ch. 5 - 8

reaction to abuse

- Shame, guilt, anger and sadness - Disconnection from one's sense of safety, self and self-in-relation to others. ➢ Abuse trauma may cause inability to associate or talk about an abusive episode or feeling about being victimized.

4 primary factors of influence that effects drugs

. Type of substance used B. The route by which the substance is administered C. The bio-psychological set of the individual who is using the substance D. The setting in which the substance is used ➢ For these reasons -- 2 people using the same drug under the same circumstances may have different experiences -- and the effects of the substance may be very different.

negative attitudes toward people with disabilities are complex

> A rehabilitation professional's attitude toward disability directly affects the quality of services they provide their clients. Determinants of unfavorable societal responses and attitudes toward people with disabilities include perceived: > Cause of disability and threat of disability, > Responsibility for the disability and prevailing > Economic reasons understanding of disability and sociocultural values

disability defined

A physical or mental impairment that constitutes or results in substantial impairment to employment, or that substantially limits one or more major life activities."

adaptation

A process of responding • Characterized in terms of movement toward adjustment outcome. • It is consider to be an evolving dynamic and a general process that all individuals go through. • Adjustment-- is the clinically hypothesized final state -when the person reaches the goal of achieving an optimal level of harmony between the renewed sense of worth and the external world- • demonstrating competency to manage one's environment and integration with Communities

abuse induced behaviors

Absence of obvious signs and symptoms makes it difficult to detect. Behavioral signs may be good indicators of abuse showing abnormalities such as: o Noncompliance and aggressive behaviors; o Withdrawals, fearfulness of others, and atypical attachment; o Eating disorders and sleep o disturbances; o Learning disabilities, distrust and self-harm.

abuse and neglect

Abuse and. neglect of people with disabilities (PWD) happen in many different environments and takes many forms. • Neglect appears to be the most common form and the most reported. Studies indicate alarming rates of abuse: 67% of women with disabilities and 65% men with disabilities have reported experiencing some type of abuse.

definition of abuse among persons with disabilities

Abuse or mistreatment of a disabled person is any behavior that is unwanted, hurtful, inappropriate, neglectful, frightening, insulting, or demeaning. It includes physical, sexual, verbal, emotional or financial mistreatment by anyone in a "helping" role or anyone in direct and frequent contact with the person." (World Institute on Disability, 2010)

attitudes toward persons with disabilities

Attitudes Toward Persons with Disabilities Attitudes toward people with disabilities influence the ways that others interact with them. Positive attitudes toward people with disabilities usually develop in positive behavior and interactions. Negative attitudes usually result in bias and discrimination. Attitudes: (ABC) Stereotypes, prejudice & discrimination: Affect- Prejudice: how we feel about members of a group Behaviors- Discrimination: behavior directed at them because of their group membership Cognitions- Stereotypes: generalized beliefs about these groups Problems arising from Negative Attitudes: Racism - Black is less than white Sexism- Female is less than male Aageism - Olde people can't do anything disabilism- a set of assumptions and practices that promote the differential or unequal treatment of people because of actual or presumed difference. Negative attitudes (prejudice): Specific negative evaluation of an individual based upon their group membership producing discrimination behaviors. Negative Attitudes: What negative attitudes and what are the goals? To conserve mental effort, to gain material benefits for one's group, to gain social approval and to manage self-image (personal/social identified). To gain social approval • adjusting our opinions/beliefs to match those of others for: • CONFORMITY, COMPLIANCE, ACCEPTANCE Internal factors that influences use of stereotypes: conformity seeking Self-monitoring Perceived social standing situational factors that influence the use of stereotypes: • time • place

guiding principles: self determination

Competent adults with disabilities have the right to: • Decide how and where to live • Choose whether to accept services and support • Make "bad" decisions which do not harm others

summary: substance abuse as a disability

Considerations: o Chronicity o Deficits in Basic Functioning o Denial o Effects all elements of life o Exists on a continuum o Impacts self-esteem, self-concept and self-image o Needs an individualized rehabilitation program o Exacerbation and Remission o Person-specific

cultural perception in rehab: a psychosocial perspective

Cultural elements such as language, family roles, gender roles, and religious beliefs can play a significant role in the etiology, symptom manifestation, and rehabilitation treatment and services for persons with disabilities. Culture can influence beliefs about causation of illness or disability, the condition of a particular disability, the expectations about what a person with disability can and should do, and the expected reactions of others towards disabilities. Language Influences our perceptions. How we talk about individuals influences our attitude towards them. PWD have been described negatively, leading to negative attitudes towards them. The language we use: Political Correctness??? Retarded he language we use indicates how think and what we have learned.

psychosocial implications

Culture and ethnic values have very strong implications on how a person with disability and society perceive disabilities in general. How chronic conditions and disabilities are medically treated. How services are provided and accepted. How rehabilitation outcomes can be predicted. Psychosocial implications (cont.) In the rehabilitation process of persons from diverse cultural backgrounds (in the US) research indicates in most cases- > that there are more similarities than differences between the practitioners and the patients or clients. Acculturalization (adapting or borrowing traits from another culture) level play a major role. Ex. West coast, southern, Mexican, assimilation, Cultural competence is very important.

adaption to disability and chronic illness from a psychological perspective

Defined as: • Psychology of disability ...is the study of normative responses from (psychologically) normal organisms to abnormal stimuli. • The study of how human organisms respond to a set of stimulus conditions associated with disability

service providers

Determine if this is an old or new behavior pattern for client • Allow room for differences and lifestyle choices which do no harm • Service providers also have their rights to privacy

determiners and reactions

Determiners (external to the individual): • The environment interaction (access & barriers) • Reactions to disablement are determined by multiple variables such as: • Type and onset of disability • Personal characteristics and responsibilities of person • Type of environment where the person evolves • Cultural context influences on emotional and behavioral reactions to disability. • Family and friends' acceptance and support • Education and socio-economic status

disability acceptance

Developed by Wright and based on the principles of the somatopsychology --is the model of adjustment to disability-- that emphasizes disability acceptance. • Acceptance includes: the individual being able to recognize the significant meaning of his/her life- rather than focusing on has been lost due to the disability. • The person then-- embraces meaning in alternative abilities, activities and life goals. > In positive situations-- the scope of what the person values broadens and- the importance placed on: > society's biased view of physical attractiveness and completeness decreases. Disability Acceptance • Instead other intrinsic (essential) characteristics gain more importance such as: • Intelligence • Determination • Wisdom • Persistence and • Quality relationships > At this stage-- the person begins to moderate how negatively disability will impact his/her life-- and the initial devastation begins to reduce. • Ex. A person who uses a wheelchair sees it as a means to mobility-- rather than seeing it as inferior to walking.

other variables to be considered

Does language affect attitudes towards disabilities and rehabilitation outcomes? Do religious believes affect attitudes and perceptions of disabilities and rehabilitation outcomes? Do culture and ethnicity affect legislative action with respect to enacting policies in favor of persons with disabilities? Is cultural diversity an important factor to be considered in the rehabilitation process? Concepts are expressed by words. Language & Attitudes Any logical train of thought is related to the language of the thinker and his/her identified culture. Western societies (different cultures) often take the position that their logic is the only true logic-- forgetting that their logic is based on their particular culture and language implications. Some Comparisons Western thoughts are based on an underlying logic that assumes or denies the subject of a proposition. Western reality is based on substance and causality, whereas Asian reality is centered on relative contrasts and relational thinking.

impact on rehab services

Holistic viewpoint for Rehabilitation professionals --the traumatic experiences of abuse and neglect have significant impact on the victimized individuals: • Functionally • Psychologically • Spiritually • Educationally • Vocationally Participating in rehabilitation services programs can provide the opportunity for -- Securing financial resources through employment Employment is the most significant motivation -- for abused individuals with disabilities to leave their harmful abusive relationship and pursue a better quality of life. Rehabilitation Professionals have crucial role in helping abused survivors: (WHY) • They are trained to identify abusive living situations of their clients • They are dedicated to enhance the independence of their clients from restrictive environments (home or facility) • They promote equality of opportunities for their clients with disabilities • Due to their specialized training- rehabilitation professionals are the first in line of defense in detecting abuse and making the proper referral to other

cultural, language, and religion

How culture, language, and religion individually and collectively affect individuals' cognition and behaviors in a variety setting? How these factors affect nations' policies towards persons with disabilities?

when are drug users covered under the ADA

However, "qualified individuals" under the ADA include those individuals: • who have been successfully rehabilitated and who are no longer engaged in the illegal use of drugs; • who are currently participating in a rehabilitation program and are no longer engaging in the illegal use of drugs; and • who are regarded, erroneously, as illegally using drugs. A former drug addict may be protected under the ADA because the addiction may be considered a substantially limiting impairment. [ However, according to the EEOC Technical Assistance Manual on the ADA, a former casual drug user is not protected: [A] person who casually used drugs illegally in the past, but did not become addicted is not an individual with a disability based on the past drug use. In order for a person to be "substantially limited" because of drug use, s/he must be addicted to the drug Individuals who abuse alcohol may be considered disabled under the ADA if the person is an alcoholic or a recovering alcoholic. Courts have usually held that alcoholism is a covered disability. Alcoholism is looked at on a case by case basis to determine if the impairment substantially limits any major life activities. Even though courts may determine that alcoholism is a covered disability, the law makes it clear that employers can enforce rules concerning alcohol in the workplace. The ADA provides that employers may: • prohibit the use of alcohol in the workplace • require that employees not be under the influence of alcohol in the workplace; and • hold an employee with alcoholism to the same employment standards to which the employer holds other employees even if the unsatisfactory performance or behavior is related to the alcoholism

incidence of abuse

In the U.S. over 18.7% of individuals experience some form of Disability (US. Census, 2010) • Research has found that over 67% of women with physical and cognitive disabilities experienced physical abuse in their lifetime (Powers, 2012) • People with disabilities experience violence 1.5 times more often than people without disabilities (Bureau of Justice Statistics, 2013) • Mandatory abuse reporting data suggests that men and women with disabilities may be at similar risk for violence, abuse and neglect. (Brown, Stein and Turk, 1995

cycle of abuse

Intimate partner violence occurs when abuser exerts power to take control of he abused person. Vicious cycle proceeds in three stages: 1. Tension building- abuser appears moody, easily agitated- the victim becomes emotionally distressed. 2. Explosive abuse actions -abuser become angry, violent and abusive in physical or sexual assaults. 3. Honeymoon period- abuser acts regretful for a short time and apologizes. In comparison with people without disabilities- those with a disability endure the cycle of abuse for longer periods and the honeymoon state disappears after the first cycle of abuse.

models of adaptation

Models of frameworks of psychological adaptation within 4 categories: • interactive • Linear stage • Pendular • Ecological > Interactive model of psychosocial adaptation is also called somatopsychological model-- > Developed by Lewin's field theory-- stating that adaptive behaviors were the function of 2 sets of interactive variable- internal & external aspects of the individual with disability.

suggestions for rehab service providers

Negative attitude pose one of the most significant barriers for people with disabilities. Positive attitudes and actions serve as a model for other professionals and society. Use person centered (non-disabling) language. When counseling a person with disability, if the disability is unrelated to the subject matter- it does not need to be discussed- unless if clarification is needed to provide the services. Focus on what the client can do not on what cannot be done. If unsure about a particular disability condition- consult someone with the knowledge and expertise in that area. Be sensitive to attitudinal barriers that may come up when approaching an employer. Negative attitudes toward disability maybe the outcome of lack of information, education and awareness. Support inclusion in your community!

neglect warning signs

Neglect is a common form of abuse endured by individuals with mobility and cognitive disabilities. • Three forms of neglect: 1. active neglect 2. passive neglect 3. self-neglect Warning signs neglect includes: • The person being cared for is not given the opportunity to speak for themselves without the presence of the caregiver. • The caregiver has an attitude of indifference or anger toward the person they are caring for. • Family members of the caregiver blame the person being cared for anything that goes wrong. • The caregiver exhibits aggressive behavior, including threats, insults or harassment toward the person being cared for. • The caregiver has addictive disorder with drugs or alcohol. • The caregiver exhibits inappropriate displays of affection towards the person being cared for in front of others. • The caregiver isolates the person with a disability from other family members. • The caregiver is unwilling to work with other care providers on a care plan for the person being cared for. • Issues of health and safety hazards in the person's living environment. • Leaving a person with a significant disability in an unsafe or isolated place • Malnourishment or dehydration and/or sudden weight loss. • Untreated medical condition.

variables contribute to attitudes

One set of variables relates to the perceived characteristics of the person with a disability. Important role of relationships of people with and without disabilities-- include parent, rehabilitation professionals, teacher, friend and others. Attitudes can be influenced by the personal characteristics of the individuals with and without disabilities and the attitudinal norms prevalent in the environment.

follow up activities

Ongoing contact with the client Continue with activities outlined in the services period, as needed Continue to monitor the client's level of risk Provide supportive counseling Alter or supplement service plan interventions

contributors to response

Other contributors to response & reactions: • type of disability, its severity-- mild/severe, hemiplegia, paraplegia, quadriplegia, TBI, etc. • its health stability-- progressive, secondary disabilities, health status • person's gender and role within family or society • inner resources and temperament • Self-image and self-esteem • family and friends support • income and financial status • availability and afford ability to technology • private and government funding trends • rehabilitation services compliance

personality variable

Other personality variables that influence reaction to disablement: Values, culture, religion Personality traits (factors) Behavioral patters Response tendencies Temperament (emotionality, energy & activation levels) Flexibility Adaptability Maturity

characters that influence attitudes

People who believe that disability is a major characteristic of individuals with disabilities tend to exhibit negative biases. In contrast-- believing that such individuals can be competent, that they are similar to people without disabilities, and-- that special skills or training are not necessary for interacting with or teaching them tends to be associated with positive attitudes.

risk factors

Personal Problems of Abuser -(untreated mental illness, drug/alcohol abuse, learned dysfunction) Imbalance of Power: • History of Violence • Dependence • Isolation of Victim • Culture of Compliance Long History of Domestic Abuse, Neglect and Violence • Cycle of violence • Role reversal o Financial tasks o Decision maker o Homemaker • Growing dependency increases stress in family, etc. • Financial dependency • Non and traditional family and marital values • Power and control issues Domestic Violence and People with Disabilities Cycle of Violence Increased Stress Financial Dependence Non and traditional marital values Power and Control Dysfunctional Abuser Characteristics • Mental or emotional illness • Learned violent behavior • Overly dependent • Financial dependence on client • Intervention Process

to manage self-image

Personal: the need to feel good about oneself o linking ourselves to successful others o distancing ourselves from unsuccessful others o scapegoating when we fail Social identity: o opinions/feelings about social groups we belong to Personal/social identities use social comparison: o downward- higher self-esteem/social identity o enhance own group/derogate other group Internal factors that influence the use of stereotypes: o in-group identification o authoritarianism Situational factors that influence the use of stereotypes: o failure

5 stages

Pre-contemplation • Unawareness or denial of the problem Contemplation • Considering change Preparation • Increasing commitment and taking initial steps Action • The actual changing of behaviors Maintenance • Sustaining new behaviors

challenges for rehab

Process Defense mechanisms: Denial • I can stop using anytime I want Projection (expressions .. Ex.) • The boss is on my back all the time. I think I'm doing a great job. I just have a drink to calm my nerves. Too much supervision is making me sick! Displacement • My counselor makes me angry. She is too controlling. She just doesn't get it that I'm trying. She's on my back. She just wants to have a good client who does what she wants.

type of substance

Psychoactive substances tend to produce discrete psychological and physical changes-¬ that can be identified by their effect and are grouped according to properties. Four major categories: 1. Stimulants, 2. Depressants, 3. Psychedelics and 4. Inhalants The Continuum Use, Abuse & Dependency: • Experimentation • Recreational -- social use • Use -- as in life style • Dependence --Chemical • Addiction -disorder Commonly Abused Substances o Drugs are psychoactive chemicals that bring about changes in biological, psychological, social and/or spiritual functioning. o This includes legal drugs (e.g., alcohol, over the counter meds, tobacco, and caffeine) and illegal drugs such as marijuana, heroin and cocaine, etc. 1. Stimulants: produce increased awareness, attention or excitement levels followed by depressed levels: e.g.: cocaine, and methamphetamines 2. Depressants: produce the opposite effects- decreased tension levels followed by an increase in tension: e.g.: alcohol, heroin, barbiturates, and pain relief medications. 3. Psychedelic: includes LS and marijuana 4. Inhalants; glue and anesthetics

psychosocial concepts

Psychosocial adjustment and psychosocial adaptation—are similar in reference to coping with adverse life crisis-- such as chronic illness and disability. Adaptation may be consider as a process of responding to: the functional, psychological and social changes that occur with the onset and experience of acquiring a disability or chronic illness Abnormal stimuli: a) biological-- (neurological paralysis) b) environmental-- (access) c) social-- (attitudinal) d) isolation-- (lack of inter-relationships) e) economic-- (employment)

role of rehab profs

Rehab professionals do not need to have all the skills to provide AD treatment services -but they must have the skills to coordinate the services such as: • Screening and identification • Case management and referral • Levels of care • Self-help and treatment • Effective utilization of self-help > Rehab professionals must reach to other professionals who provide AD treatment services and recovering facilities in the community. > The collaboration and willingness of the client to recover makes to rehabilitation effort a success.

come comparisons

The linear -logical- analytic- verbal mode of the left brain dominates Western thinking. The functioning of the right brain ... that is intuitive -holistic- creative- nonverbal-- has been neglected in Western cultures— and is seen as a less legitimate mode of expression.

understanding abuse

The phenomenon of violence against people with disabilities is complex and involves: • Health issues • Social and well being • Criminal justice- and • Human rights problems These acts of abuse and neglect occur in this country and all over the word. The most commonly context of violent abuse of women is between: • Intimate partners or domestic violence (household) • Spousal abuse (men & women) • Females account for the vast majority of victims- highest rate between ages 16 to 24. • Males account for the majority of perpetrators.

conclusion

The recovery process of abused persons with disabilities has two essential goals: 1. establish safety and 2. restoring self-control over the survivors lives Rehabilitation professional can help clients with: > fostering self-image as income-generating workers, > providing information about other help agencies and > acknowledging their potential for success Rehab-services have implications in areas of health care, transportation services, attendant care, and vocational or career counseling.

title 1 of the ADA

Title 1 of the ADA provides limited protection from discrimination for recovering drug users and alcoholics. The following is an overview of the current legal obligations for employers and employees: • An individual who is currently engaging in the illegal use of drugs is not an " qualified individual with a disability" when the employer acts on the basis of such use. • An employer may not discriminate against a person who has a history of drug addiction but who is not currently using drugs and who has been rehabilitated. • An employer may prohibit the illegal use of drugs and the use of alcohol at the workplace. • It is not a violation of the ADA for an employer to give tests for the illegal use of drugs. • An employer may discharge or deny employment to persons who currently engage in the illegal use of drugs. • Employees who use drugs or alcohol may be required to meet the same standards of performance and conduct that are set for other employees. • Employees may be required to follow the Drug-Free Workplace Act of 1988 and rules set by federal agencies pertaining to drug and alcohol use in the

goals of services and follow-up

To provide long term support and intervention to prevent further abuse/neglect • Development of a case plan • Arranging for services/interventions in case plan • Monitoring progress in the case

report abuse

Voluntary Reporting Mandated Reporting An adult with a disability Living in the community (not a licensed care facility) Must be an alleged abuser (not self-neglect) Must constitute Abuse, Neglect or Exploitation

abuse-induced vocational problems

o Abusers frequently interfere with victims' efforts to acquire vocational skills and education. o Victims shown signs or scars of abuse may not want to be in public (job/school). o Barrier to rehabilitation services and education may include the lack of: • Education and training • Skills that are transferable • Accommodation (transportation) • Childcare • Family support

substance abuse and other disabilities

o Alcohol and drug abuse also limit rehabilitation outcomes by contributing to functional limitations. o Indirect and direct self-destructive behaviors associated with alcohol and drug abuse -¬ such as refusal of essential treatment and other forms of self-neglect-- may continue after the onset of disability and adversely affect the potential for rehabilitation. Substance Abuse and other Disabilities • Early identification of persons with disabilities who abuse or/are addicted to substances -¬ should minimize the incidence of secondary complications of disabilities, decrease the cost of rehabilitation, and improve rehabilitation outcomes. Rehabilitation and health care professionals including psychologists -- continue to enhance their knowledge concerning the dual problems of substance abuse and disability. Rehabilitation and health care professionals must be trained to recognize substance abuse problems and to intervene in a timely and effective manner.

ad and substance abuse as a disability

o Americans with Disabilities Act of 1990 ADA statues and guidelines recognize substance abuse as a disability • People with a substance abuse problem are protected at work, unless they are currently engaging in the illegal use of drugs. • A person with a coexisting disability can be legally discharged from a job if illegally abusing substances

professional beliefs

o Before the ADA persons with additive disorders were not protected under the law. o Attitudes and beliefs were based on the "moral model." o This model suggest that persons with substance abuse disabilities is to be blame for their own problem- bad judgment and bad behavior. o Also suggest- individuals can be reformed by exercising their will power and adopting correct attitudes, beliefs, and values- ADA can be cured and people can use responsibly. o Rehabilitation professionals are not immune from inaccurate and often negative beliefs held within the broader culture. Formal education, training and clinical practice has improved the attitude and beliefs about this disorder.

abuse induced physical problems

o CDC indicated that violence is serious health problem and possess high risk for women with disabilities. o Violence and abuse endanger women's physical and mental health and impair their function abilities o Women with disabilities from low SES are found to have an increase in abuse and neglect: > Women living in abusive relationship experienced worse health outcomes than those without history of abuse. > Abuse produced a stronger negative impact than poverty. >Health problems subsided after abuse ended.

abused-induced mental health

o Depending upon the degree of violence and others circumstances, survivors of abuse are found to suffer an increased risk of developing Posttraumatic Stress Disorder (PTSD). o Mental illness resulting from abuse has devastating impacts on work performance and employment retention. o Abuse-induced poor physical and mental health affects: o Employment opportunities and prospects for employment retention. o Abuse and poor health are markers for welfare dependency. o Necessary components of stable employment include social support, education/training, work skills and experience

effects on family and friends

o Entire family is affected and may need counseling. o In some case family and friends turn their backs on the victims. Intervention and Prevention Guiding Principles: • Mandatory Reporting-- combines voluntary and mandatory reporting of abuse to protect the victim. • Professionals who provide services to adults with disabilities must report suspected abuse • All other persons are encouraged to report voluntarily • Protection and Immunity is provided for all reporters

substance abuse

o Many individuals with disabilities who live in abusive situations tum to alcohol and drugs to cover up traumatic feelings and emotional distress- if they have access to them. o Substance abuse creates more serious problem in particular when they are given by forced to the individual for other purposes

treatment

o Medical detox o Methadone Maintenance o Drug-free Outpatient Treatment o Chemical Dependency (28 days detox) o Therapeutic Communities o Self-help groups The rehabilitation professionals are increasingly recognizing the need to identify effective stages for working with PWD who are experiencing coexisting AD disorders.

psychological and emotional effects

o Psychological: stigmatization, overwhelming fear for their lives, lack of trust on others, and low self-esteem -- and o Feelings of hopelessness and helplessness. o Emotional: severe emotional distress, social isolation poverty and concurrent or two or more health conditions (insomnia and anxiety) (depression and phobias). o Assault induced stress can lead to functional impairment of body defense systems (Immune an endocrine systems- pituitary gland, pancreas, thyroid gland, etc)). o Victim becomes more susceptible to infectious disease. o All impede successful rehabilitation outcomes.

psychosocial adaptation

• 2005 in the U.S.-- one out of every two adults or approximately over 133 million had at least one chronic illness • About one-fourth of these individuals had one or more activities of daily (ADL) living limitations. > Disability and chronic illness-- interfere significantly with physical, psychological, social, vocational and economic functions of those affected. l> Psychosocial adaptation and adjustment issues present significant barriers-- to participation in rehabilitation services and successful rehabilitation.

defining attitudes

• A fairly stable evaluation of a disposition that makes a person think, feel or behave positively or negatively about some person, group or social issue. • Attitudes are a mental construct which can be "acquired or modified by absorbing or reacting to the attitudes of others."

ADA defined

• A person who has a physical or mental impairment that limits one or more major life activity; • A record of such an impairment; • Is regarded as having such impairment

AD common terms

• Addiction -- the state characterized by a repeated activity that involves continues, compulsive engagement in rewarding stimuli, despite adverse consequences. • Psychological dependence- the dependence that involves emotional-motivation withdrawals symptoms. • Addictive behavior- the behavior that is both rewarding and reinforcing (sometimes uncontrollable). • Disorder -- something that is not the expected norm or behavior related to human behavior, habit and judgment. • Abuse- Maladaptive pattern of substance use leading to clinically significant impairment or distress

addictive disorders

• Addictive disorders as primary or a coexisting disability have a significant impact on the process of rehabilitation - and presents considerable challenges for the client and the rehabilitation professional providing the services. • AD can be a pre-existing condition or it may have an onset after a disability or after chronic disabling condition has been diagnosed— • AD can be the result of- use and/or abuse of addictive substances as a life style, or to cope with a condition (pain killers, alcohol, etc.) • AD- as in the case of substance abuse has negative consequences in the individual's medical, vocational, social and psychological aspects physiological aspects of the individuals

guiding principles: ethics

• Adults with disabilities have the right to be safe. • Clients retain all their civil and constitutional rights unless some of these rights have been restricted by court action. • Clients have the right to make decisions that do not conform with societal norms as long as these decisions do not harm others. • Adults with disabilities are presumed to have decision making capacity unless a court adjudicates otherwise • Adults with decision making capacity have the right to accept or refuse services

institutional abuse and hate crime

• All forms of abuse listed above can be found in domestic and institutional settings. • Abuse may also take place in educational institutions, health care providers, VR training facilities and other places where PWD receive services. • Peers with or without disabilities can become the abusers in some cases. • Similar to race, life styles or religion offences certain people have biases against PWD and commit hate crime against them. • The impact of bias against PWD- includes inequities in education, employment, housing and public accommodations.

social model

• Based on the recognition of impact of negative life experiences e.g.: societal attitudes, family relationships, finances, work pressures etc. -maladaptive patterns of coping are possible causative agents for substance abuse.

warning signs/symptoms

• Biological-loss of weight, liver disease, gastrointestinal (GI) conditions, discoloration and loss of tooth enamel. • Psychological - increase in anger, irritability, lethargy, confusion • Social- socializing with drug users, isolated from non-using friends, lack of family relationships, loss of job, problems with law (arrests) • Spiritual-loss of values, denial of morality • Medical detection- urinalysis can detect presence of certain drug-related electrolytes and metabolites in the urine. Breathalyzer, hair samples as well

other variables

• Community resources • Hospitalization, medical rehabilitation and health status experience Health care services and rehabilitation institutions • Assistive technology and afford ability • Assistance with some functional limitations (ADL) • Individual cultural and ethnic background • Disablement as a learning process Rehabilitation services access

exploitation

• Financial-: Means the misuse or withholding of a person with a disability's resources ($$ SSDI, SSI, etc.)-- by another person to the disadvantage of the victim (PWD) and or the profit or advantage of a person other than the person with a disability. • Slavery

impact of disability

• Gain and losses caused by the disability • Other expected life opportunities • Challenging life ahead • Acknowledging and Working with peers

individual concerns

• Impact of disablement is contingent on the extent-- to which it interferes with what the person was doing or planning to do at the onset. • Interruption of plans (education, work, family, etc.). Changing plans to more realistic goals • Adjusting interests • Wanting to do things never thought or planned before

lewins field theory: somatopsychological mode

• Internal aspects are associated with physical elements-- • e.g., type and severity of the disability • The psychological elements-- • e.g., self-concept, stress management skills. The external environment factors include: • social, vocational, and physical environment barriers > A person's level of adaptation reflects the bi-dimensional conjoint (linked) effects of internal characteristics.

guiding principles:intervention steps

• Involve the client in all discussions and decisions to be made • Respect the client's right to confidentiality • Need to be direct in discussing the situation • Intervene with the family if possible with the clients consent

linear stage model

• Is the early psychological adaptation-- emphasizing the sequential nature of the adaptation process. • Focuses on the psychological impact to the person- once the permanent & irreversible damage done to the physical body is understood. • It is expected that the linear progression of stages would be automatically activated. • The person would go through the emotional phases of: shock, denial, anxiety, anger, acceptance & adjustment. • If more advanced stages are experience earlier- the person must "work through" all stages to reach the final stage successfully. Linear Stage Model • A more unified (simpler) model of adaptation to physical disability developed by Livneh. • These psychological reactions were grouped into 3 main categories: • Earlier reactions (e.g., shock, anxiety & denial) • Intermediate reactions (e.g., depression and anger • Later reactions (e.g., acknowledgement, behavioral adaptation, and disability integration)

neglect

• Passive - Passive Neglect: Is the failure of a caregiver or personal assistant to provide a person with a disability with the necessities of life including, but not limited to, food, clothing, shelter, supervision and medical care. • Willful Deprivation (Leaving SCI -nude, cold, and wet in bath tubs, locking them up, keeping medication)

pendular recurrent model

• Pendular Model= Adaptation is viewed as an ongoing cycle • The process of adaptation tends to occur-- in a dual directional pendular trajectory- that swings back and forth between non-disabled self to current disabled self. • Ecological model= environmental, disability consequences and personality characteristics are all of major concerns to the individual. Reactions to Disablement Realization: person with disability vs. significant others. Passive- aggressive- understanding.

spiritual model

• People who use substance and alcohol have lost touch with a higher power and as a result have lost his or her way- suggests to return to a spiritual source and this action will result in changing one's abusive ways

impact of abuse

• Personal -affects self-esteem, self-concept, and self-value • Community includes local government, law enforcement, hospitals, social services and the community. • Short term and long term

ad experience by professionals

• Personal Experience- our own use or non-use may affect our views of AD, individuals that have recovered from addictive disorder contribute to the rehabilitation of others who have not recovered yet. • Family History- Professionals may find themselves emotionally affected or involved with clients in ways that do not enhance the therapeutic relationship. Peer-to-peer support has been successful in most cases. Effects of Psychoactive Substances

abuse

• Physical- causes or inflicting bodily harm...Kick, burns, slapping, hitting, chocking, etc. • Sexual- without consent...rape, molestation, fondling, unwanted touch • Emotional- acts to diminish the spirit...name calling, humiliation, intimidation, demeaning remarks, etc. • Confinement- Restraining or isolating a person with a disability for other than medical reasoning

moral model

• Places blame on the individual for the abuse and suggest that people who use substances and alcohol are weak and they makes a conscious choice not to abuse substances.

determinants to reaction

• Reaction determinants (unique to the individual): 1. those emanating from the disability itself 2. those linked to the person who becomes disabled 3. those present in the person's immediate environment 4. those that are part of the larger cultural context Individual Concerns • Other individual concerns: *Stability of the disability- changes over time (consequences) * Progressive conditions/disorders (MS, MD, etc.) * Dealing with residual disablement * Secondary disabilities (comorbidity)

guiding principles:advoacy

• Recognize that the person with a disability maybe in a vulnerable situation • Assist the client through interventions • Professionals serve as advocates of the person's rights • Assist the person in obtaining needed services

rehab services

• Recommend community based services rather than institutional care, if possible • Recognize that inappropriate intervention may be worse than none at all • The client's interest comes first

response to disability

• Response patterns= adjusting to, coping with or accepting new condition • Emotional and behavioral reactions of persons with disabilities= are complex and unique to the person. • Personal characteristics situations= determine the types and intensities of their reactions --to the lack or loss of capabilities taken for granted. Response to Disability • Time in person's life and type of disability onset-- influences reaction (i.e., age, family and social role & plans for the future). • Different psychological and social reactions (i.e., reactions of other people) • Children-- young adults-- older adults (i.e., differences in adaptation influenced by age, maturity and human's development) • Born with vs. acquiring a disability later in life (i. e., learning adaptation and coping skills)

bio-psycho-social model

• Sees substance abuse in a broad manner including biological, psychological and social factors. The Bio-psycho-social-spiritual model adds the spiritual component. These are holistic models that place emphasis on all areas essential to personal well¬ being and integration

liveh unified model of adaptation

• Shock= impact of an overwhelming experience-- • such as a sudden onset of severe physical injury (SCI) or the news of a diagnosis of a terminal disease. • Anxiety= the sense of possible consequences and severity of trauma event and worry about possible complication. • Later reactions= includes sub areas of acknowledgement and adjustment. • Acknowledgment-- is the first sign reaching a stage of cognitive reconstruction of how the "self' is viewed. • Adjustment is reaching a state of harmonious continuation and expected to be long term.

psychological model

• Similar to disease model- focuses on maladaptation/poor adjustment at the emotional and/or cognitive level- substance abuse is seen as a compulsion.

cultural beliefs and psychoactive substnace use

• Society has maintained a "love-hate" relationship with psychoactive substances since colonial times. • Despite significant attempts to control, regulate and prevent the use of psychoactive substances -- the use, misuse and abuse continue among all levels of society. • While addictive behavior increased --the number of qualified clinician counselors was not sufficient to care for this population with AD. • It was difficult to agree that addictive disorders could be considered as a form of disability.

disease model

• Substance abuse is an illness and should be treated as such- places importance on biological factors.

process of change

• These are coping methods or strategies utilized when trying to implement change. Each change process is a category of coping activities which entails numerous techniques or interventions -Cognitive-Affective • Consciousness raising • Self-evaluation • Dramatic relief • Environmental re-evaluation • Social liberation -Behavioral • Counter-conditioning • Stimulus control • Reinforcement management • Helping relationships • Self-liberation Predictors of Change Self-efficacy • Confidence in the ability to perform certain tasks • Usually lowest during pre-contemplation stage and highest during maintenance Decisional balance • Evaluation of pros and cons pertaining to the performance of specific tasks Impact of Substance Abuse and Disability Basic living skills • homelessness, lack of income, repeated legal problems Health • Poor or deteriorating health often results from years of abuse & neglect of health Education • Substance abuse can lead to significant deficits in academic development and basic learning skills Employment • Early onset and lengthy periods of substance abuse often result in difficulty in obtaining & retaining meaningful employment Relationships • Interpersonal & socialization skills may be poor because relationships were often based on the acquisition and use of drugs. The ability to communicate outside of the drug community is frequently impaired. ➢ Rehabilitation professional are involved with the client in all aspects of helping services- to reduce the negative impact and reinforce recovery.

attitudes and beliefs about AD disorders

• Traditionally-- the lack of interaction with and between the non-disabled population and persons with disabilities has created the most substantial barriers for persons with disabilities. Attitudes and beliefs may be due to: • lack of knowledge about disability types • lack of knowledge about addictive disorders • lack of understanding about the potential of rehabilitation methods-- and • Socio-culturally based opinions about how & why AD was acquired. AD and its implications to disability represents one of the most significant challenges because of the cultural message that it gives to society- about using or abusing addictive substances. The cultural messages influence the beliefs and behaviors of the client and the rehabilitation professional.

guiding principles: intervention

• Understand that collaboration will provide the client with the broadest range of options, improve access to services • Recognize that each team (client, family, counselors, etc.) member brings a different work philosophy • Strive to understand and respect the roles and responsibilities of each team member • If possible, plan together as a team

reactions to disability depend on

• when in a person's life happened? • how did it happened? • what caused it? • who is at fault? • where it happened? • why did it happened