Substance use disorder (SUD) among disabled adults is an important issue because people with a disability are more likely to experience SUD. It can be difficult for disabled people to get medical help for SUD because treatment is sometimes inaccessible, providers may lack awareness of the needs and experiences of disabled people, and the treatment may not be effective. This exploratory study begins with a synthesis of evidence on facilitators and barriers to SUD treatment among disabled adults. We then describe what is known about the effectiveness of SUD treatments among disabled adults and describe research gaps.
Why This Matters
Despite experiencing higher risk for SUD, the SUD-related needs of people with a disability often remain unmet within existing health care frameworks, making access to effective treatment for SUD treatment among disabled people a pressing public health concern. Policy changes that impact barriers and facilitators to take-up of effective treatment among people with a disability can minimize the harms of SUD. Strategic research in collaboration with disabled people with diverse experiences has the potential to identify effective treatments by type of disability and identify policies that minimize barriers and maximize facilitators for people with a disability.
What We Found
Common barriers to SUD treatment (e.g., transportation, SUD stigma, unidentified SUD) are often magnified for adults with disabilities. For disabled adults, specific barriers include treatment that does not accommodate physical or sensory barriers, lack of specialized screening and treatment tools, disability stigma, and gaps in provider awareness of the needs and experiences of disabled people.
Facilitators include screening for disability, adapting interventions for specific disability types (e.g., intellectual disabilities), incorporating flexibility and accommodations into treatment policies, integrating treatment into disability services (e.g., at Centers for Independent Living), and creating welcoming, integrated treatment environments. Other facilitators include offering treatment in accessible locations with diverse material formats and increasing the share of providers with nuanced understanding of the experiences and needs of disabled people (including by recruiting providers with a disability). Interviews with people with lived expertise highlighted the importance of 12-step programs (e.g., Alcoholics Anonymous) and peer support, particularly from disabled individuals with lived expertise.
Little empirical information exists about the effectiveness of SUD treatment among people with different disabilities. Adapted SUD interventions for those with intellectual disabilities or cognitive impairments show promise, such as substance refusal skills training and extended brief interventions to reinforce changes in substance use. For individuals with mild to borderline intellectual disabilities, specialized programs like Take It Personal!+ and adapted evidence-based practices, such as motivational interviewing and cognitive behavior therapy, have been developed.
More research is needed to fill gaps in evidence about when and how preferred treatment (e.g., 12-step, peer support) should be tailored to adults with different disabilities, with a particular need for more robust studies with larger, diverse samples and outcome measures that reflect broad measures of recovery and well-being. Limited research on SUD-specific experiences, risk factors, and treatment outcomes for adults with disabilities and insufficient data on disability in administrative datasets hampers progress.
How We Did It
We conducted a rapid review of the literature and interviews of technical experts and individuals with lived expertise.
