Drug Abuse Among People with Disabilities

written by Brianna Aldridge, Undergraduate Student, University of Florida

Not infrequently, people with disabilities receive some form of medication prescribed by their physician with the intent being to assuage pain. This is a natural route for a person with a disability, seeing as they more likely than not will experience some form of pain (be it physical, mental, or emotional) on a regular basis. However, an issue arises when the drugs that an individual takes become abused.

The adverse effects of drug abuse produce countless consequences for those who abuse them, disabled or not. As such, research has been conducted that attempts to determine the background behind abuse as well as factors that play some type of role. When disabled youth become the focus of this discussion, a new realm of possible outcomes arises. How are the social relationships of disabled children and their peers affected? How do parents and teachers deal with situations stemming from differences among students? What is the role of a health educator or exercise therapist in this population?

This particular paper will discuss drug abuse among people with disabilities. In a more general sense, it will discuss disabilities of individuals in the adolescent stage of life. Results of research will show the examination of the characteristics of drug abuse and its prevalence in both the overall population and the youth cohort. It will place a scope on drug abuse in these disabled populations and briefly mention preventive measures. Furthermore, this paper will expose the recurring fact that there is limited research in and around this topic. As such, the conclusion will attempt to explain what can be done in response, and why changes should be implemented. Throughout the paper, exercise therapy techniques will be mentioned and validated.

Before drug abuse in a certain population can be discussed, it is crucial to understand the characteristics of drug abuse in general. According to the National Institute on Drug Abuse, drug abuse occurs when drugs are consumed for a purpose not intended by the physician ("Prescription and over-the-counter," 2012). Prescription drug abuse is perceived to be the most common form of drug abuse among people with disabilities, seeing as their physician typically prescribes them medicine. In addition, this type of abuse is most common in young people, which correlates with the population we have discussed for the majority of this course. Abuse of most drugs, including prescription, is characterized by an increase in the amount of pleasure the body feels. When drugs are used, neurotransmitters (typically dopamine) are stimulated to bring pleasure. To continue to feel that pleasure, an individual may use the drug more than was intended by their physician. A person with disabilities abusing drugs increases their chances of experiencing harm and adverse effects.

The Department of Health Education and Behavior at the University of Florida offers a course titled: Exercise Therapy, Adapted Physical Activity and Health. The course discusses multiple forms of disability, be it physical or mental. Another major component of the course focused on the well-being of individuals afflicted with a disability as well as the people around them. In a home or school setting, parents and teachers become the primary recipients of stress, uncertainty and overall hardship in regard to these particular children and students. Are there available coping mechanisms? Perhaps a guide to working with a child with a disability?

According to one study, professional caregiving services that focus on the family holistically are the greatest assets to stress alleviation in parents (King, King, Rosenbaum & Goffin, 1999). Parents responded positively to valid solutions that can help them and their children equally. Figure 1 expounds upon the factors that enhance parental distress and other psychosocial behaviors. Another group of researchers consider parent to parent self-help groups as a viable and effective method for dealing with their offspring who have disabilities (Singer, Marquis, Powers, Blanchard, Divenere, Santelli, Ainbinder & Sharp, 1999). These methods provide exceptional comprehensive solutions to parents regarding the issue of having a child with disabilities.

In the classroom, though, various situations can arise, many of which do not equate to home situations. As such, teachers have offered insight into their world when faced with the challenge of training up students who have disabilities. Their responses were recorded in a journal titled Exceptional Children. What can be gathered from this body of work is a plethora of "transforming experiences" (Giangreco, Dennis, Cloninger, Edelman & Schattman, 1993). Teachers who initially only accepted a student with disabilities into their classroom based on the level of support that would be received (i.e. technical assistance, increased attention to the class, etc.) reversed their mindset after experiencing the child in the classroom. The transformation was not nor was it expected to be immediate. Rather, after two years transpired, educators began to recognize the student with disabilities on the same level as the other students. They cited efforts like challenging themselves, increasing expectations and responsibility levels, and having an overall sincere feeling of devotion towards their student.

It should be stated that the aforementioned studies provide implications for exercise therapy procedures for these youth with disabilities. As stated earlier, the course offered under the Department of Health Education and Behavior focuses on numerous therapeutic opportunities all involving exercise. Though the studies just discussed do not mention exercise as a form of coping or creating a positive attitude, there is no question that exercise will do just that. Placing children with disabilities in an arena where they can be physically active (i.e. be just like a "normal kid") prove to be outlets of joy and self-expression. Parents and teachers receive the chance to engage with their child or student on a level that is not intellectual but just as crucial to effective development.

Figure 1

Source: Journal of Pediatric Psychology

Scholars have found that drug abuse is present among those with mental illness, but there is little research beyond that to organize prevention methods or even construct in-depth research articles. LeeAnn Christian and Alan Poling published an article discussing a few research findings. They noted that drug abuse among people suffering from mental retardation occurs at a lower rate than for people who do not suffer from mental retardation (Christian & Poling, 1997). Nevertheless, level of harm for people with mental disabilities can be more severe.

Another study that was reviewed mentioned that only a small dosage of a prescribed drug might produce adverse effects when paired with alcohol or other drugs. An interesting point made in Christian and Poling's research stated that the same risk factors of drug abuse for a person without a disability (family history, age at which abuse began, etc.) are evident in people with a disability. Though the authors of this article desire to confer with readers as to what types of treatment and/or prevention are available, the unfortunate reality is that a problem has not really been identified, as noted by Phillips and Johnson in their review about the development of drug abuse among those afflicted with psychotic illness (Phillips & Johnson, 2001). A possible explanation is that many believe that individuals with mental retardation do not drink or have access to drugs (Christian and Poling, 1997). The ultimate goal that many researchers like these share is to obtain more evidence on what can be done for people suffering from mental illness.

Though published prevention methods for drug abusers who have disabilities are sparse, the numbers showing abuse of certain drugs in general is staggering, as shown in Figure 2. Nonetheless, there are some ideas as to what can be done to assist the drug abusers of the disabled population. An article in the Multiple Sclerosis Journal talks about drug abuse among people suffering from multiple sclerosis. Their form of research tackled many facets of MS in a specific community, ranging from interest in change to disease severity. The results after testing showed that between 14 and 19 percent of the community abused or misused drugs in the span of a month. With this data, ideas for prevention arose. These ideas included substance abuse screening and counsel on reducing or entirely cutting off drug intake (Bombardier, Blake, Ehde, Gibbons, Moore & Kraft, 2004). Published ideas on this topic produce a step in the right direction towards published articles on prevention. As students and researchers alike await progress, there are other possibilities. Preventive measures can be furthered with medically managed care.

Figure 2

Source: National Institute on Drug Abuse

Medical care for people with disabilities is highly utilized. The same can be said for disabled individuals who have succumbed to drug abuse. Adverse effects of drug abuse revolve around withdrawal: physiological setbacks, social consequences, and economic disparity. In regards to physiological setbacks, Medicaid managed care has come into play. Though utilitarian, there are multiple factors to consider before drug abusers with disabilities receive Medicaid. A group of researchers (Bachman, Drainoni & Tobias, 2004) reported on literature that stated that medical services are not ever-present for drug abusers with disabilities. However, drug abusers with disabilities are more likely to receive health benefits and monetary support from Supplemental Security Income (SSI), a federally funded means of assistance. Because of this likelihood, the chances for receipt of Medicaid managed care increase.

Despite the possibilities, Medicaid for this group of people comes at a dauntingly high expense. The major issue regarding the topic of Medicaid managed care for these individuals is the lack of published literature available for researchers. As such, Bachman and colleagues concluded that there are multiple routes to take when furthering documentation of care for the affected population. One form of care that has substantial documentation is exercise therapy.

With the perceived and actual repercussions of drug abuse, some form of therapy must be implemented to begin the healing process. Exercise therapy is the key to physical, mental and emotional rehabilitation for people with disabilities. The Adapted Physical Activity course has explained in depth the numerous ways in which exercise can be utilized in populations of people with disabilities. Researchers have claimed, "The process of exercising, via the provision of distraction and social interaction rather than the exercise itself" is what makes this form of therapy so effective (Faulkner & Sparkes, 1999). The confidence and inner strength that can be established through exercise therapy is a testament to its greatness.

Putting a person with a disability in a situation where they must physically work to create an outcome gives them autonomy, as well as the notion that pity is not desired nor warranted. Exercise is also a fantastic outlet for drug abusers, as withdrawal periods can be combated with the introduction of exercise into the daily routine. There are no limits to the equipment that can be used, or the methods that can be performed. Because drug abuse does indeed occur among people with disabilities, it would be ideal for more research to be available that describes exercise therapy as a form of rehabilitation.

The facts of drug abuse are highly documented, as are the general methods of care for people with disabilities. A positive outlook on this topic comes from parents and teachers who feel their child or student is performing at an adequate level. They report receiving support, feeling minimal levels of stress, and wholly responding confidently to the children who have disabilities. Unfortunately, the research that has been presented tackling the topic of drug abuse among people with disabilities is scarce. As a result, literature reviews contain research coupled with speculation and assumptions.

It is clear that there needs to be concrete solutions to aid in the prevention of drug misuse and abuse, but first, the discussion much reach multiple areas. Until this occurs and more research is published, health educators and other interested parties will be forced to make decisions based on good judgment and limited professional assistance. Despite these challenges, there is no doubt that researchers are trying to shine a brighter light on drug abuse among people with disabilities, both its prevalence and how to manage it. Health educators desire to have a broader understanding on the topic in order to manage patients more efficiently. Students yearn to enter into a field where they can be the primary agents of change and progression. Because of these wants, strides are being made in this area of health education, and with collaborative efforts, there will eventually be a plethora of literature reviews tackling every area of this topic.

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