The efforts of the RRTC on Drugs and Disability from 1997 through 2002 were focused on improving vocational rehabilitation outcomes for individuals with substance abuse problems. In accordance with NIDRR's directive in its program announcement, the research, training and dissemination activities of the RRTC chiefly addressed the needs of individuals with substance use problems as they co-exist with other disabilities. During the indicated grant cycle the Center undertook epidemiological and evaluative research studies of substance abuse and substance abuse services for consumers of the State-Federal Program of Vocational Rehabilitation (VR) and other persons with disabilities. Recent legislative changes in benefits, HIV-specific VR services, and the needs of youth with disabilities who are transitioning into work were also studied. The RRTC's efforts also included extensive initiatives in the areas of training, dissemination, and technical assistance. Stakeholder concerns and interests related to the Center's research, training, and dissemination-related pursuits, were addressed on an ongoing basis via several mechanisms, including a formal subcontract with a national consumer group, the National Association on Alcohol, Drugs, and Disability (NAADD). Multiple, work-based collaborations were also established with several major Federal agencies, including the Substance Abuse and Mental Health Services Administration (SAMHSA), the U.S. Department of Labor, the National Addiction Technology Transfer Centers (ATTCs) funded by the Center for Substance Abuse Treatment (CSAT), and the Regional Rehabilitation Continuing Education Programs (RRCEPs) as well as other professional and consumer organizations, national clearinghouses, other RRTCs, and institutions of higher education.
- R1: Conduct epidemiological studies to advance understanding of the relationship between substance abuse and disability among individuals who are eligible for services under the Federal-State Vocational Rehabilitation Program, including determining the relative prevalence of substance abuse among persons with more severe disabilities.
- R2, R3: Develop, identify, and evaluate information about effective methods for providing vocational rehabilitation services to individuals who are substance abusers.
- R2: Investigate the impact of recent legislative changes (including welfare reform and SSA eligibility) and changes in health care management and financing of substance abuse treatment on the provision of vocational rehabilitation services to individuals who are substance abusers
- R2, Training & Dissemination: Disseminate informational materials and provide assistance and training to Federal-State VR eligible individuals whose substance abuse has resulted in a work disability, or who have some other disability that results in a substantial impediment to employment but whose substance abuse interferes with their ability to benefit from vocational rehabilitation services, vocational rehabilitation personnel, and related rehabilitation disciplines concerning effective strategies for providing vocational rehabilitation services
- R1: The major findings of this initial, three-year epidemiology study (RRTC, 1996a) can be summarized in terms of the following four areas: 1. Prevalence and patterns of illicit drug use. Compared to the National Household Survey, illicit drug use was much higher in every drug use category for consumers of VR services than the general population. For example, reported marijuana use rates and cocaine use rates in the past year and past month were almost double the rates for the general population. This finding is of particular concern because the individuals reporting this level of use did not have a primary disability of chemical dependency. (Subjects with chemical dependency as a primary disability were excluded from this analysis.) Marijuana was by far the most prevalent illicit drug used by people with disabilities, with about 9% of the sample reporting some use in the past month and 16.2% using it in the past year. 2. Illicit drug use and disability. Incidence and prevalence of illicit drug use varied among different disability groups. Not surprisingly, individuals with chemical dependency as primary disability (44.2%) and HIV/AIDS (50%) reported the highest incidence of illicit drug use in the past 12 months, while respondents with blindness (10.8%), mental retardation (12.8%), deafness (14.3%), and visual impairment (14.8%) reported the lowest rates of illicit drug use in the sample. Drug use was also examined between congenital (19.5%) and acquired disability groups (21.7%) and between those who reported multiple disabilities (21.9%) and those who did not (20.0%). 3. Illicit drug use and demographic characteristics. As in the general population, men in the study reported a higher drug use rate than their female counterparts, with 23.8% of males and 18.5% of females reporting illicit drug use in the past 12 months. The highest drug use rates (25.3%) were reported by those who were 25 to 34 years old. In general, younger respondents were more likely to use illicit drugs than older ones, and the lowest use rates were for subjects 45 years of age or older. Among ethnic groups, African Americans reported the highest rate of illicit drug use in the past year (25%) followed by 21.3% of Native Americans, 20.6% of Caucasians, and 11.8% of Hispanic Americans. 4. Consumers with substance abuse problems during rehabilitation services. Approximately 21% of the survey respondents reported receiving treatment or other services for alcohol or other drug problems, with 22.5% of the same sample considering themselves an alcoholic or drug addict in recovery. Some 21.7% of respondents self-identifying as substance abusers reported being in drug treatment while enrolled in a state VR system.
- R2: The primary objective of the multi-site study was to evaluate the impact of a well-designed case management program for individuals with traumatic brain injury (TBI) who also exhibit substance abuse problems. Although the results obtained to date are not 100% unequivocal, they do strongly suggest that case management does have beneficial effects for adults with concomitant TBI and substance abuse problems. These effects are evident in terms of life and family satisfaction, as well as physical well-being. Large changes in the benefits accrued in regard to employment were not observed, but somewhat limited analysis of cost data suggests that case management-related treatment may be cost-effective in many settings.
- R3: Overall, a significantly greater proportion of the consumers living with HIV/AIDS in the R3 study had substance abuse problems than did the six-state sample of VR consumers involved in the epidemiology study (R1), with over 60 percent of the R3 subjects having MAST scores that indicate an alcohol problem and almost 50% reporting that they used illegal drugs within the year preceding the initial interview.
- It appears that a larger proportion of the consumers in R3 who participated in VR have received treatment services for alcohol/drug problems and consider themselves to be alcoholics or addicts in recovery than the comparable proportion of sampled consumers who did not participate in VR.
- Of the males, who made up 75% of the R3 consumer sample, 36% reported using drugs in the past month and two-thirds had MAST scores that indicated alcohol problems, while for the subsample of females only 8% reported using drugs in the last 30 days and a half had MAST scores that might indicate an alcohol problem.
- Roughly half of the R3 consumer sample who were unemployed had high MAST scores and self-reported drug use in the past year, while for those who were working full time, these usage indicators were 100% for the MAST and 14% for drug use in the past year.
- Initial comparisons of (1) high and (2) low alcohol/drug use subsamples of consumers yielded no significant relationships (correlations) between substance use and either ability to work or vocational rehabilitation outcomes.
- It was found that satisfaction with VR services for those consumers who participated in such services was significantly positively correlated with job satisfaction and positive employment changes.
- R4: Results suggest that in the limited pilot tests completed PALS was successful in bringing about positive changes in students' levels of knowledge regarding the "dangers" of substance use, their understanding of peer pressure to engage in substance use, and their actual behavior regarding the use of some substances. At the same time, the data obtained from participating teachers were very positive - they liked the training, though they had learned some important concepts and skills as a result of their involvement with PALS, felt the materials and activities covered both during the PALS workshop and the follow-up ("booster") session were very appropriate for their students, and most importantly, they actually used those materials and activities in their classrooms with their special education students.
Dennis Moore, Ed.D.
- National Association on Alcohol, Drugs, and Disability (NAADD)
- Rehabilitation Institute of Chicago
- The TBI Network
- The Ohio State University
- New York University
Publications and Presentations
- Moore, D. (1999). Substance abuse and persons with developmental disabilities: Where are we at? Impact, 12 (3), 2-3, 22-23.
- Moore, D. (2000). News from the Rehabilitation Research and Training Center, Wright State University. The NAADD Report, 3 (1), 4-5. San Francisco, CA: National Association on Alcohol, Drugs, and Disability.
- Moore, D. & Li, L. (1998). Prevalence and risk factors of illicit drug use by people with disabilities. The American Journal on Addictions, 7 (2), 93-102.
- Personal Stories. (2001, summer). Six personal stories depicting aspects of substance abuse and persons with disabilities. Dayton, OH: RRTC on Drugs and Disability, Wright State University. Published in the RRTC website: http://www.med.wright.edu/citar/sardi/rrtc.html.
- Pringle, D., Li, L., Sample, E., Moore, D., Imbrogno, D. & Glaser, R. (1997). Evaluation of physical fitness, activity level, and substance abuse in vocational rehabilitation patients (abstract). Medicine & Science in Sports & Exercise, 34 (5), s1172.
- RRTC on Drugs and Disability. (1999). Educational and health survey. In Substance use disorder treatment for people with physical and cognitive disabilities: treatment improvement protocol (TIP). Rockville, MD: Center for Substance Abuse Treatment (CSAT/SAMHSA) and the National Clearinghouse on Alcohol and Drug Information.
- Sample, E., Li, L. & Moore, D. (1997). Alcohol use, ethnicity, and disability: comparison of African-American and Caucasian groups. Social Behavior and Personality, 25 (3), 265-276.
- Siegal, H.A., Li, L., Leviton, L.C., Cole, P.A., Hook, E.W., Bachmann, L., & Ford, J. (1999). Under the influence: Risky sexual behavior and substance abuse among driving under the influence offenders. Sexually Transmitted Diseases, 26 (2), 87-92.
- Substance Abuse Among Consumers of Vocational Rehabilitation Services: summary of an epidemiology study (1997). Dayton, OH: RRTC on Drugs and Disability, SARDI Program, Wright State University. Published in the RRTC website: http://www.med.wright.edu/citar/sardi/rrtc.html.
- Wolkstein, E. (2000). Employing the GrASP to determine vocational rehabilitation goals for persons with substance abuse disabilities. New York, NY: New York State Office of Alcoholism and Substance Abuse Services. • Wolkstein, E. & Spiller, H. (1998). Providing vocational services to clients in substance abuse rehabilitation. Directions in Rehabilitation Counseling, 9, 65-77.