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Severe substance use disorders are increasingly viewed as chronic conditions, much like diabetes, hypertension, or asthma, requiring profound lifestyle changes and close monitoring. This article compares substance use disorders with chronic physical disorders and disabilities on the following: prevalence, diagnostic criteria, cost to society, risk factors, genetic influence, outcome, and treatment variables. Implications for rehabilitation services are explored.
Substance use disorder is a complex biopsychosocialspiritual condition (Goodwin, 2009a, 2009b), which affects 15.9 percent (40.3 million) of the United States population aged 12 and older. Another 31.7 percent (80.4 million) engages in risky use threatening their health and safety (National Center on Addiction and Substance Abuse, 2012a). It is more prevalent than those with heart disease (11.5%), diabetes (11.9%), or cancer (8.2%) (Center for Disease Control and Prevention, http://www.cdc.gov/ nchs/fastats/).
Rehabilitation professionals working in vocational, medical, mental health, and rehabilitation settings encounter consumers with substance use disorders (SUDs). When compared to the general population, SUDs occur 2 to 4 times more often in persons with disabilities (PWDs), with prevalence rates approaching or exceeding 50% for those with traumatic brain injury, spinal cord injury, or mental illness (Office on Disability, 2010). Estimates of SUDs among consumers of state and federal vocational rehabilitation (VR) services range from 25 to 66% depending on the cooccurring disability (Heinemann, Lazowksi, Moore, Miller & McAweeney, 2008). A quarter of all VR applicants have an active SUD at the time they apply for services (Moore & Keferl, 2008).
For the purposes of this article, "condition" is defined as an ailment which is in its early stages or is well managed and causes no major life impairments. "Disability" is defined as a condition which causes major life impairments. For example, an individual may have diabetes (a condition) and not have a disability. That is, the diabetes may be well managed and have no impact on major life functions (e.g., loss of sight, kidney problems, or gangrenous infections requiring amputations). Further, an individual may have both a health condition and a disability. Thus the terms "condition" and "disability" are not used interchangeably in this journal article.
Substance Use Continuum
Psychoactive substance use exists on a continuum from having never used substances to having an unmanaged chronic, relapsing disorder with a range of variations of...