Physical, and Sensory
Disabilities
People with substance use disorders may experience a coexisting cognitive or physical disability. A study by the New York State Office of Alcoholism and Substance Abuse Services found that more than 22 percent of the clients served by licensed treatment facili- ties had a co-occurring mental or physical disability (CSAT 1998d). Self-reports from inmates in 1997 indicate that 31 percent of State prisoners and 23 percent of Federal prisoners had learning or speech disabilities, hearing or vision problems, or mental or physical conditions. This includes 108,000 individuals with learning disabilities, 135,000
with physical impairments, 65,000 with hear- ing problems, and 94,000 with vision prob- lems (Maruschak and Beck 2001).
Evidence suggests that people with cognitive disabilities are disproportionately involved in the criminal justice system (Cockram et al. 1998). Nearly one third of inmates in State prisons and one quarter of those in Federal prisons report having a physical or cognitive disability. These data, derived from self- reports, are likely to underrepresent some conditions, including learning disabilities, of which inmates themselves may not be aware. Ten percent of State and 5 percent of Federal prison inmates report a learning disability. Also, data from inmates in State prisons show that they are three times more likely than the general population to have a speech disability and more than twice as likely to have
impaired vision. These inmates are, however, slightly less likely to have a hearing impair- ment, but this can be accounted for by the age and gender differences from the general population (Maruschak and Beck 2001). People with cognitive disabilities are at a sig- nificant disadvantage in their contacts with the criminal justice system. For example, offenders with developmental challenges are disproportionately likely to be arrested and coerced into a confession for a crime they did not commit. They may not understand their Miranda rights and are eager to please, igno- rant of the value of remaining silent, suscepti- ble to leading questions, insensitive to non- verbal cues, and desirous of appearing com- petent (Cockram et al. 1998). They also are easily led into criminal activity by others, and, in their desire to feel like they belong to a group, they may even view arrest and incar- ceration as successful achievements (Wood and White 1992). Inside jails and prisons, they tend to be victimized by other inmates, and often try to hide the presence of their dis- ability in order to avoid further victimization. According to focus group interviews with fam- ily members of people with cognitive disabili- ties, one way the criminal justice system could better assist people with cognitive disabilities
is to provide qualified staff members to work with them in the early stages of the legal pro- cess (Cockram et al. 1998).
Jails and prisons can be difficult places for people with physical disabilities (e.g., there may be no wheelchair access and bathrooms may not be fitted with hand rails). Sometimes clients with disabilities can be moved to other facilities that are not necessarily appropriate for them, given their sentence (e.g., they may be moved to a medium security facility even though their sentence warrants maximum security). In June 1998, the U.S. Supreme Court ruled that State prisons must comply with the provisions of the Americans with Disabilities Act. This means that they must make reasonable accommodations to provide access to basic facilities and services for eligi- ble prisoners with disabilities (American Civil Liberties Union 1998).
Certain physical disabilities require medica- tion, and this can pose particular problems for treatment facilities in jails and prisons. Facilities may need to give offenders medica- tions at specific times that could conflict with other scheduled activities. Clients under com- munity supervision require a support system that can help them manage their medication and oversee compliance.
Clients who have conditions such as diabetes that require the administration of medication by means of a syringe may face daily what could be a significant trigger for substance use. In the community, they will have to con- tend with the theft or use of their syringes by others. These clients will need assistance in looking at these triggers and developing a relapse prevention plan that addresses them. For example, individuals who need to admin- ister medications using a syringe who are no longer in a residential program could have a friend or relative available to be with them when they give themselves their shots (at least for the first few months after release).
Programs can provide these individuals with a small safe where they can keep needles and should advise them to keep syringes in more
than one place so that if any are stolen they will still be able to administer their medica- tion. Individuals should always check their syringes to see if others have used them and should keep a supply of bleach available to clean needles if they suspect their needles have been used.
Given the prevalence of disabilities in incar- cerated populations, especially among offend- ers with substance use disorders, the consen- sus panel suggests that treatment providers be able to screen for co-existing disabilities and make accommodations for offenders who have them. For example, someone with mental retardation may not be able to participate in a traditional TC and may need to be sent to a modified TC or have another suitable treat- ment option available. Information on treat- ment for clients with co-existing disabilities can be found in TIP 29, Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities (CSAT 1998d).