An estimated 7 to 8 million Americans who have an intellectual disability (I/DD) also suffer from substance use problems. Surprised? In the United States, families, support workers, and some state and federal agencies are often in denial about the co-occurrence of I/DD and substance abuse and, indeed, about the size of the problem.
There’s a common misperception that clients with I/DD don’t drink or use drugs, says Susan Tatum, assistant director of clinical and emergency services at the Alexandria Department of Community and Human Services in Virginia. They may experience problems resulting from substance abuse, she says, but substance use may not be suspected as the source of the problems.
Given the numbers and the denial, how can you support individuals you’re working with who may need help?
Understanding Substance Abuse and Addiction
First, know that having a substance use disorder does not equate to being immoral, weak-willed, lazy, bad, or senseless. According to the National Institute on Drug Abuse (NIDA), drug addiction and alcohol abuse are chronic, relapsing brain diseases characterized by compulsive drug/alcohol seeking and use, despite harmful consequences. Drugs and alcohol change the brain and how it works, and these changes can be long lasting, leading to harmful behaviors. In addition, the use of alcohol can take a toll on the body, not only affecting the brain but also the liver and heart.
Why Do People Use Drugs?
Thinking about the implications people with I/DD face in their lives on a daily basis, it is helpful to understand why this population, like the general population, turn to alcohol and drug use. NIDA describes the reasons why most people use drugs:
- To Feel Good The “high” is often associated with feelings of power, confidence and increased energy or even relaxation or satisfaction.
- To Feel Better Some individuals use drugs to ease social anxiety, stress, and depression. Stress can play a major role in beginning and continuing drug use, as well as causing relapse during recovery.
- To Do Better Some people begin using or experimenting with drugs to improve or enhance athletic or cognitive performance.
- “Because Everyone Else Is” Peer pressure can cause some individuals, especially teens and young adults, to participate in daring or thrill-seeking behavior.
- Because They’re Addicted Over time, individuals progress from using to abusing a drug just to feel “normal,” despite negative consequences or risks.
Identifying Treatment Strategies
Substance use disorder is a disease, but treatment involves a lot more than going through detox and attending recovery meetings. Effective treatment must be individualized and should involve treating an individual’s multiple needs, not just the drug abuse. Many individuals with drug addiction have other mental disorders that must be also addressed and treated.
Earlier, we mentioned the public’s denial about the problem. Since 1) we often assumed that people with I/DD are unlikely to use or abuse substances and 2) signs and symptoms of use and abuse are sometimes camouflaged by characteristics of an individual’s disability, abuse disorders all too often go untreated. Moreover, some researchers note that there have been few studies into effective treatments for individuals with I/DD.
Social workers, case managers, and program managers were interviewed for an article in Social Work Today (see Resources, below). They pointed to the need for adapted, accessible treatment and prevention materials, as well as alternative referral and programming strategies for people with I/DD who face barriers in traditional treatment programs, including Alcoholics Anonymous or 12-step programs.
Laura Yager, of Virginia’s Fairfax-Falls Church Community Services Board, recommends, for example, that reading assignments and written exercises be replaced with verbal discussions. If individuals are participating in group treatment, fellow group members may need education about I/DD and about how they can be supportive.
Addressing Relapse, Discrimination, and Other Factors
Professionals now consider relapse to be a natural part of the recovery process. According to a NIDA report, “Treatment of chronic 
diseases involves changing deeply rooted behaviors, and relapse doesn’t mean treatment failed.” Relapse is simply a call to reassess treatment approaches and make changes that address the individual’s needs in their current circumstances.
It’s important for employment specialists to also be aware that recovering addicts are protected from workplace and employment discrimination through the Americans with Disabilities Act, the Rehabilitation Act of 1973, the Fair Housing Act, and the Workforce Investment Opportunity Act. However, these laws do not extend those protections to individuals currently abusing illegal substances.
Keep in mind, it’s difficult to recover from abuse disorders if homelessness, isolation, hunger, and safety are also factors. It obviously can become a vicious cycle since addiction can lead to these issues, and yet these issues can prevent access to treatment. This is why you, as the employment consultant, vocational rehabilitation counselor, or community rehabilitation provider, need to keep an open mind and work with other community providers, such as case managers, to support participants on the long road to recovery.
Resources
- Find a treatment facility, Psychology Today
- National H.I.R.E Network
- National Institute on Drug Abuse (NIDA)
- “Substance abuse among individuals with intellectual disabilities,” Science Direct
- “Substance abuse in people with intellectual and developmental disabilities — breaking down treatment barriers,” Social Work Today