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Understanding and overcoming barriers to substance abuse treatment access for people with mental retardation
- Author:
- SLAYTER Elspeth M.
- Journal article citation:
- Journal of Social Work in Disability and Rehabilitation, 7(2), 2008, pp.63-80.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
People with learning disabilities have experienced greater levels of freedom and access to community living in the USA over the past 40 years, and this includes access to alcohol and illicit drugs. Although the risks attendant on substance abuse are known to be greater for those with learning disabilities, there is insufficient good quality knowledge about accessible and effective treatment approaches. People with learning disabilities also face barriers in accessing treatment because of: the fragmentation of substance abuse and mental health/learning disability service provision; the lack of knowledge and expertise on concurrent treatment approaches; paradigm clashes between the rights/empowerment approach to learning disability and the abstinence/responsibility approach to substance abuse; and the lack of clinical knowledge and tools. The implications for research and social work practice are discussed.
Disparities in access to substance abuse treatment among people with intellectual disabilities and serious mental illness
- Author:
- SLAYTER Elspeth M.
- Journal article citation:
- Health and Social Work, 35(1), February 2010, pp.49-59.
- Publisher:
- Oxford University Press
Whilst people with intellectual disabilities (ID) have experienced increasing levels of community participation and inclusion since deinstitutionalisation, this freedom has facilitated greater access to alcohol and drugs, and the potential for developing substance abuse (SA) disorders. People with ID who are known to have high rates of co-occurring serious mental illness (SMI) may be especially vulnerable to the consequences of this disease, yet less likely to use SA treatment. Using standardised performance measures for SA treatment access, rates were retrospectively examined for Medicaid beneficiaries with ID/SA/SMI, aged between 12 and 99 years (numbering 5,099) and their counterparts with no ID/SA/SMI (221,875). Guided by the sociobehavioural model of health care utilisation, logistic regression models were conducted, where it was discovered people with ID/SA/SMI were less likely than their counterparts to have access to treatment. Factors associated with initiation included being non-white, living in a rural area, and not being dually eligible for Medicare, whereas factors associated with engagement included all of the previous plus having a fee-for-service plan, a chronic SA-related disorder, or both. The authors discuss social work policy and practice implications for improving the health of people with ID/SA/SMI through policy change, cross-system collaboration, and the use of integrated treatment approaches.