Treating Alcoholics In The Deaf Community

According to information provided by the National Institute on Deafness and Other Communication Disorders (NIDOCD), the determination of the number of individuals in the United States who are “deaf” depends on how deafness is defined. When considering individuals who have significant hearing loss in both ears that results in them not being able to hear at all or needing significant assistance to hear, it is estimated that approximately 200 million people in the United States are functionally deaf, and a good percentage of these individuals are elderly individuals. However, far more people have some form of detected hearing loss that may result in various levels of functional impairment or other issues.

How Many Individuals with Deafness Have Substance Use Disorders?

Again, determining the number of individuals with hearing impairments who also suffer from substance use disorders is difficult. Reliable statistical information is difficult to obtain regarding the number of individuals who are believed to be deaf and also suffer from various substance use disorders, such as an alcohol use disorder. For many years, substance abuse issues among deaf people were basically uncounted and left untreated. The existent research is most likely still incomplete.

• Research published in the Journal of Drug Education in 2010 using two different samples of high school participants with hearing impairment estimated that the percentage of these individuals who will use alcohol as adults ranged from 42 percent to 60 percent.
• Research published in the medical journal The Lancet in 2012 suggested at least 25 percent of individuals categorized as deaf had significant mental health needs, including issues with substance abuse.
• Earlier research by the National Council on Alcoholism and Drug Dependence (NCADD) in 1989 suggested that at least 600,000 individuals classified as deaf also suffered from a significant alcohol use disorder.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the evidence indicates that alcohol use disorders occur in deaf individuals at least at the same rate as they occur in non-hearing-impaired individuals. There may be reason to suspect that deaf individuals have higher rates of alcohol abuse issues.

People with deafness are in a heterogeneous group of individuals who experience far-reaching effects on their emotional, social, cognitive, educational, and occupational development. Many of these individuals will regard themselves as members of a cultural minority group that are singled out when they use sign language or other aids to communicate. The sources above suggest that early access to effective communication with family members and peers is a protective factor regarding the development of a mental health issue including the development of substance use disorders.

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Risk Factors for Alcohol Abuse in Deaf Individuals

Individuals who are deaf will be prone to the same set of risk factors that increase the probability that any individual will develop a substance use issue, such as:

• A family history of substance abuse, which is often taken to imply a genetic component but can also represent learned behaviors.
• Being male, as in most instances males are more likely to have issues with alcohol abuse than females
• A history of abuse or trauma
• Adopting the notion that using alcohol or other drugs is an acceptable way of dealing with stress and other issues

In addition to these risk factors, individuals who have hearing impairments face added issues and risks that can increase the likelihood of alcohol abuse. Some of these factors include:

• Limited family discussions and other social learning experiences that prepare them for the dangers of alcohol abuse
• Decreased exposure to formal substance abuse prevention programs
• Decreased family support, as the vast majority of children with significant hearing loss have parents and other relatives who do not have these issues
• The effects of their deafness on their self-esteem and personal identity
• An increased risk of feelings of social isolation
• A deep desire to fit in with non-hearing-impaired peers, including individuals who use alcohol excessively
• Enablement by the non-hearing-impaired population that can lead to a sense of entitlement in deaf individuals because of their perceived limitations and isolation from others

A very interesting study reported in the Journal of Deaf Studies and Deaf Education in 2008 also indicated that deaf individuals have complications that interact with known risk factors that might increase the risk of the development of substance abuse issues, such as alcohol abuse.

• Deaf individuals tend to have a lower age of onset of substance abuse issues than non-hearing-impaired individuals. Having a lower age of substance abuse onset is associated with more significant and severe substance abuse issues.
• They have more severe diagnostic profiles, including more severe physical dependence than non-hearing-impaired individuals.
• They have higher rates of childhood victimization.
• They have higher rates of co-occurring disorders, particularly issues with depression, trauma- and stressor-related disorders, and conduct problems as children.
• They are more likely to have social networks that are primarily composed of individuals with alcohol abuse or other substance abuse issues.
• They are at a higher risk for being homeless or running away from home as a child.

Special Issues Treating Deaf Individuals with Alcohol Use Disorders

Obviously, individuals who are significantly hearing-impaired have special needs that must be addressed if they are to receive competent treatment for an alcohol use disorder. These individuals will require the same overall treatment protocol used on all individuals with alcohol use disorders; however, they will also require individualized adjustments, additional care, and other considerations in order for treatment to be properly delivered.

• There is a lack of qualified interpreters with documented or certified skills in American Sign Language in substance use disorder treatment programs.
• Treatment providers for alcohol use disorders have a significant lack of understanding regarding individuals who are deaf.
• Deaf individuals often have trouble obtaining any treatment at all for issues related to alcohol abuse and face numerous obstacles, such as being able to contact treatment providers on the phone, finding appropriate treatment providers, etc.
• Hearing-impaired individuals experience significant frustration that contributes to their alcohol abuse and discourages them from seeking appropriate treatment sources.
• SAMHSA reported that in 2009, there were five inpatient treatment providers that offered treatment services for deaf individuals and four that provided outpatient treatment.

Suggestions from the above sources and from the book Mental Health Care of Deaf People: A Culturally Affirmative Approach suggests macro-level approaches to remediate the situation.

• There should be more thorough training in addressing individuals with disabilities at all levels, including in medical school, graduate psychology and counseling programs, social work programs, etc.
• Professional training resources, including workshops, conferences, and other community events designed to improve the skills and knowledge of addiction treatment providers regarding the deaf community, should be developed and implemented.
• Organizations for the deaf should coordinate efforts with training centers and other academic institutions to inform and train students regarding issues that individuals who are deaf face.
• States and local communities should develop a registry of individuals who are qualified to work with and treat alcohol abuse and other substance use disorders in individuals who have disabilities such as deafness.
• More thorough screening techniques to detect disabilities in substance use disorder clinics, hospitals, etc., should be used.
• Efforts to increase the number of qualified interpreters in substance use disorder treatment programs should be undertaken.
• The use of qualified interpreters in support groups, such as Alcoholics Anonymous, should be implemented.
• More thorough prevention and educational programs aimed at deaf individuals, beginning when these individuals are in elementary and middle school, should be implemented.
• Technological devices in the assessment and treatment of individuals who are deaf should be used, such as videos with close caption, reading materials, and other communication devices.
• Efforts to increase other types of anti-drug messages to deaf individual, such as flyers, workshops, etc., should be increased.
• Educational programs should target the parents of deaf children to inform these parents of the risks that their children may develop issues with alcohol abuse and other substance abuse.
• Services such as electronic mailing lists, videoconferences, and other techniques that can connect hearing-impaired individuals to appropriate and qualified specialists who treat substance use disorders should be used.
• Deaf individuals should be encouraged to utilize online treatment sources, such as online 12-Step groups, counseling, and other sources.

According to principles and information from the book Psychotherapy with Deaf Clients from Diverse Groups, therapists and other treatment providers who are going to provide services to deaf individuals should:

• Have the ability to directly communicate with deaf individuals, implying proficiency in American Sign Language
• Offer the use of visual communication systems for individuals who are deaf
• Utilize other services and technology when appropriate, such as certified interpreters, real-time captioning devices, and assistive listening devices
• Have an extensive awareness of the psychosocial impact of the disability on individuals who are deaf
• Be able to form special groups consisting of deaf individuals with substance disorders and other substance abuse issues

It is apparent that substance abuse is a significant problem in individuals who are deaf. This population is underserved, and all individuals should have equal access to treatment for medical issues, including those who have issues with alcohol use disorders and substance use disorders. Concerned substance use disorder treatment providers should make efforts to become aware and competent in treating individuals with disabilities, including individuals who are hearing impaired.

For additional information on treating substance abuse in individuals who are hearing impaired or about individuals with hearing impairments in general, contact the National Association of the Deaf.