The prevalence of individuals who have ambulatory problems increases with age, such that older individuals have higher rates of ambulatory issues than younger individuals. According to the National Institutes of Health (NIH), there are approximately 2.2 million Americans who rely on a wheelchair to get around on a daily basis. Many of these individuals have different types of physical disabilities, and a good proportion may have more than one disability, including a physical disability, a cognitive disability, and even an emotional issue.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the prevalence of substance use disorders, including alcohol use disorders, is higher for younger individuals than it is for individuals over the age of 65. However, no reliable estimates of the prevalence of alcohol use disorders for individuals who are bound to a wheelchair exist. It is generally estimated by sources such, as NIH and SAMHSA, that the prevalence for substance use disorders in individuals with physical, cognitive, and emotional disabilities can be expected to be at least as high as it is in the general population, and according to the American Psychiatric Association (APA), a person who is diagnosed with any type of mental health disorder is at an increased risk to develop a substance use disorder, particularly an alcohol use disorder.
It may well be that individuals who are confined to wheelchairs have significant rates of alcohol use and alcohol use disorders that may encompass up to 25 percent or more of these individuals. This might suggest that over 600,000 individuals who are confined to a wheelchair may suffer some sort of alcohol abuse or other substance abuse issue.
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Factors That May Increase the Risk for Substance Abuse in Wheelchair-Bound People
NIH and SAMHSA note that individuals with disabilities, such as those who are wheelchair-bound, may have specific risk factors that can contribute to an increased probability that they may develop some type of substance use disorder. The particular type of disability may also be related to the type of substance an individual is at risk to abuse. For instance, individuals who are wheelchair-bound and with significant chronic pain may be prescribed opiate medications for pain control, and this might increase their risk to develop an opiate use disorder. Individuals with combinations of chronic pain and emotional distress may also turn to other drugs in addition to opiates.
A common drug of abuse is alcohol because it is easily attainable; it depresses the central nervous system; and its effects result in feelings of relaxation, physical and mental numbing, and decreased susceptibility to stress initially. However, when abused, alcohol actually exacerbates pre-existing issues and leads to the development of more complicated problems.
Some factors may make wheelchair-bound individuals more susceptible to alcohol use disorders.
- As a group, these individuals often have lower income levels and higher levels of unemployment.
- As a group, these individuals are often socially isolated.
- As a group, these individuals tend to have poorer access to higher education.
- This group may be enabled by caregivers to use alcohol or other substances.
- These individuals are often at an increased risk to be abused by others.
- These individuals are at an increased risk to feel marginalized due to their disability.
Statutes Regarding Discrimination
According to SAMHSA, there are federal statutes that protect individuals with disabilities from discrimination and protect their equal access to services. The major act that protects wheelchair-bound individuals from being discriminated against is the Americans with Disabilities Act (ADA). The ADA specifically states that no person can suffer discrimination on the basis of any type of disability regarding “full and equal enjoyment” of goods, services, privileges, advantages, facilities, etc., by any individual who either owns or operates a “place of public accommodation.” This essentially means that individuals who are wheelchair-bound and seeking treatment for an alcohol use disorder should receive fair and equal treatment, and have fair and equal access to the services provided by substance use disorder treatment facilities. This is particularly true of facilities that get state or federal funding, but it applies to private facilities as well. While there are statutes that are designed to protect the rights of individuals who are wheelchair-bound and allow them equal access to treatment, the above-mentioned factors regarding the increased potential of these individuals to develop substance abuse issues might also result in decreased access to treatment for this group. This is because they may not readily seek help for their alcohol abuse.
The unique needs of wheelchair-bound individuals would include:
- Accommodations for entry and exit to a treatment facility, such as specialized parking spaces, ramps for entry and exit, and accommodations to allow the individual to move freely within the facility
- Equal access to restrooms and other areas of the facility
- Special housing accommodations for residential and inpatient treatment facilities
- Specialized training for treatment providers in order to address the special needs of individuals with physical, emotional, and cognitive disabilities.
Wheelchair-bound individuals may have special issues that drive their substance abuse, which are outside their control and that represent longstanding feelings of resentment, inadequacy, and isolation. For individuals who have been wheelchair-bound for most of their lives, these issues may represent ingrained problems that need long-term intervention. For other individuals who may have recently experienced an accident, disease, or other condition that resulted in them needing the use of a wheelchair, there may be a whole different set of factors that need to be addressed. These can include issues with grief and loss of one’s ability to ambulate, loss of other faculties, feelings of uncertainty, changes in relationships, etc. Such individuals may require an entirely different approach than individuals who have been wheelchair-bound for most of their lives.
Providers who treat wheelchair-bound individuals should be trained to recognize the specific issues that occur in this population. They must be trained to either directly address these issues or refer the individual to an appropriate source.
It is extremely important that those who treat clients with substance use disorders don’t fall into the notion of “therapeutic narcissism” where they mistakenly believe it is up to them to help everyone who is referred to them. Competent treatment providers should be willing to direct individuals with special needs whom they cannot accommodate to an appropriate source. Treatment providers should be able to recognize these issues, treat these individuals with understanding and compassion, and help them adjust to their difficulties and function in a manner that allows them to maintain sobriety, or refer them to an appropriate treatment provider who can do so.
- Treatment providers should seek out specialty training to help them better serve individuals who are wheelchair-bound.
- When assessing individuals who are wheelchair-bound, the clinician should make appropriate accommodations for these individuals, consider their situation, and make inferences about the results of the assessment.
- Treatment providers can consult with disability experts to determine the exact level of specialized accommodations for any client who is wheelchair-bound.
- The provision of special accommodations or the use of specialized treatment plans for wheelchair-bound individuals is not equivalent to giving these individuals special privileges. Instead, it involves reducing any barriers and allowing these individuals to participate equally in substance use disorder treatment.
- Ensuring that wheelchair-bound people are integrated into the same services that are offered to everyone is extremely important. This includes integrating these individuals into the same groups as non-wheelchair-bound individuals.
- When the treatment provider cannot eliminate barriers to participation for an individual with a disability, they should attempt to make their services accessible to those individuals or refer them to be an appropriate treatment provider.
Given the above special considerations, individuals who are wheelchair-bound would be involved in the same overall treatment process as most individuals who are treated for an alcohol use disorder. This program of recovery should include:
- Equal access to physician-assisted withdrawal management programs (medical detox programs)
- Equal access to inpatient, residential, partial hospitalization, or intensive outpatient treatment programs, when any of these are deemed necessary
- Medically assisted treatments for alcohol use disorders, when appropriate
- Alcohol use disorder therapy in an individual or group setting (or both)
- Any other counseling or therapy services as required in the specific case
- Treatment for any co-occurring disorders
- Access to participation in peer support groups, such as Alcoholics Anonymous or non-12-Step groups
- Complementary and alternative interventions
- Access to long-term aftercare programs following residential or inpatient treatment
- Any other special services that are required in the individual case to address issues identified in the assessment process
There are several resources that individuals who are wheelchair-bound and seeking treatment for alcohol use disorders can use to get further information: