This TIP, Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities, is intended to enhance treatment providers' knowledge concerning people who have a physical or cognitive disability in addition to their substance use disorder. Treatment programs for substance use disorders already see many individuals with coexisting disabilities, but many providers fail to accommodate these individuals either because they are unaware of the disability or how accommodations can improve treatment outcomes (even though such accommodations are legally mandated). The first chapter defines and explains the issues involved in treating people with coexisting disabilities. Chapter 2 discusses how to screen for coexisting disabilities and how to adapt substance use disorder screenings for clients who have a disability. Chapter 3 discusses treatment planning and counseling; it also describes how treatment can be modified to meet the particular needs of people with coexisting disabilities. Forming linkages with other service providers is the topic of Chapter 4, and Chapter 5 presents material for program administrators. In Appendix B, there is a comprehensive list of resources. Appendix C discusses the proper language to use when referring to people with disabilities. Alcohol and Drug Programs and the Americans With Disabilities Act, a pamphlet from the Pacific Research and Training Alliance, is reproduced in Appendix D.

Contents

• What Is a TIP?
• Editorial Advisory Board
• Consensus Panel
• Foreword
• Executive Summary and Recommendations
• Chapter1—Overview of Treatment Issues
  • Definitions and Terminology
  • Disabilities and Chemical Dependency
  • Recognizing Barriers to Treatment
  • Mainstreaming Versus Specialized Services
  • Working With People With Disabilities
• Chapter 2—Screening Issues
  • "Disability Etiquette"
  • Screening for Disabilities
  • From Screening to Treatment
  • Intake
  • Adapting Substance Use Disorder Screening for Persons With Coexisting Disabilities
  • Use of Screening Information
• Chapter 3—Treatment Planning and Service Delivery
  • Understanding Client Attitudes in Treatment
  • Treatment Planning
  • Counseling Issues
  • Medication Assessment And Management
  • Aftercare
• Chapter 4 --Treatment Planning and the Community: Linkages and Case Management
  • Building Linkages for Treatment Programs
  • Linkages in Case Finding And Pretreatment
  • Linkages in Primary Treatment
  • Linkages in Aftercare
  • Community Partnerships
• Chapter 5—Administrative Tasks
  • Provider Knowledge of People With Disabilities
  • Organizational Factors
  • Funding Mechanisms
  • Marketing the Program
• Appendix A -- Bibliography
• Appendix B—Information Resources
• Appendix C—How To Refer to People With Disabilities
• Appendix D—Alcohol and Drug Programs and The Americans With Disabilities Act
• Appendix E—Resource Panel
• Appendix F—Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number 270-95-0013 with The CDM Group, Inc. (CDM). Sandra Clunies, MS, ICADC, served as the CSAT government project officer. Rose M Urban, MSW, JD, CSAC served as the CDM TIPs project director. Other CDM TIPs personnel included Jonathan Gilbert, MA, managing editor, Y-Lang Nguyen, copy/production editor, Raquel Ingraham, MS, project manager, Mary Smolenski, EdD, CRNP, former project director, and MaryLou Leonard, former project manager. Special thanks go to consulting writers Jeff Allen, PhD, ABPP, Janet Dickinson, PhD, Debra Guthmann, EdD, and Elizabeth Villalobos, MSW, for their contributions to this document.

The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines in this document should not be considered substitutes for individualized patient care and treatment decisions.