to use NRT in a cessation attempt (30 percent
vs. 49 percent).^170
Legal Barriers.............................................................................................................
Unlike other chronic health conditions, addiction
involving illicit drugs, by definition, marks a
person as having engaged in illegal activity.
Treatment providers see this as a barrier to
treatment access: CASA Columbia’s survey of
treatment providers in New York State found
that a significant proportion of the respondents
said that fear of being sent to prison or jail
“somewhat” (41.0 percent of program directors
and 42.8 percent of staff providers) or “very
much” (42.2 percent of program directors and
37.0 percent of staff providers) stands in the way
of people looking for needed addiction
treatment.^171
Barriers to Treatment Access and Completion in Special Populations ...........................
The barriers to treatment outlined above apply to
most individuals with addiction; however,
certain populations face additional barriers that
exacerbate the difficulty of accessing needed
treatment.*
Individuals with Co-Occurring Conditions ................................................................
An estimated 20 percent of the U.S. population
has a disability that limits their functioning.† 172
- The special populations discussed in this section do
not necessarily mirror those discussed in Chapter VI
since not all populations that require specialized
screening or treatment protocols have barriers to
treatment access that surpass or differ from those of
the general population (e.g., individuals involved in
the justice system). Likewise, not all special
populations that have additional or unique barriers to
treatment access necessarily require specialized
screening or treatment protocols (e.g., rural
populations).
† Including individuals with sensory disabilities
involving sight or hearing; physical disabilities that
limit basic physical activities such as walking, lifting,
carrying; mental disabilities that involve difficulty in
learning, remembering or concentrating; or
disabilities that impede self-care such as dressing,
bathing or getting around.
People with disabilities use addictive substances
at nearly twice the rate of the general
population.^173 While individuals with co-
occurring addiction and mental health disorders
such as anxiety and depression access treatment
at higher rates than individuals in the general
population (although most treatment facilities do
not provide services tailored to this
population),^174 those with other disabilities that
impede functioning access treatment services at
substantially lower rates than the general
population.^175Many health and social service professionals fail
to identify the presence of risky substance use or
addiction in people with disabilities,^176 despite
their high rate of substance use.^177 Many
barriers stand in the way of treatment for people
with disabilities, such as erroneous attitudes or
beliefs of medical providers,‡ lack of staff
training in how to work with disabled people
and treatment methods and materials that are not
tailored to the needs of people with
disabilities.^178 People with disabilities who have
addiction also may be deterred by
accommodation barriers to treatment, such as
lack of personal or public transportation to a
treatment center^179 and facilities that do not have
adequate accommodations, such as restrooms,
parking facilities, hallways and ramps that are
accessible to patients with mobility
impairments.^180Treatment personnel often do not have the
proper training to meet the physical and other
health care needs of patients with disabilities,
such as knowledge of sign language or Braille.^181
In 2009, 27.7 percent of facilities offered
services in sign language for the hearing
impaired.^182‡ e.g., believing that people with disabilities deserve
pity so they should be allowed more latitude to
engage in substance use.