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Clinical Professionals
This Months Featured Article

Treatment of Substance Abuse Disorder: Referral and Support

If you are a clinical professional providing services to persons with developmental disabilities, you may encounter situations where treatment for substance use disorder is the appropriate recommendation. Traditional providers of drug and alcohol treatment services may require some support to appropriately treat the consumer that you refer.

Making Referrals
When referring a consumer for treatment you may need to provide additional information that will assist treatment staff. A representative summary of strengths, needs, and preferences of the individual will allow for individualization of supports. Information about effective means of communication with the person and suggestions for content and style of interactions should also be offered. Certain attributes of the consumer may not be evident to treatment staff without this initial input from the referring professional or agency.

When making a referral, extra care regarding the treatment modality can mean the difference between success and failure of the program. Modalities that rely on conceptual or abstract ideas such as group therapy may be an ineffective approach for a person who functions best in a concrete and structured manner. As a clinical professional with developmental disabilities experience, you may be in the best position to evaluate the potential for effectiveness of the various treatment options.

Making Accommodations
Assure that not only physical but communication barriers for persons with cognitive or developmental disabilities are addressed. For instance, the person being interviewed should not be asked if they use alcohol; rather, they should be asked if they like to drink beer, wine, or wine coolers, for example. Rather than ask how many ounces were consumed, it may help to use empty containers of different sizes to allow for a pointing choice. It is recommended that persons with disabilities not be excluded from existing treatment options, therefore staff may need assistance to find creative ways to work with persons with coexisting disabilities. The more specific the information that is provided at the time of referral, the greater the chance that treatment will be effective.

Functional limitations such as an inability to read, write, or understand the treatment plan may be especially frustrating for persons with cognitive disabilities. The treatment staff may need training in order to facilitate effective communication and treatment. Evaluations that contain functional information should be provided at the time of referral.

Treatment Planning and Service Delivery
A summary of previous treatment may be offered as a starting point for drug and alcohol treatment teams. For instance, risk avoidance may be a barrier to treatment for a person with mental retardation because she has been victimized in the past and now avoids developing new friendships and other relationships. Learning to trust a stranger or attend a large meeting may be difficult for a person with such experience. Optimizing an individual's strengths is a key to effective treatment planning.

Case Management and Linkages
Persons with disabilities may be receiving services from multiple providers. Substance use disorder treatment needs to be integrated into the total plan for the individual and the case manager serves an advocacy role in this regard. In fact, recent research indicates that the case management role is key to the success of the treatment plan.

Linkages from the regional center and substance use disorder treatment providers can improve the prognosis for recovery when factors that contributed to the substance use such as isolation and lack of employment are addressed. A plan for the individual after he or she leaves the formal treatment setting should involve addressing the other life issues even if these issues were not addressed in treatment. Coordination of services and access to resources help ensure that the consumer will benefit from the treatment plan.

Support for Treatment Providers
Multiple levels of training for staff are necessary to improve the quality of substance use disorder treatment for individuals with disabilities and, therefore, the success of the program. Some training topics to be addressed are: The Americans with Disabilities Act; disabilities etiquette; use of assistive devices and environmental accommodation; impact of disabilities and a coexisting substance use disorder; communication strategies; and sensitivity. Sources for such training may be provided by the referring professional or agency.

The U.S. Department of Health and Human Services, Center for Substance Abuse Treatment (CSAT) has published a Treatment Improvement Protocol (TIP) specifically for persons with coexisting substance use disorder and physical and cognitive disabilities. The TIP should be read in its entirety and may be ordered from the National Clearinghouse for Alcohol and Drug Information (NCADI) at (800)-729-6686. It is also available online at Some of the recommendations therein are applicable to persons with developmental disabilities. This alone will not be enough for most treatment programs and regional center staff, consultants, and vendors may provide additional support to ensure successful treatment.

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