ERIC Identifier: ED469441
Publication Date: 2002-08-00
Author: McCombs, Kathryn - Moore, Dennis
Clearinghouse on Disabilities and Gifted Education Arlington VA.
Substance Abuse Prevention and Intervention for Students with
Disabilities: A Call to Educators. ERIC Digest.
Youth with disabilities experience a substantially higher substance abuse
risk than their nondisabled peers. In addition to the same risk factors for
substance abuse, e.g., peer pressure, media enticements, and stress-as their
counterparts in regular education, they also face many disability-specific
factors for substance abuse, such as prescribed medications, chronic medical
problems, social isolation, co-existing behavioral problems, and
disenfranchisement. While educating youth with disabilities in inclusive
settings exposes them to positive learning opportunities in the classroom, they
also have more exposure to peer pressure for substance use, and at earlier ages.
On the other hand, children in contained special education classrooms often have
less socialization practice or skills, and may use substances in order to feel
accepted by their peers. Compared with adolescents who have never been in
classes for learning problems, a significantly greater proportion of students
who have been in special education classes live in single-parent and
nontraditional households, have a family member with an alcohol or other drug
problem, have witnessed or experienced physical abuse, and report a history of
sexual abuse and poor emotional health (Borowsky & Resnick, 1998). All of
these contribute to identified risk factors for substance abuse, yet in a recent
survey, more than half of special education teachers reported that they conduct
prevention activities once a year or less; only 15% conducted such activities at
least once a week (Morgan, Genaux, & Likins, 1994).
RISKS ASSOCIATED WITH SPECIFIC DISABILITIES
proportion of students in special education have learning disabilities (LD),
mild to moderate mental retardation or developmental disability (MR/DD), or
emotional disturbance (ED). These conditions are examples of hidden
disabilities: disabilities that are not readily recognized by someone seeing or
greeting the person who has them. Nationwide, in the 2000-2001 school year,
nearly three-fourths of students in special education had hidden disabilities
that compounded their potential risks in specific ways discussed below (Office
of Special Education Programs, 2001). If a child is going to be successful
academically, teachers must adapt lessons to meet that child's specific learning
needs. If students with disabilities are going to successfully address alcohol
and other drug concerns, those lessons must be adapted as well.
Research indicates that people with MR/DD, 11% of the special education
population nationwide in 2000-2001, use alcohol and other drugs at rates less
than or similar to the general population (Westermeyer, Kemp & Nugent,
1996). Because judgment and other social skills tend to require more
concentration for MR/DD students, the same amount of alcohol can impact
cognitive and motor skills more severely. Other significant risks faced by youth
with MR/DD include communication barriers, increased family stress, enabling
behaviors of family and friends, use of therapeutic medications which may
themselves be addictive, and secondary complications from combining therapeutic
medications with illicit drugs or alcohol. Nonetheless, controlled research
dealing with the origin and prevention of drug abuse among people with MR is
essentially nonexistent, but badly needed (Christian, & Poling, 1997).
Special education students with emotional disturbance (ED), who in 2001
comprised 8% of the special education population nationwide, frequently have one
or more additional disabilities. Speculated to be the highest risk group of all
students in school, these students are put at an inordinate risk for violence
and substance abuse by stressful family situations and unsuccessful school
experiences. The increased risks appear to be related to the inability to
develop healthy peer and family relationships, social isolation,
oppositional-defiant behavior, use of therapeutic psychotropic medications, and
social and communication barriers.
About half the students diagnosed with attention- deficit/hyperactivity
disorder (ADHD) receive special education services as a result of other learning
disabilities (Substance Abuse and Mental Health Services Administration, 1998).
People with this condition often experience a variety of coexisting problems
including anxiety and depression, low self-esteem, obsessive- compulsive
behaviors and chemical addictions (Hallowell & Ratey, 1995). With or without
hyperactivity, attention deficit disorder does not disappear after the onset of
puberty, and it can lead to social and scholastic failure. It often results in
increased risk of substance abuse, as well as trauma, conduct and affective
disorders during adolescence and marital disharmony, family dysfunction, divorce
and incarceration in adulthood. Additionally, prescribed medications may be a
risk factor for some forms of subsequent alcohol and other drug abuse.
Low incidence disabilities (e.g. blindness, deafness, or orthopedic
disability) account for less than 5% of students in special education. Most of
these students face disability-specific risk factors. For example, increased
risk for alcohol and other drug abuse problems among people who are blind or
visually impaired has been associated with isolation, excess free time, and
underemployment (Nelipovich & Buss, 1991). Youth with visual impairments may
face fewer consequences from alcohol and other drug abuse due to the enabling of
others, social isolation, and constraints imposed by the disability. Other
research has found that people with severe hearing loss or deafness do not have
ready access to appropriate alcohol and other drug information. When problems do
exist, treatment professionals lack the training required to meet the needs of
these clients (Guthmann, 1995). Alcohol and other drug abuse prevention
materials do not take into account the cultural, language, or communication
differences faced by people who are hearing impaired. There is also concern that
people who are deaf more vigorously attempt to avoid social stigma associated
with an alcohol or other drug abuse label, thereby making detection of problem
use more difficult.
Disabilities with traumatic origin are strongly associated with substance
abuse. Specifically, as many as 50% of spinal cord injuries (SCI) and traumatic
brain injuries (TBI) occur as a direct result of alcohol or drug abuse
(Corrigan, Rust, & Lamb-Hart, 1995). Many people with SCI or TBI continue to
be at risk for substance abuse problems post-injury. Some people with mobility
limitations are required to take several medications for health management,
which greatly increases the risk for complications arising from alcohol or other
drug misuse. For example, many brain-injured individuals take medications to
prevent seizures. There are serious contraindications for use, even in small
quantities, of alcohol or non-prescribed drugs for people using anti- seizure
Substance abuse prevention efforts have improved
greatly during the past decade. Schools are attempting more comprehensive,
research-based strategies; community and family involvement are being identified
as required ingredients for successful programming. Unfortunately, youth with
disabilities have been largely neglected in this process. Drug-free school
coordinators and substance abuse counselors rarely have the necessary training
to adapt traditional prevention messages for special education students. Special
education teachers seldom have the necessary training in substance abuse to
conduct prevention activities or to identify risk factors or signs of abuse.
Consequently, very few, if any, school or social service personnel are prepared
to intervene or educate disabled students relative to substance abuse. Special
education teachers and drug-free school coordinators need to work together to
ensure that programs reach all students.
The need to advocate for appropriate prevention and treatment options for
students with disabilities is clear. Our children in special education are no
longer "sheltered" from the rest of the world in contained classes and separate
schools. The need for specific prevention education training and materials for
teachers and other adults is equally clear. Seeking out training and expertise
that help adults learn how they respond to those with disabilities and that
assists in the development of appropriate materials is an essential step to
improving substance abuse prevention and intervention for students with
disabilities. By adapting and modifying activities, all those who care about and
work with young people with disabilities can address the particular learning
style(s) of the child to make prevention messages more relevant and
interventions more effective. If we clearly understand the nature of the
disability and our individual reaction to it, and know where to find appropriate
materials and how to adapt them, we can ensure that all our youth receive the
information and support they need and deserve.
Borowsky, I. W. & Resnick, M. D. (1998).
Environmental stressors and emotional status of adolescents who have been in
special education classes. Archives of Pediatrics and Adolescent Medicine,
Christian, L., & Poling, A. (1997). Drug abuse in persons with mental
retardation: A review. American Journal of Mental Retardation, 102(2), 126-36.
Corrigan, J. D., Rust, E., & Lamb-Hart, G. L. (1995). The nature and
extent of substance abuse problems in persons with traumatic brain injury.
Journal of Head Trauma Rehabilitation, 10(3), 29.
Guthmann, D. (1995). An analysis of variables that impact treatment outcomes
of chemically dependent deaf and hard of hearing individuals. (Reports from the
Minnesota Chemical Dependency Program, Minneapolis.) ERIC Document Reproduction
Service No. ED 396 194.
Hallowell, E. M. & Ratey, J. J. (1995). Understanding attention deficit
disorder and addiction [Workbook]. Center City, MN: Hazelden Foundation.
Morgan, D., Genaux, M. & Likins, M. (1994). Substance use prevention for
students with behavioral disorders: A Survey of classroom practices. Logan, UT:
Department of Special education, Utah State University.
Nelipovich, M. & Buss, E. (1991). Investigating alcohol abuse among
persons who are blind. Journal of Visual Impairment and Blindness, 85(8),
Substance Abuse and Mental Health Services Administration (SAMHSA) Consensus
Panel (1992). Treatment Improvement Protocol #29: Substance use disorder
treatment for people with physical and cognitive disabilities. Rockville, MD.
Office of Special Education Programs, Washington, DC: U.S. Department of
Education (2001). 23rd Annual Report to Congress on the Implementation of the
Individuals with Disabilities Education Act. Available on line at
Westermeyer, J., Kemp, K. & Nugent, S. (1996). Substance disorder among
persons with mild mental retardation: A comparative study. American Journal on
Addictions, 5(1), 23-31.