People with amputations represent a very diverse group of individuals who may have significant disability or few functional deficits, depending on the type of amputation they have.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is one of the main organizations that attempts to collect reliable data regarding the prevalence of substance abuse and substance use disorders in the United States. SAMHSA reports that it is very difficult to estimate the number of individuals who have any type of physical disability and a co-occurring substance use disorder. There are some studies that report that people with physical disabilities, such as amputees, have higher rates of substance use and substance abuse than the general population, and other studies report lower rates of substance use and abuse. The information regarding rates of substance use disorders in amputees alone is unreliable.
The use of the term amputee encompasses a very large group of individuals who have amputations, ranging from loss of part of a finger to loss of an entire limb. People with minor amputations generally do not experience the same level of distress as people with major amputations, such as the loss of one or both legs or arms.
There is a general agreement that having an active substance use disorder, such as an alcohol use disorder, can result in detrimental effects to the quality of life of anyone, including any individual with any type of physical disability. An active substance use disorder can:
- Cause difficulties being involved in rehabilitation for one’s disability
- Interfere with the actions of medications
- Interfere with one’s ability to engage in self-care
- Impair cognitive abilities
- Increase feelings of social isolation
- Increase strife in relationships
- Contribute to detrimental issues with physical health
- Inhibit one’s ability to further their education
- Result in difficulties with obtaining employment or difficulties at one’s job.
These issues can differentially affect individuals with amputations, depending on the type of amputation, the person’s reaction to their loss, co-occurring mental health conditions, etc.
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People with Amputations May Be at an Increased Risk for Alcohol Abuse
There are numerous factors that can increase the risk to develop a substance use disorder, including an alcohol use disorder. In addition to the general risk factors that may lead to increased risk that affect everyone, such as heredity, trauma and stress, beginning the use of alcohol at an early age, etc., there are some specific risk factors that may affect the probability that someone with an amputation would abuse alcohol. These factors increase the likelihood of these individuals abusing alcohol:
- Increased issues with chronic pain
- Chronic medical issues
- Greater access to prescription pain medications
- Feeling marginalized or socially isolated
- Grief, loss, and depression
- Limited opportunities for employment, education, and social interaction
- Enabling behaviors by family, caregivers, etc. (e.g., family members excusing the person’s drinking by rationalizing that the person needs alcohol to cope)
- Less exposure to education programs aimed at the prevention of alcohol abuse
Individuals who have amputations may suffer one or more of these additional burdens that can contribute to engaging in alcohol abuse. Rationalizing one’s use of alcohol, even when it becomes dysfunctional, is a common factor that occurs over all individuals who develop substance use disorders, including alcohol use disorders. People with physical amputations may believe that their use of alcohol empowers them, even though their alcohol abuse results in significant impairment in daily functioning or in distress in their relationships.
Services for Amputees with Alcohol Use Disorders
There appear to be very few specialized services for amputees who develop alcohol use disorders, but individuals can utilize services intended for any person who has any type of physical disability. The services for these individuals will typically parallel the services for anyone, but include special information or considerations for specific types of physical disabilities. Overall, the array of available services will include:
- Information in different formats that educates individuals in how to avoid alcohol use
- Comprehensive evaluations by a licensed clinician to determine whether a person has an alcohol use disorder and what level of care they need if they do have one
- Inpatient or outpatient medically supervised withdrawal from alcohol (medical detox)
- Medication -assisted treatment options for alcohol abuse, such as Antabuse (disulfiram), ReVia (naltrexone), or Campral (acamprosate)
- Behavioral and psychosocial interventions, such as therapy
- Participation in peer support groups, such as Alcoholics Anonymous or SMART Recovery
- Other specific interventions, as identified in the initial assessment
Special considerations for the treatment of individuals with amputations include family therapy, therapy for grief and loss, counseling to help the individual readjust, specialized vocational training, and other specific interventions that are designed to address the needs of the person.
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The Americans with Disabilities Act (ADA) requires that most treatment facilities make special considerations for individuals with physical disabilities. Nonetheless, many treatment facilities may not be fully accessible for certain types of disabilities, such as people who have double leg amputations. This situation can result in people feeling marginalized or being unable to fully access treatment. In addition, many treatment providers may believe that their facility is more accessible than it really is. Interestingly, many outpatient treatment providers for alcohol use disorders are likely to report that their facility is more accessible to people with specific types of disabilities than it actually is, and more likely to report that they have more specialized training to help people with physical disabilities than they actually do.
There is little information or research that can reliably estimate the number of individuals with amputations who have either been turned down for treatment for an alcohol use disorder or avoided getting treatment. However, the ADA requires that treatment providers offer equal access to all individuals. Individuals with amputations have a basic right to receive treatment for any issue, including alcohol use disorder, that is of the same quality as that available to anyone else being treated for the same condition.
Individuals with amputations who seek treatment for alcohol abuse should inquire with potential treatment providers regarding:
- Accessibility of the facility
- Any certifications or special training staff members have that would apply to their situation
- The availability of any specialized therapy or social support groups that focus on physical disabilities
If the treatment provider cannot provide for the person’s special needs, the person should ask for referrals to qualified treatment providers in their area that can address these needs.
The majority of providers will be frank and open with potential clients regarding their ability to serve the client’s needs. In addition, most providers will refer a potential client to a more appropriate source if they believe they cannot fully address that person’s needs. Individuals with amputations seeking treatment for alcohol use disorder can discuss their situation with several different treatment providers, and choose the one that is best for them.