RELIEF...
AT WHAT COST?
WOMEN WITH DISABILITIES
AND
SUBSTANCE USE/MISUSE:
TOBACCO, ALCOHOL AND OTHER DRUGS

SUMMARY OF THEMES

March 1996

DAWN Canada: DisAbled Women's Network Canada

Prepared by: Monika Chappell

This research project was generously funded through Health Canada, Health Promotion Directorate,
Tobacco Reduction Programs and Alcohol and Other Drugs Issues

The opinions expressed in this report are those of the author
and do not necessarily reflect those of Health Canada

TABLE OF CONTENTS
ACKNOWLEDGMENTS ...................................................................................................... .. Page iii
EXECUTIVE SUMMARY...................................................................................................... .. Page 1
1.0

INTRODUCTION...................................................................................................... .. Page 4

2.0

CONTEXT ................................................................................................................... ..
2.1
Who is DAWN Canada? .............................................................................. ..
2.2 Extent of the problem................................................................................... ..
2.3
Substances causing the most problems................................................... ..
2.3
Defining substance misuse.......................................................................... ..

3.0

FACTORS LEADING TO SUBSTANCE USE/MISUSE..................................... .. Page 8
3.1
Sexual, physical and psychological abuse ............................................... .. Page 8
3.2
Discrimination, societal lack of acceptance, isolation and poverty... .. Page 9
3.3
High levels of stress...................................................................................... .. Page 9
3.4
Physical and psychological pain and overall level of ill health............ . Page 10
3.6
Anger, despair, hopelessness, shame and lack of self esteem ............ . Page 11
3.7
Lack of knowledge regarding addiction and substance use/misuse.. . Page 11

4.0

WHY WOMEN WITH DISABILITIES USE SUBSTANCES ............................. .
4.1
Helps women cope with feelings including those regarding abuse... .
4.2
Relieves stress and anger ............................................................................ .
4.3
Helps women cope with disability either by self medicating or
.
through physician control...........................................................
4.4
Provides pleasure, something to do and helps women socialize........ .
4.5
Addiction and/or substances are too hard to quit................................. .

Page 11
Page 11
Page 12

BARRIERS TO SEEKING HELP............................................................................ .
5.1
Lack of accessibility to help and accessible transportation ................. .
5.2
Lack of training\poor attitudes of service providers............................... .
5.3
Lack of knowledgeable and sensitive care by medical personnel,
overprescribing ...............................................................................
.
5.4
Need for substances even though they cause some harm .................. .
5.5
Requirement to be substance-free to enter most treatment
programs...........................................................................................
.
5.6
Reliance on caregiving / needs for personal care....................................... .
5.7
Need to fit group model treatment programs......................................... .
5.8
Lack of child caretpoverty issues............................................................... .
5.9
Language /cultural issues.............................................................................. .
5.10 Internal barriers ............................................................................................ .

Page 14
Page 14
Page 15

5.0

DAWN Canada

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Page 5
Page 5
Page 5
Page 7
Page 7

Page 12
Page 13
Page 13

Page 15
Page 17
Page 17
Page 17
Page 17
Page 18
Page 19
Page 19

Page i

6.0

IMPORTANT CHARACTERISTICS OF SERVICES ........................................... . Page 19
Need for women-only services .................................................................... . Page 19
6.1
Need for both integrated and tailored services....................................... . Page 20
6.2
Need to address low self esteem, stress, anger, shame and isolation. . Page 20
6.3
6.4
Need for help from peers who have been there..................................... . Page 20
6.4
Need for accessible programs including accessible transportation... . Page 21
6.6
Need for accessible informational materials........................................... . Page 21
6.7
Need to provide sensitivity training to service providers....................... . Page 22
Current health crisis important factor in stopping or reducing use... . Page 22
6.8
Peer, work, or family pressures important factors in stopping or
6.9
reducing use . ..........................................
Page 22

6.0

REFERENCES............................................................................................................. . Page 25

DAWN Canada

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Substance Use/Misuse and Women with Disabilities

ACKNOWLEDGMENTS

DAWN Canada would like to gratefully acknowledge the funding and
technical assistance of Health Canada, through the Women and Tobacco
Initiative Section of the Tobacco Demand Reduction Strategy and Alcohol,
Drugs and Dependency Issues Programs, for assisting us in producing this
ground breaking work. Technical assistance from Health Canada’s Women’s
Health Bureau was also invaluable.
The assistance, expert guidance and insightful comments of the Advisory
Committee were absolutely essential in ensuring the full consideration of all
issues.

The DAWN Canada Board of Directors’ diversity, experience and
determination played a major factor in the project’s positive outcome. They
participated in the Advisory Committee, set up focus groups, gathered DAWN
Canada key informants together and gave the researcher a welcome human
touch during the long road trip.
DAWN Canada would especially like to acknowledge the assistance of
the many women with disabilities who shared their experience with us. Each
woman provided a voice for numerous others. We are grateful to your
continued willingness to voice your truths. This truly is your work.
The information and help provided by the various service providers who
participated is also gratefully acknowledged. A special thanks to Pauline
Doiron, of Support for Single Mothers in New Brunswick and a very special
thanks also goes to Aline La Flamme, of the North West Territories Native
Women’s Association, who was instrumental in assisting the researcher during
the North West Territories portion of the project.
Appreciation also needs to go to Michéle Reçhtman-Smolkin who
provided the French translation of the initial education bulletin, Maryvon
Delanoë who provided the French translation of the summary documents,
Susie Kâtz who translated the focus group format into French, Julien Longtin
who provided simultaneous French/English whisper translation, and Nathalie
Lévèille who facilitated the Quebec Francophone group and transcribed the
answers back into English.

Aid given by Information Specialists at various addiction and disability
resource centres was essential to the success of this project.
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I Substance Use/Misuse and Women with Disabilities

Help provided by computer whiz Yvonne Johnson, editors stormn and
Wendy Stanyon and computer researcher Chloe Sekora was invaluable.
The guidance and direction of the Project Supervisor, Eileen O’Brien,
and the Project Coordinator, Shirley Masuda solidified this research. The
Coordinator’s vast wealth of experience gained during many past DAWN
Canada projects and the Supervisor’s long years of experience in the feminist
women’s community provided the initial building blocks that allowed this
project to grow and also provided the mortar that held this project together.
Last, but certainly not least, enormous thanks and gratitude goes to the
following group. The entire DAWN Canada team, the Project Supervisor, the
Project Coordinator, the past Chair of DAWN Canada, and many others who
know who they are, provided lifesaving support and encouragement, during
what proved to be a major crisis in the researcher’s life. Your caring and
assistance made all the difference. Thank you.

Project Supervisor
Eileen O’Brien

DAWN Canada

Project Researcher
Monika Chappell

SUMMARY OF THEMES

Project Coordinator
Shirley Masuda

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Substance Use/Misuse and Women with Disabilities

EXECUTIVE SUMMARY
Women with disabilities, as a separate research population, are almost
completely missing from current literature. While conducting the literature
search for this project a number of databases were searched for the key words:
women, disabilities and substance use; zero entries were found, even after the
key word combinations were expanded to cover all possible permutations of
those words. Disability and addiction resource centres had information about
people with disabilities and about people with specific types of disabilities but
none about women and disabilities. Through much effort a couple of articles
and chapters in books were discovered. (Finkelstein et al, '90; Toews, '87)

Perhaps it is not surprising then that almost nothing is known about the
extent of substance use by this population and/or whether it causes problems.
In Canada, awareness on this subject has recently begun to expand. Women
with disabilities were mentioned in recent Women and Tobacco Initiative
Sections of the Tobacco Demand Reduction Strategy and the Alcohol, Drug s
and Dependency Issues documents as an unknown population needing
research.

At a conservative estimate there are over a half a million women with
disabilities in Canada who are addicted to substances. Despite the fact that
there are clear indications that the rate of addiction among persons with
disabilities is at least twice that of non-disabled persons, in Canada we have
just reached the starting block when it comes to providing services thatmeet
the needs of women with disabilities..
This ground-breaking work, generously funded by Health Canada,
attempts to address this major gap in knowledge.
In this work, we sought to find which substances caused the most
problems and we defined substance misuse. We sought out common themes
leading to substance use/misuse and why women with disabilities use
substances, including tobacco. We probed for the important issues that
surround the use of tobacco, alcohol and other drugs, including how the use of
substances is different from non-disabled women.

The use of substances within the whole context of a woman's life - the
social, political, economic and intimate realities of her day-to-day existence as a
woman with disabilities was examined.

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Most of all, we looked at progams and whether they were successful, and
if women were currently using them, and why or why not We looked for
barriers to existing programs and what are the important characteristics of
services.
Participants thought tobacco was the substance most commonly used.
However, most felt the use of alcohol and prescription medications caused the
most problems for them. Little information was known about the use of
'Illegal” drugs and over-the-counter medications and less than half the
participants felt their use caused problems for women.

Substance misuse problems are hard for women to detect because most
have to use substances in order to manage their disabilities. Key factors that
define substance misuse were:

a) not taking a substance as it is intended,
b) when the use of substances seriously impairs their ability to function
c) when the use causes related legal and health problems.
The key internal barrier that stops disabled women from addressing their
substance misuse is lack of self esteem and self worth. If women do not value
or believe in themselves, they will not even begin the process of recovery from
addiction. Other internal barriers that need to be addressed are internalized
societal stigma, shame, isolation, confidentiality concerns and anger.
Inaccessibility of services and lack of sensitivity/training of service
providers were crucial external barriers to help. Another major handicap was
the lack of accessible transportation as well as the lack of availability of
alternate format material (eg. Braille, captioned videotapes, plain language
literature, etc.)

Women felt it was important to be able to go to women-only services.
They also wanted a choice between going to mainstream services with other
non-disabled women and going to services tailored to women with disabilities.
Yet, no services tailored to women with disabilities were found during the
research and a number of provinces did not have any women-only services.
Over two thirds of current treatment services are completely inaccessible.

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Substance Use/Misuse and Women with Disabilities

Inaccessible in the broadest sense includes but is not restricted to:
facilities that do not have proper ramps or wheechair access or washrooms
with bars and doors wide enough for wheelchair access; places that do not
have light strips at stairs and doors; no TTD/TTY; no provision for personal
care attendants or interpreters; and program staff who are not knowledgable or
sensitive to women’s disablitites. It often includes financial inaccessibility.
Complete specifications can be found in the DAWN Canada document
Meeting Our Needs.
Of approximately 350 accessible services, most could not serve women
with cognitive disabilities, women who had spinal cord injuries or who required
a high level of personal care, women who were completely visually or hearing
impaired as well as those who had more than moderately severe mental health
disabilities. Stories were told of women who were turned away from help
because those services were unable to meet their needs.

A note of some concern was the high incidence of Fetal Alcohol
Syndrome and Fetal Alcohol Effect (FAS/FAE), particulary in tiny rural and
northern communities and the lack of services for pregnant FAS mothers.
Information about substance misuse and the availability and accessibility
of programs does not get out to women in disability communities. Women in
the deaf community who have been deaf from birth may have very low levels of
general reading and comprehension; many have the understanding that
addiction is an “infectious” moral disease.

Another important component of successful substance misuse
programming is self esteem-building; support groups need to be peer led,
services need to be completely accessible; and service providers need to have
welcoming non-iudgemental attititudes.
The primary reason why women reduce or stop their use of substances is
current health problems. Many women also consider stopping or reducing their
use of substances because of pressure from their peers, families or work
situations.

Overall women wanted help, but did not want that choice forced upon
them. They wanted to be able to make the choice to seek it out Services need
to be there when women with disabilities make the choice to access them.

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Substance Use/Misuse and Women with Disabilities

1 .0

INTRODUCTION
The Office of Alcohol, Drugs and Dependency Issues of Health Canada
held a workshop in 1994 on women and substance use where the need was
expressed for information about women with (physical) disabilities and their
use of alcohol and other drugs. In the same year, Health Canada held a women
and tobacco conference which was attended by DAWN Canada. Initial
discussions took place between those two parties and a proposal was sought by
Women and Tobacco Reduction Programs for a needs assessment related to
tobacco use. DAWN Canada felt strongly that it was necessary to focus on the
use of all addictive substances by women with disabilities.

Further discussions took place between DAWN Canada and Health
Canada and a proposal was submitted early in 1995. It was decided that this
project would be a needs assessment of issues surrounding the use of tobacco,
alcohol and other drugs, based on community input, with particular emphasis
placed on use of current programs and what would make programs work for
these women. An literature review began the needs assessment process.
After distribution of an initial education bulletin, twelve focus groups
took place across Canada (October, 1995) comprised of DAWN Canada key
informants (women with disabilities chosen for their expertise in this field). The
focus group locations were:

Newfoundland
Ontario
Quebec (English and French)
British Columbia (plus pilot group)

New Brunswick
Manitoba
North West Territories (4)
Alberta

Total number of participants was 110, of which 64% (70) were focus
group participants and 36% (40) were respondents outside of focus groups,
including 10 women who mailed in an
swers to the focus group format’s
questions. Focus groups were arranged in both small and large communities,
with the majority being in larger cities. Several groups were held in very small
Native communities and one was held in a rural town.

The women who responded by phone or fax (27%) did not give any
identifying characteristics and were not counted among the following statistics.
The majority of women identified as Canadian/Québécois (56%), the next
largest group was Non-status Aboriginals (19%). Not far behind were women
who identified as Status Aboriginal (11%). Nine percent identified as Irish,
Jewish or American. Only four percent identified as first generation Canadians.
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Substance Use/Misuse and Women with Disabilities

Most disability categories were present among participants, although
several were under-represented. The range of disabilities included mobility,
hidden, drug/alcohol dependency, mental health, learning and visual
disabilities, brain injury, hearing impairment and being labelled mentally
handicapped.

An important gap was no one identified themselves as having HIV/AIDS.
This might have been due to the possible stigma and fear of consequences of
disclosing their HIV/AIDS status in a group or it may have been due to the
reluctance of women who have HIV/AIDS identifying themselves as having a
disability. It may have also beenthat there were no participants who were
infected.
Other definite population gaps in the research were: no one identified
themselves as a landed immigrant; few women of colour participated; much
fewer young women under 21 participated than other ages and/or seniors; and
there was a lack of representation from inner city women with disabilities.

This document summarizes the main document. Lessons From the
Research. The focus of this work was to link common themes that cut across
each of the substances, identifying major differences among substances and
with non-disabled women, and also seeking to find out how these themes
might be used to design future cessation/reduction programs.
2 .0
2.1

CONTEXT
Who is DAWN Canada?
DAWN Canada: DisAbled Women’s Network Canada is a national, non­
profit, cross disability organization of women with disabilities in Canada. We
are affiliated with provincial DAWN groups and other disabled women’s groups
in Canada and internationally. DAWN Canada’s focus for the last eight years
has been in the area of research, defining needs and concerns of women with
disabilities and designing programs to address those needs and concerns.

2.2

Extent of the problem
The proportion of women from the total population that are current
smokers (28%) is approximately the same as men (31%). Total number of
current smokers has steadily declined since statistics began to be collected in
1978. In contrast, current use of tobacco by teenaged women, which had seen
a steep decline between 1979 -1990 (46% - 21%), rose to 29% in 1994.^
1. Women in Canada A Statistical Report. (1995) pp. 39. 51. Ottawa. Ontario: Statistics Canada..

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Substance Use/Misuse and Women with Disabilities

Women are less likely than men to be current drinkers. Canada’s Alcohol
and Other Drugs Survey (CADS) showed, in 1994, of those who had consumed
alcohol in the pastyear, 66.7% were women and 78.1% were men.^

CADS surveyed five types of prescription medications and reported that
women use more prescription drugs than men (23.9% - 17.7%). Women used
more than twice as many anti-depressants (4.2% - 1.7%) and almost one and a
half times more sleeping pills (5.4% - 3.7%). They also used just over one and a
half times more tranquilizers than men (5.3% - 3.4%). However, the difference
in usage between women and men was much less marked for the use of pain
relievers, with the percentage of women being slightly more than men (14.1% 12.0%). ’
Although women use more prescription and over-the-counter
medications, men use more ‘Illicit” drugs. CADS reported that over the last
year, men used marijuana almost double the rate of women (10.0% - 4.9%).
Men also used twice the amount that women used of most other “illegal” drugs
suveyed including heroin, LSD and speed. Overall use of these drugs has more
than doubled since 1989 (0.4% - 1.1%). Figures were not broken down by
gender for the use of cocaine; the overall use of cocaine has dropped to almost
half the rate of use in 1989 (1.4% - 0.7%)?

Reports of the actual incidence of substance misuse in the disabled
population vary. Statistics provided by the United States National
Clearinghouse on Alcoholism and Alcohol Abuse show that one in ten persons
will become chemically dependant
While relatively little research has been done on the prevalence of
substance misuse among various disability communities, professionals have
published studies that estimate the rate of substance abuse and addiction is as
much as three times more common in this population thanfor nondisabled
persons (15 to 30%).
2. Canada's Alcohol and Other Drugs survey (1995) pp 2. Ottawa, Ontario: Health Canada.
3. Ibid, pp 4.

4. Op. Cil. [See note 2. pp 5.]
5. Guthmann, D. (1995) An analysis of variables that impact treatment outcomes of chemically dependant deaf and hard of bearing
individuals, pp 3. Minneapolis, MN: Minnesota Chemical Dependance Program.

6. Greer, B. (1986) “Substance abuse among people with disabilities: A problem of too much accessibility.” in Journal of Rehabilitation.
January-March, pp 34-38.
1. Buss, A; Cramer, C, (1989) Incidence of Alcohol Use by People With Disabilities: A Wisconsin survey of Persons With A Disability.
-Madison, Wl: Office of Persons With Disabilities. Department of Health & Social services.

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Substance Use/Misuse and Women with Disabilities

Estimates of substance abuse and addiction vary according to substance
type, severity and type of disability. Persons with mental health and learning
disabilites or who have spinal cord and head injuries seem to have the highest
rates of incidence of substance abuse. Rates of substance abuse may reach as
high as 83% of persons with some types of mental health disorders also abuse
,.
8910
substances.
There are 2.2 million women with disabilities living in Canada (16.2% of
the total female population). From the figures previously quoted there are
upwards of thirty percent of women with disabilities who have addictions. Thus,
even using a conservative estimate of 20%, almost half a million Canadian
women with disabilities have problems with addiction and need help.
Many of them are not receiving the help they need to be able to acheive their
potential as full and equal members of society..

Substances causing the most problems
Participants thought tobacco was the substance most commonly used.
However, most felt the use of alcohol and prescription medications caused the
most problems for them. Little information was known about the use of
“illegal” drugs and over-the-counter medications and less than half the
participants felt their use caused problems for women. A small number
thought the use of caffeine and household solvents caused problems for
women with disabilities.
2.3

Defining substance misuse
The Diagnostic and Statistical Manual of Mental Disorders provides a
medical definition of substance dependance and addiction that is currently
accepted by professionals. A more suitable definition for people with disabilities
proposed by de Miranda, a well known reseacher in the field of substance
misuse by people with disabilities, states that substance misuse is the use of
“any substance for other than its intended purpose and which seriously
12
damages either the person’s health or his/her ability to function”

2.3

8. Heinman. AW. (July 1991) “Substance abuse and spinal cord injury." in Paraplegia News, pp 16-17.
9. Karacostas, D.D.; Fisher. G.L. (1993) “Chemical dependancy in students with and without learning disabilities." in Journal of Learning
Disabilities 26(7) Aug-Sept, pp 491-3. Los Vegas, Nevada: Clark Count)’ School District.
10. “Comorbidity rates of substance abuse, mental illness found to be surprisingly high.” (December 21. 1990) in Psychiatric News.
11. Op. Cit. [See note 1. pp 163.]
12. de Miranda. John. (1990) The Common Ground: alcoholism, addiction and disability. Addiction and Recovery. Cited in- Substance Abuse
and Disabled Persons: An Information Package, pp 1. Toronto, Ontario: Addiction Research Foundation..

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The research participants proposed a similar definition. They also
suggested that substance misuse problems are hard for women to detect
because most have to use some medications in order to manage their
disabilities. Key factors that define substance misuse were:

a) not taking a substance as it is intended,
b) when the use of substances seriously impairs their ability to function
c) when the use causes related legal and health problems.
FACTORS LEADING TO SUBSTANCE USE/MISUSE
Sexual, physical and psychological abuse
Most participants clearly and emphatically stated that histories of
violence and abuse affect their use of substances. Primary reasons women
use/misuse substances is to kill the pain, to escape and to numb themselves.
Women said substances allow them to forget about their problems, to rebel
against family, caretakers and society as a whole, and to maintain denial about
their abuse. Although cautioned to speak generally about communities, several
women disclosed stories of abuse and their need to escape, mentally and
physically, through substances use/misuse.

3 .0
3.1

DAWN Canada's most recent research showed exceptionally high rates
of abuse. Of the almost 400 women with disabilities who participated in their
recent survey, 50.8% had reported physical abuse, 51.1% reported emotional
abuse, 43.1% were neglected and 66.3% had experienced sexual abuse.^^

Of the 2.2 million women with disabilities in Canada, extrapolating
DAWN Canada's latest statistics, over one million women have experienced
physical violence and almost 1.5 million have experienced sexual abuse.
Some researchers have reported that high percentages of women in
treatment for alcohol and drug problems are survivors of childhood sexual
abuse.^^^"" The link between the use/misuse of substances and having a history
of abuse is slowly being established. Although these figures are not specifically
reported for women with disabilities, it is likely the link is similar. This has clear
implications for what must be addressed in designing programs.

13. Masuda, S. (1993) Don’t Tell Me To Take A Hot Bath: Resource Manual For Crisis Workers, pp 93. Vancouver. British Columbia.:
DAWN Canada: DisAbled Women'.s Network Canada
14. Covinton, S.S.: Kohen, J. (1984) Women, Alcohol And Sexuality. Advances In Alcohol And Substance.Abuse. 4(1). pp. 41-46.
15. Doiron, Paula. (1993) Needs Assessment Report for Women and Substance Abuse: The Invisible Problem, pp 3. Moncton, New
Brunswick: Support for Single Mothers Inc./Crossroads for Women/New Brunswick Advisory Council on the Status of Women.

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This link between substance misuse and violence\abuse also supports
the need for women-only programs. Since most sexual abuse is perpetrated by
men and often there are male abusers in a co-ed facility, it seems only logical
that women should have the choice of not having to face abusers while in the
vulnerable state of trying to recover from substance addictions.

Discrimination, societal lack of acceptance, isolation and poverty
Many participants voiced concerns about discrimination and societal lack
of acceptance and how they play a role in substance use. Feeling unwelcome
and unwanted is a factor in women's low self esteem and increases feelings of
stress and isolation. Continually women said they felt isolated from the world,
citing reasons of not feeling they fit in, not feeling accepted and general
inaccessibility of society. They then sit at home and use/misuse substances to
cope with those feelings, a self-perpetuating cycle of loneliness and pain.

3.2

Women with disabilities are among the poorest of the poor. Many are
unable to work and must rely on the social welfare system. Others experience
discrimination while seeking employment. These employable women often are
forced to sit at home, isolated and without meaningful work. Loneliness, lack of
self esteem and high levels of poverty increase their stress and the desire for
escape.
Discrimination also fuels anger. Many women voiced their anger over
the discrimination that women with disabilities experience. One woman noted,
''Smoking is a way of acting out our anger and frustration at our disabilities, at
the lack of access, at society’s attitudes, at everything.” Another respondent
said, "Women in general suffer from discrimination. However, discrimination is
much greater for women with disabilities and even more so if you also belong
to other marginalized groups. This causes so much pain and anger that we
isolate and abuse alcohol.” Programs will need to find ways to positively
address the negative feelings caused by discrimination and its surrounding
issues of isolation and poverty that women with disabilities experience.

High levels of stress
Participants noted that the high level of stress they experience can
definitely lead to substance use. Although all women feel stress/pressure to
conform to society’s norms, this stress is greater for women with disabilities
because disabilities make it more difficult to fit to society’s norms.
3.3

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Unlike non-disabled women, disabled women have stress related to
society's inaccessibility, to the feelings surrounding newly diagnosed
disabilities, the lack of control in their lives and the need to balance
necessary medications with addiction. This may cause disabled women to
move more towards substance misuse.

As noted previously, stress is also related to the abuse, discrimination,
isolation and poverty that women experience. Effective programs will need to
help women positively cope with on-going stress.
Physical and psychological pain and overall level of ill health
Most women have an overall level of poor health as a result of their
disabilities. Perhaps the biggest difference to non-disabled women is most
women with disabilities are in constant physical pain or discomfort Others
must contend with spasms, nausea, regular infections and illnesses, and very
low levels of energy. Still others live with varying degrees of psychological
distress. Living with constant pain and distress can certainly lead to substance
use/misuse and may be difficult to address when designing programs.

3. 4

3. 5

Lack of control over life
Research participants often stated that women with disabilities lacked
control over their lives. Relatively few women have employment and
independent incomes. Their need to depend on the social welfare system for
basic existence requirements results in feelings of powerlessness, shame,
frustration, anger, a fear of 'rocking the boat’, as well as high levels of stress.
Some have to depend on caregivers while others rely on difficult and
impractical accessible transportation systems. They can not just make a
decision to go on an outing, rather they must book transportation days in
advance. Most women are also dependent on a physician’s care, one who may
or may not be supportive of them. Women are unable to alter the fact they
have (often progressive) disabilities, are subject to the disabilities’ changing
effects and often can not control whether or not they use prescription
medications.

A number of women said that being able to control something, even if it
was just their substance use, particularly of tobacco and some other drugs,
definitely leads to the use/misuse of substances. One woman pointed out, “If
you can’t control your life, family or money, you can always get cigarettes,
whether you beg them or buy them, That’s something I control.” Helping
women feel they have some control over their lives is an important factor for
programs to address.
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Anger, despair, hopelessness, shame and lack of self esteem
Although many women experience varying degrees of low self esteem
and feelings of anger, despair, hopelessness and shame, the degree to which
women with disabilities experience these feelings is much greater.
3.6

Over and over women told us that having negative views of themselves, a
complete lack of self-worth, anger over discrimination and societal lack of
access, despair over their lives, hopelessness about the future and shame about
being poor, unemployed and disabled leads women to use/misuse substances.
One participant poignantly stated, ‘What other choices do we have? There’s no
job, nothing to do and no hope for the future. Why should I quit?” Touching on
women’s depths of despair, hopelessness and shame, one respondent noted,
“(Smoking) is a socially acceptable way to die”. Addressing lack of self esteem,
shame and anger were named as being primary to effective programs.

3.7

Lack of knowledge regarding addiction and substance use/misuse
It was fairly evident throughout the research that many women lack
knowledge regarding addiction and substance use/misuse. Many women had
never talked openly about substance use/misuse, particularly of “other drug
use”. For many information regarding addiction is not provided in
understandable and useable formats. Women from the deaf community said
many of their members have very low levels of English comprehension and
hold out-dated views on addiction. Participants noted that physicians often did
not tell them about the addictive qualities of prescription medications or the
dangers of multiple medications. They also noted that little information about
alcohol reaches their communities. More information reaches communities
about the effects of smoking however, a number of women were suspicious
about this information. Lack of knowledge regarding addiction can certainly
lead to substance use/misuse.

WHY WOMEN WITH DISABILITIES USE SUBSTANCES
Helps women cope with feelings including those regarding abuse
Most, if not all, women have some difficulty coping with feelings,
especially those regarding abuse and many use substances to cope with these
feelings. As noted earlier, women with disabilities experience high levels of
abuse/violence and research is slowly establishing links between substance
use/misuse and experiencing abuse/violence.
4 .0
4.1

Women said that smoking helps them cope with feelings of despair. They
told us that the use of alcohol and other drugs help them cope with or numb
feelings connected to the abuse they had suffered.
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A statement of concern expressed in the North was that First Nations
women feel they have a right to take prescription drugs, to hide the pain
caused by the abuse they suffered at residential schools and churches, as well
as today’s ongoing racism and oppression. In the previous section it was noted
that women with disabilities experience almost a complete lack of self esteem
and feelings of despair, hopelessness and shame, using substances help women
cope with these overwhelming feelings.

Relieves stress and anger
Although the relief of stress and anger were reasons why women used
all types of substances, stress was most relevant in the use of tobacco and
other drugs (marijuana, heroin, prescription medications etc.) and anger was
most relevant in the use of alcohol and tobacco.

4. 2

One young mother with a learning disability said, “I really want to quit
smoking but I'm so stressed and smoking relaxes me. Well, I know it really
doesn’t but it just seems to. I guess I’ll quit when things calm down.” Another
woman commented. Pot in particular helps with anger and stress but you feel
less motivated to do anything. You just feel mellow.” An older mother stated
with some force, "I just quit smoking and I”m so angry all the time. I just want
to scream and I don’t even know about what!” Another woman exclaimed, ‘'Our
use (of alcohol) is different because of our intense anger! We are angry because
society is not accommodating, but we are really angry because they say 'Stop
using alcohol.’ But on the other hand they don’t give us any help to stop.”
Helps women cope with disability either by self medicating or
through physician control
Women told us smoking seems to have a calming and relaxing effect
which can help pain reduction and also reduce mental health distress.
4. 3

Alcohol is often used to relieve psychological distress, particularly to help
women cope with (forget) they have disabilities. One woman told us, "We drink
like crazy to forget we can’t walk.” Drinking reduces anxiety, allows women with
agoraphobia to leave their house and may cause or mask depression. Women
with disabilities which affect muscle coordination said small amounts of
alcohol can help muscle spasms and coordination.
Coping with the side-effects of disabilities, like nausea, pain, discomfort
and mental health distress are primary reasons that women need prescription
medications. The use of other substances like pot, heroin, solvents seems to be
dependant on the particular effect of each substance.
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While most of these other substances are used to relieve psychological
pain, heroin is also used for effective physical pain control, marijuana is used
to control spasms, nausea and to calm and relax women, while cocaine is used
for energy. One participant told us that most addicts she knows used drugs as
a result of trying to self-medicate psychological and physical problems like
depression and migraines.

Provides pleasure, something to do and helps women socialize
Providing pleasure/fun, giving women something to do and socializing
are reasons mostly relevant to using alcohol and tobacco. Women told us they
drank and smoked to socialize, to be part of the gang, to have fun and to have
something to do. One participant noted, You can’t get out, so you smoke as a
pastime.” Another said, “Its a social thing, to be part of the gang.” Women
explained that drinking helped them feel like adults, an important issue for
women with disabilities, many of whom say they are treated as children.

4. 4

Providing pleasure and socializing seemed irrelevant for most other
substances (pot, heroin, solvents etc.), as women said their use tended to be
very hidden and often caused extreme isolation.

Addiction and/or substances are too hard to quit
Almost all participants felt tobacco was too hard to quit and about three
quarters felt that addiction to smoking played a major role in why women
continue to smoke. (Interestingly, almost all participants also felt that women in
their communities did not consider tobacco use a problem. ) These two factors
were relevant to all substances, but more so for tobacco than any other
drugs/substances.

4. 5

All research participants felt addiction to prescription medications was a
major problem in their communities. Close to half felt addiction to other
substances like alcohol, heroin and marijuana was a reason why women
continued their use.

One woman spoke up, ‘Addiction is a really big problem seldom talked
about out loud. There’s something really shameful about it and women with
disabilities don’t want to admit that it is a problem in case all medications
and/or services are taken away. Besides it’s so hard to tell what’s addiction and
what’s not. It’s such a fine line for us. Since most of us have to take drugs of
some kind or another, it’s very hard to tell when it’s a problem or not.
Especially when the drugs you’re taking make the difference between
committing suicide and staying alive!”
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BARRIERS TO SEEKING HELP
Lack of accessibility to help and accessible transportation
Most participants stated that women with disabilities are not using
existing services, primarily because of inaccessibility. Risking a lot, one
participant told us, "I did try to get help. With my abuse issues, I only wanted to
go to a women’s program. I went to the only place around here that I knew
about, but they couldn’t help me because I was in a wheelchair!”
5 .0
5. 1

The inaccessibility of helping services was noted primarily as an issue for
alcohol and other drug use/misuse, although women noted the need to hold
stop smoking programs in accessible buildings. Women told us that most
recovery and treatment programs are inaccessible and the disability services
they use lack knowledge about addiction, leaving them unsure about where to
go for help. A number of women were particularly concerned that residential
addiction programs do not accommodate disabilities, especially if women need
attendants, are in wheelchairs, have cognitive, visual or hearing impairments or
have spinal cord injuries. Many treatment programs do not accept self referrals.
Participants were unaware of any programs tailored to women with
disabilities aimed at stopping or reducing their use of substances and many
were unaware of any women-only programs. Women said they do not know
where to go or who to phone for help. The accessibility of helping services is
not well known and information about accessibility improvements of previously
inaccessible services does not reach the women who need these services.

Out of approximately 1,100 treatment services in the Canadian Centre
for Substance Abuse Treatment Database, about 350 services accept women
and self report some level of accessibility. This number is however in doubt, as
disabled women report that many services which say they are accessible are
often times not truly accessible.
Key informants were also almost completely unaware of programs or
resource manuals which offer help in alternate formats. Most current materials
are unusable and are not understood by many women with disabilities. Lack of
informational materials in alternate formats, such as large print, simplified
concepts or captioned videotapes is another major barrier to seeking and
obtaining help.

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Another major barrier is the lack of accessible transportation and many
comments were heard about the lack of accessible transportation?^ Use of
existing transportation is linked to confidentiality concerns. Women fear word
may get out that they have a drinking problem because the only accessible
transportation is available through the disability organization where they, their
friends or caregivers work. They fear others may find out and they may lose
employment or services.

Explaining that some women are using services, one respondent put it
this way, “Some women with disabilities are using existing programs, it depends
on their disabilities and how severe they are. Women who have mild to
moderate psychiatric disabilities, very mild developmental disabilities, partial
sight and hearing loss or learning disabilities, can, and are being helped. It is
the same for most women with HIV/AIDS and hidden disabilities. But the
majority of women outside those categories are not using programs.”

5.2

Lack of training / poor attitudes of service providers

Insensitive and judgmental attitudes of service providers is another
primary reason why women do not get help. In the words of one woman, “How
you get in is not really the problem, it’s how you are treated when you get in
that makes all the difference in the world!”

Participants told us service providers lack knowledge and staff are not
trained in the needs of women with disabilities. Women said service providers
often focus on the disability, not the addiction, and often enable substance use
saying women have a right to use drugs because their lives are so difficult

Lack of knowledgeable and sensitive care by medical personnel,
over prescribing
Women felt that many physicians are uninformed and insensitive about
their disabilities. Most physicians encourage women to take prescription
medications. The women sometimes felt that it made the doctor feel better to
actually be doing something for them.
5.3

16. Although many urban places have at least one accessible van through disability organizations or may have a handy bus system almost
none have accessible taxi’s or accessible regular buses. Vancouver has a fleet of about 50 accessible taxis and Toronto has a few. Most subways and Rapid
Transit systems arc inaccessible. The researcher used systems in Montreal, Toronto and Vancouver, only Vancouver’s was accessible, except one stop,

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One woman said, "If s so much easier for doctors to give us pills rather
than deal with their difficulties around the fact that we can’t be fixed. I went to
a doctor who prescribed me medications. I didn’t want to take them because I
thought they were too high a dosage. When I protested he said 1 absolutely had
to take these medications or find another doctor!

A number of participants noted problems they had with physicians and
the medical system. One woman explained, “I don’t trust doctors. They are not
careful and the medical profession is driven by large pharmaceutical
companies.” Another participant noted, "Doctors are sometimes not helpful
and don’t give us what we need because they are too cautious or because they
don’t really listen to us. In addition, little information is given to us about the
effects of drugs so women assume the drugs are safe and nonaddictive;
Another said, Women with disabilities are forced to remain dependent on a
system which sees women as weak and helpless and not to be taken seriously!

Another problem is the different levels of available health care,
particularly prescription drug coverage. Women who do not have prescription
drug coverage are forced to use whatever means necessary to get the
medications they need. This also applies to attending treatment programs,
costs which are often covered by having a certain level of health care. Disabled
women who are working at low paying jobs may not be covered.
Women also noted drugs often were not effective. Pain relief has not
been addressed very well. Current drugs are very addictive and are not really
effective. Women end up being addicted rather than combating pain.
Participants felt that many women were over prescribed medications and
pointed out that this decreases their quality of life and they are unable to live
up to their full potential. Other problems mentioned by many were the risk of
drug interactions, including overdosing, confusion, inability to concentrate or
make decisions and inability to function. Loneliness, shame, isolation,
forgetfulness, memory loss and financial problems related to increased health
costs were also mentioned. Women told us many physicians lack a global view
and follow up inadequately.
One participant addressed the problem of senior women. Based on a
conversation with a health care professional, she noted that the majority of
geriatric psychiatric admissions to hospitals were the result of overmedicating
and the mismanagement and mixing of medications.

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Need for substances even though they cause some harm
A primary difference between non-disabled women and women with
disabilities is that the latter need to take some medications to cope with their
disabilities. The fact that medications are often necessary to cope with the
effects of disabilities, yet still may cause addiction/life problems, is a major
challenge to women and service providers alike. For each woman the solution
may be different and both general and individualized solutions must be sought
to find the proper balance between necessary use of substances and
addiction/life problems.

5. 4

5. 5

Requirement to be substance-free to enter most treatment
programs
Many treatment programs require clients to be substance-free to attend
their program. Although some programs may make allowances for anti­
depressants, this requirement still poses a barrier to many women who need to
be on medications, including pain relievers and major tranquillizers.

5. 6

Reliance on caregivers/need for personal care
Another key difference from non-disabled women is that women with
certain disabilities need personal care and/or rely on caregivers. Some women
who are seeking help for their addictions need interpreters, attendants, private
rooms or several hours personal care time per day in order to attend these
programs. Most treatment programs are not set up to accommodate their
needs.
A number of women are dependant on caregivers who may or may not
be supportive of their substance use/misuse and of their attempts to seek help.
Women might wish to stop their substance use/misuse yet may be in the care
of a caregiver that uses substances and forced to use substances against their
wishes. Few women will speak out as they fear needed services will be taken
away or they will be abused.
Other caregivers enable women’s smoking (and drinking) because of the
caregivers inability to work past their own discomfort to communicate with the
women. It seems easier for them to not challenge the behaviour.

Need to fit group model treatment programs
Participants pointed out another major barrier to service. They said
group leaders\intake workers often feel that support groups are inappropriate
for some women with disabilities because they are unable to understand
materials or because they do not fit in with the current group.

5. 7

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Group model treatment programs put the needs of the group first and if
women do not fit or are potentially too upsetting to group routine they are told
to seek help elsewhere. This particularly applies to women who have moderate
to severe mental health or cognitive disabilities, as well as women who have
visual or hearing impairments.

Unfortunately, most groups must have a certain number of participants.
It may be difficult to find the required number of peers for a more compatible
group. As has been noted previously there are relatively few services which are
accessible and the vast majority of them are only accessible to women in
wheelchairs who require limited personal care and can participate in groups.
This leaves the large numbers of women with disabilities who require these
services with very few options.
5. 8

Lack of child care\poverty issues
Nearly all the participants felt poverty was a barrier to seeking help,
particularly regarding transportation. One woman said, Poverty is a barrier, for
transportation and child care to attend programs. Your overall level of self
esteem is lower when you are poor and you have less access to knowledge and
help. You’re less likely to know your rights and to know what to do to fight for
them. All these things make it harder to get help.”

Another woman noted, “Private counselling costs mega dollars, or if they
are free they have long waiting lists. Transportation is a barrier, accessible
private cabs are very expensive and there are very few around. Not too many
women with disabilities have their own accessible vehicle and if there is an
accessible van service, usually you have to book 48 hours in advance. When
you are picked up, sometimes you have to ride the entire circuit, even if you
don’t need to, because they follow a pre-set route.”

Less women felt lack of access to child care was an issue in not trying to
stop or reduce their use of tobacco, alcohol and other drugs. Possibly this may
be the result of lack of awareness or that few mothers with disabilities have
tried to stop. It is also possible that few disabled mothers were included among
participants, that there actually is adequate child care or that other issues
seemed more important during this part of the discussion.

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5.9

Language\cultural issues
First Nations women, women from Quebec and women from the deaf
community felt that language and cultural issues posed barriers to service.
Most First Nations women were very concerned about these issues and wanted
treatment programs to have major cultural elements and where possible, to be
able to speak or learn their own language. Some women from Quebec were
concerned about the lack of services for women who did not speak French.
Women from the deaf community felt that lack of interpreters, inadequate
knowledge of American Sign Language (ASL) and lack of knowledge about
deaf culture definitely posed barriers to seeking help.
5.10 Internal barriers
Women do not want to see themselves as being addicts and are afraid it
will affect their services if they admit to addiction problems. As well, for the
most part, they have difficulty even asking for help. Their denial, shame, lack of
self worth and self esteem, fear of the effort needed to actually stop using
substances, fear of being seen as having another dependancy and the fact that
they live under close scrutiny in the disability community present major
barriers to seeking help.

The main internal barriers of women with disabilities are:

►
►
►
►
►
►
►

believing they have a problem
working through their fears about what may happen if they take steps to
reduce or stop their use of tobacco and substances
getting past their fear of the stigma and possible loss of confidentiality
raising their self esteem enough to face their addiction problem(s)
finding the energy to overcome societal handicaps,
believing they deserve help
valuing themselves enough to take the steps to find it

6 .0
IMPORTANT CHARACTERISTICS OF SERVICES
6.1
Need for women-only services
As noted previously, the link between substance use/misuse and
abuse/violence is slowly being established. Similar to non-disabled women,
many women with disabilities who misuse substances have experienced or are
experiencing violence. Women wanted to go to women-only services because of
their past abuse; they are afraid of being in treatment with males while they
deal with abuse issues and also fear the real potential for abuse at co-ed
facilities.

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In addition, participants noted that they are women with substance
misuse problems and they are subject to the same myths, biases and
oppressions all women face; most would rather attend women-only services
than co-ed services for all people with disabilities. Women need to be able to
choose to attend women-only services.

Need for both integrated and tailored services
Almost all participants said that both integrated programs (programs for
women with and without disabilities) and tailored programs (programs
specifically for women with disabilities) were necessary in order for them to find
help stopping or reducing their use of substances. One woman remarked, "If s
best to mainstream (include women with disabilities in programs used for non­
disabled women). But, either as a separate program or within these
(mainstream) programs, if s also important to discuss issues with women with
disabilities as their own group.” Others noted that women should have a
personal right to choose between either type of program.
6.2

6.3 Need to address low self esteem, stress, anger, shame and
isolation
Throughout the research women told us that the most important issue
for programs to address is their lack of self esteem. In addition, programs
must address women’s high level of stress and their feelings of anger and
shame. Programs must teach women positive skills and methods to end their
isolation and cope with their feelings and life situations.

One woman put it simply, “The basic issue is low self esteem. We are
more susceptible to drinking and it is almost impossible for us to value
ourselves enough to go and get help.”
Need for help from peers who have been there
The help of a disabled woman who has had substance misuse problems
and has overcome these problems is also extremely important. Women said
they need to know they are not alone. Twelve-step programs and mainstream
support groups can be helpful; however, they may be held in inaccessible
facilities and are often not able to provide the unique support that another
disabled woman would be able to provide. Borrowing a concept from twelve­
step programs, women felt the value of having peer help is unquestionable.

6.4

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One group member told us, We need to encourage peer support with
positive role models that talk about reducing our use of substances and these
groups need to be led by women with disabilities who have been there. It is
probably better to bring in professional outsiders to our own environment after
a level of comfort and trust has already been built. The women in DAWN need
to be sensitized to this issue and we need to work toward mainstreaming
women into existing services.

Need for accessible programs including accessible transportation
Over and over women said programs need to be accessible. Not only do
facilities need to have adequate space for women using wheelchairs and
women with other mobility impairments including accessible washrooms, but
they also need to be accessible to women with other types of disabilities.
Service providers need to consider using light strips at doors and stairways,
bells and raised numbers on elevators, shaking beds for alarms and flashing
lights for phones. They also need to know how to access interpreters. Service
providers should purchase and become proficient in the use of a touch-teletype
device for the deaf (TTD/TTY). Service providers need to be aware of the need
to have their space as smoke and scent-free as possible.
6.4

Adequate time needs to be built in for breaks and personal care and
private rooms for personal care need to be available. Group leaders need to be
able to adjust their teaching speed and must be willing, if necessary, to use
simple, repetitive concepts. More specific requirements are contained in the
DAWN Canada document Meeting Our Needs: An Access Manual For
Transition Homes. Programs also need to be available and affordable.

As detailed previously, women need accessible transportation to attend
helping programs. If adequate accessible transportation is not available, then
service providers need to consider purchasing, renting or contracting out
accessible transportation for their mobility impaired clients. A small petty cash
fund for accessible taxicabs is another possible option.
Need for accessible informational materials
Many women with disabilities have difficulty using current mainstream
materials. Information needs to be available in accessible formats: large print,
plain language, audio and video tapes with very simple concepts, picture ideas,
Braille and American Sign Language (ASL)/captioned videotapes.

6.6

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Creative solutions are most effective in reaching women who require
help. Some ideas are videos in health clinics, workshops that use theatre, plays
and large print, simple concept, picture idea, plain language and Braille
pamphlets in doctor’s offices. In particular, women said that using cartoons and
humour has value in catching their attention.
If women can not understand the process of addiction nor understand
the tools of recovery then it becomes almost impossible for them to even begin
the process of treatment. As one woman noted, 'Information is power. It is the
key that gives women with disabilities the ability to stop.”

Need to provide sensitivity training to service providers
As noted previously, judgmental, non-welcoming attitudes of service
providers are even more of a barrier to women than lack of physical
accessibility. The insensitivity of service providers and their own lack of self
esteem were named as the two most important access barriers to women.

6.7

Services can be completely accessible but if women do not feel welcome
they will not use that service. Service providers need to learn about the issues
of women with disabilities including their need to use certain medications and
other accessibility needs. They need to learn to find ways to work with the
particular disabilities of women so that women can have full access to help.

6.8

Current health crisis important factor in stopping or reducing use
Women told us that a current health crisis is the most important reason
that causes them to consider stopping or reducing their use of all substances.
Participants felt that a current health crisis is a much more important
consideration than thinking about future health problems, knowing they are
addicted or attending cessation\reduction programs. Possibly education about
addiction and its health related consequences may be effective in helping
women stop their use of substances.
Peer, work, or family pressures important factors in stopping or
reducing use
Many women also felt that the opinions of their peers, families and
employers mattered. Women who misuse substances have high levels of
shame, fear their confidentiality will not be maintained. They also fear the
potential stigma that comes from admitting they are addicts. However, pressure
to quit or control their use of substances from persons in their more
immediate circle was important.

6.9

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Education programs should consider using the value of these
relationships to encourage women to actively take steps to reduce or stop their
use of substances.
6.10 Alternatives to substance use
Women noted these positive alternatives to substance use:
- herbs
- acupuncture
- spiritual healers
- TENS machines
- good nutrition
- read books
- writing
- Tai Chi
- prayer and going to church

- therapy
- meditation
- primal therapy,
- herbal teas
- laser therapy
- listen to music
- art work
- yoga

Participants also mentioned a wide range of types of bodywork such as,
massage therapy, physiotherapy, therapeutic massage, therapeutic touch,
reflexology, kinesiology and naturopaths.
First Nations women suggested traditional cultural remedies such as:
- Sweats
- Healing Circles
- holding Eagle feathers
- talking with Elders & Medicine People

- Smudges
- Yuwippi’s & Shaking Tents
- going out on the land.
- Fasting

IF YOU WERE a depressed mother, who is a wheelchair-user, with MS
and developmental disabilities, living in poverty, strung out on prescribed
sleeping pills, who smokes tobacco and uses marijuana for spasms, and you
wanted to find help, probably you would be out of luck.

Even if you could get past your low self esteem and knew you had a
problem, you would not know where to find the appropriate help you needed.

In most communities across Canada, you would not be able to access
help because you were in a wheelchair, needed attendant care and particularly
because you had a cognitive disability. You would find that most places are
inaccessible. They are not set up to allow attendant care and will not allow
persons with more than very mild cognitive disabilities to attend.
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If you were unable to stop the use of anti-depressants, major
tranquilizers or required pain relievers then treatment services may be
unavailable to you. If you had difficulty participating in a group setting because
of your personal care needs or mental health disabilities you would most likely
be told you were inappropriate for this service. Another barrier may be if your
MS had progressed to the point that it affected your sight, your ability to
communicate or your ability to participate in usually strenuous treatment
programs.
If you even believed your smoking was a problem and you wished to cut
back or stop you would have difficulty. Because of your low self esteem, you
may not believe you deserve any help. You may not know where help exists
and you may not know where to begin looking for help. Help may not even
exist

You may be unable to understand needed educational materials or
groups may be held in inaccessible places. You may be unable to participate in
groups because you do not have access to appropriate transportation or you
may be unable to pay for child care.
The group leader may feel that because you are unable to understand
the material or that you do not fit in with the group, this type of help is
inappropriate for you. Since most groups need to have a certain number of
participants you may be unable to find the required number of peers for a
more compatible group.
Stop aids like the '‘patch” may interfere with your medication or may be
too expensive. If you are successful in stopping, staying stopped may prove
impossible, while coping with your isolation and increased awareness of
feelings of anger and low self esteem, without a support network

While this case scenario is quite specific, it is typical of the many
problems women with disabilities face when trying to find help to stop their
use of substances.

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6.0

REFERENCES

Buss, A; Cramer, C. (1989) Incidence of Alcohol Use by People with Disabilities: A
Wisconsin Survey of Persons with a Disability. Madison, WI: Office of Persons With
Disabilities, Department of Health & Social Services.

Canada’s Alcohol and Other Drugs Survey (1995) Ottawa, Ontario: Health Canada.
“Comorbidity rates of substance abuse, mental illness found to be surprisingly high.”
(December 21, 1990) in Psychiatric News.

Covinton, S.S. & Kohen, J. (1984) Women, Alcohol And Sexuality, in Advances In Alcohol
And Substance Abuse, 4(1).
de Miranda, John. (1992) Preventing Alcohol and Other Drug Problems Among People with
Disabilities: Something Old, Something New. San Mateo, California: California State
Alcohol and Drug Programs/Penninsula Health Concepts.
de Miranda, John. (1990) The Common Ground: alcoholism, addiction and disability. In
Addiction and Recovery. (August).

Doiron, Paula. (1993) Needs Assessment Report for Women and Substance Abuse: The
Invisible Problem. Moncton, New Brunswick: Support for Single Mothers Inc., Crossroads
for Women & New Brunswick Advisory Council on the Status of Women.
Finkelstein, Norma; Duncan, Sally; Derman, Laura; Smeltz, Janet. (1990) “Alcohol, drugs and
disabled women.” in Getting Sober; Getting Well: A Treatment Guide For Caregivers Who
Work With Women. Cambridge, MA The Women’s Alcoholism Program of CASPAR.

Greer, B. (1986) ’’Substance abuse among people with disabilities: A problem of too much
accessibility.” in Journal of Rehabilitation January\March.
Guthmann, D. (1995) An analysis of variables that impact treatment outcomes of
chemically dependant deaf and hard of hearing individuals. Minneapolis, MN: Minnesota
Chemical Dependancy Program.

Heinman, AW. (July 1991) “Substance abuse and spinal cord injury.” in Paraplegia News.

Karacostas, D.D.; Fisher, G.L (1993) “Chemical dependancy in students with and without
learning disabilities.” in Journal of Learning Disabilities 26(7) Aug\Sept. Los Vegas, Nevada:
Clarke County School District
Lewis, Beverly & Abbott, Beverly & Harvey-Jansen, Z’Anne. (1992) Treating Addicted
Women: The Henwood Experience. Edmonton, Aberta: Aberta Acohol and Drug Abuse
Commission.

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Masuda, Shirley. (1995) Don't Tell Me To Take A Hot Bath: Resource Manual For Crisis
Workers. Vancouver, British Columbia: DAWN Canada: DisAbled Women’s Network
Canada.

Masuda, Shirley; Ridington, J. (1992)Meeting Our Needs: An Access Manual for Transition
Houses. Vancouver, British Columbia: DAWN Canada: DisAbled Women’s Network
Canada.
Masuda, Shirley. (1995) Tobacco and Substance Misuse and Women with Disabilities: A
Literature Review. Vancouver, British Columbia: DAWN Canada: DisAbled Women’s
Network Canada.
Single, Eric, MacLennan, Anne, MacNeil, Patricia. (1994) Horizons 1994: alcohol and other
drug use in Canada. Ottawa, Ontario: Studies Unit, Health Promotion Directorate, Health
Canada and Canadian Centre on Substance Abuse: “Published under Canada’s Drug
Strategy”.
Substance Abuse and Disabled Persons: An Information Package. (1995) Toronto,
Ontario: Addiction Research Foundation.

The Many Faces of Women and Substance Use. (1991) A Review of the Literature. Regina,
Saskatchewan: Alcohol and Chemical Studies. University Extension.
Toews, Charlene. (1987) Valium is Cheaper Than Handi-Transit Addictions and Women
with Disabilities. Winnepeg, Manitoba: Health Promotion Directorate.
Women in Canada A Statistical Report (1995) Ottawa, Ontario: Statistics Canada.

Woodland, Bonnie. (1989) Skirting The Issue: Treatment Needs of Women with
Addictions. St. Johns, Newfoundland: Community Services Council Newfoundland and
Labrador.

Working Together: A National Workshop for Action on Women and Substance Use.
(1994) Ottawa, Ontario: Alcohol and Other Drugs Unit, Health Programs and Services
Branch.

DAWN Canada

SUMMARY OF THEMES

Page 26

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