive or sensory disabilities.

The consensus panel urges treatment professionals to:

• Examine their programs to eliminate barriers to treatment for persons with disabilities, including attitudinal barriers; discriminatory policies; communications barriers; and architectural barriers.
• Train staff to understand functional limitations and the need to accommodate those who cannot adapt to treatment as usual.
• Determine when it is beneficial to integrate people with disabilities into existing treatment services and when specialized services may be needed.

The document also warns that substance use disorders can mimic mental health concerns in recently detoxified clients, such as paranoid behavior that will dissipate in time. Substance abuse can mask underlying disabilities, as well, since it is difficult to distinguish a drunk or high person with developmental disabilities from a drunk or high person without this impairment.

TIP 29 includes an appendix outlining requirements for drug and alcohol treatment programs under the Americans With Disabilities Act.

The consensus panel was chaired by Dennis Moore, Ed.D., Director of Rehabilitation Research and Training Center on Drugs and Disability at Wright State University in Dayton, Ohio. The Executive Director of the National Association on Alcohol, Drugs, and Disability, Inc., John de Miranda, Ed.M. was a member of the 15-person panel.

The Center for Substance Abuse Treatment (CSAT) is part of the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA, a public health agency within the U.S. Department of Health and Human Services, is the lead Federal agency for improving the quality and availability of substance abuse prevention, addiction treatment and mental health services in the U.S. TIPs are available on the CSAT web page at www.samhsa.gov or they can be ordered by contacting SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686; TDD (for hearing impaired), 1-800-487-4889.

Last Updated 11-7-02