Individuals are diverse and so are groups composed of different ethnicities, genders, sexual orientations, ages, disabilities, and so forth. Substance use disorder treatment is not "one size fits all," and counselors need to be cognizant of specific risk factors that are more prominent for some groups than others. People with disabilities are often marginalized and may present with multiple stressors due to physical, cognitive, sensory, or affective issues. The prevalence for substance use disorders for this population is twice as high as in the general population. Therefore, it is important that substance use disorder counselors recognize the unique risk factors for this population. These factors include:

Health and Medical

The presence of a disability or chronic illness can create an increased risk of dependence or mishaps due to substance misuse. Some disabilities can put people at risk for problems related to medication use if they also use substances. In addition, the medications taken for certain disabilities or conditions (e.g., hypoglycemia, HIV/AIDS, ulcers, hematological diseases, or cardiovascular diseases, to name just a few) can decrease an individual's tolerance for some substances. This can increase risks for overdosing. Another risk factor exists for people who have chronic pain. They can become dependent on the pain medication that they use for relief and experience withdrawal symptoms if the medication is stopped.

Psychological:

Disabilities often come with a host of related stressors. Some individuals with disabilities may use substances to cope with both the disability and these associated stressors. Individuals with disabilities are also more likely to be encouraged by loved ones to use substances to cope than are those without disabilities. A disability can also diminish feelings of self-worth in the individual, which can lead to low self-esteem.

Social:

Social factors include isolation and a reduced support network. Some disabilities can make socialization difficult, and some people still ostracize those who have a disability. Individuals with disabilities may face isolation due to transportation issues and lack of recreational or social opportunities. Individuals with disabilities may be more susceptible to peer pressure to use substances in order to fit in and be accepted. These individuals may also be drawn to substance use to help alleviate their loneliness, frustration, and isolation.

Economic:

Having a disability can be expensive due to special needs and medical treatment. Depending on the disability, individuals with disabilities may also have reduced employment opportunities. Many have a lower income than their non-disabled counterparts. This can create financial stress.

Access:

Individuals with traumatic brain injury, spinal cord injuries, or disabilities associated with a loss of mobility also may have reduced accessibility to substance use disorder treatment. There may also be access issues due to language barriers, learning style, or sensory limitations (e.g., a person being sight or hearing impaired). In addition, people with disabilities who have a substance use disorder may have their substance use disorder virtually ignored, as the disability often takes precedence in terms of treatment.Read the following vignette about Manny, who has HIV and a disability that limits his mobility. Then answer the questions that follow.Manny is a 61-year-old Latino male who is a Vietnam War veteran. He was severely injured in the war and lost the use of his legs. He has been confined to a wheelchair for the last 40 years. He also has HIV and takes multiple medications to keep the condition from developing into AIDS. Manny lives alone in a small house in a poor neighborhood. His parents are deceased and his only brother lives in another part of the United States. Manny lives on a small military pension supplemented by food assistance and Social Security disability benefits. Manny attends his neighborhood church in order to feel connected with God and his neighborhood. Over the years, several families have befriended Manny while they lived in the neighborhood, but one by one, the families moved away. Except for holidays such as Christmas or Thanksgiving, the people at the church and from the neighborhood do not visit Manny. They always seem to be busy with their own lives. Manny receives some home health care services due to his disabilities, but the nurses come infrequently, and come mostly to administer medication or to check on his health condition. Manny does not have a car, and every now and then when he really needs to, Manny accepts a ride through a Medicaid-funded service in order to see his primary care physician. However, the long drive wears him out and the car ride makes him sick; therefore, Manny does not go as often as he should. Most days, Manny ends up at the local bar where he sees other veterans and other people who accept him for who he is. These people are Manny's friends, but they never come over to see him at his house. Every now and then, Manny drinks more than he intends to, and the bartender calls the police or an ambulance. This is mostly because the bartender does not have the resources to take care of Manny when he is in that state. When this happens, Manny usually ends up in jail for public intoxication so that he can "sleep it off." Manny is always released the next day once he is sober. Once or twice, Manny has had to go to the hospital for alcohol poisoning. A caseworker once contacted different treatment centers to try to find a facility for Manny, but none would take him because he did not have any financial means and most of the centers did not have the ability to meet needs related to Manny's multiple medical conditions. Following these unsuccessful efforts to access treatment, Manny's caseworker stopped contacting him.

1. What types of stressors or issues does Manny have related to his health?

2. Are there any stressors for Manny or issues for which he must find a way to cope due to his disabilities? How might Manny view himself due to the way he is treated in his neighborhood?

3. What factors about Manny's social life put him at risk for substance use?

4. What is the state of Manny's financial resources, and how might this contribute to his risk for substance use?

5. What has been Manny's experience in getting treatment for his substance use and for his medical issues?