Substance use disorder (SUD) among disabled people is an important issue because people with a disability are more likely to experience SUD. But it can be difficult for people with a disability to get medical help for SUD because medical providers may not routinely screen disabled people for SUD, and the screening tools providers use may not be effective for people with different disabilities. In addition, providers often lack awareness of the needs and experiences of disabled people. This exploratory study begins with a synthesis of evidence on facilitators and barriers to screening for SUD among disabled adults. We then describe what is known about the effectiveness of screening tools and describe research gaps.
Why This Matters
Despite the increased risk for SUD among people with a disability and the knowledge that effective screening can identify people experiencing SUD and facilitate help, little attention is paid to the barriers and facilitators of effective SUD screening among disabled people. Policy changes that impact barriers and facilitators to effective SUD screening can minimize SUD harms. Strategic research in collaboration with disabled people with diverse experiences has the potential to identify effective SUD screening tools by type of disability and identify policies that minimize barriers and maximize facilitators for people with a disability and SUD.
What We Found
Barriers to effective SUD screening among disabled people include the barriers nondisabled people experience (e.g., SUD stigma and lack of provider skill, confidence, and time) plus inaccessible health care facilities, insufficient provider awareness of the needs and experiences of people with a disability, lack of validated and accessible screening tools, and disability stigma.
Facilitators include conducting voluntary cognitive screenings to improve the identification of SUD and adapting screeners and screening processes for different types of disabilities (e.g., beginning with an open dialogue about accommodations that would be helpful). Facilitators also include increasing the share of providers with a nuanced understanding of the experiences and needs of disabled people (including by recruiting providers with a disability) and providing SUD screenings in accessible settings (e.g., online, in the community) with accessible formats (e.g., braille).
There is little empirical information about the effectiveness of SUD screening tools for people with different types of disabilities. Some studies find that standard tools, such as GAIN-SS, AUDIT, and ASSIST, can reasonably identify SUD among disabled people but little comparative research exists by type of disability. Some studies find that screening tools may require adjustments (e.g., including visual aids and dropping items that lead to false positive SUD screening results in people experiencing chronic pain), but these have not been comprehensively studied, including in large studies with people with diverse disabilities.
Research gaps identified include the need for more disability statistics on SUD prevalence, co-occurring conditions, and SUD risk factors overall and by type of disability. Other research gaps include the development of validated screening tools tailored, as necessary, to people with different types of disability and developed collaboratively with disabled people. In addition, people with lived expertise emphasized the importance of finding ways to expand screening and treatment by linking SUD treatment programs with disability services.
How We Did It
We conducted a rapid review of the literature and interviews of technical experts and individuals with lived expertise.
