Addiction Treatment for the Visually Impaired

With all of the digital resources available to us, we can find instant answers to many questions, provided someone has already asked and posted the question. Some do not always have simple answers, such as how many Americans are blind and how many of them need treatment for substance use disorder.

What is Legal Blindness?

The National Eye Institute and other sources state that about one million Americans were legally blind in 2015 (though an Americans with Disabilities Act guide says 2.5 million), but that’s not total blindness.

Legal blindness begins when an individual, even with corrective lenses, only has 20/200 vision—one-tenth of the vision as someone with 20/20 vision—when looking straight ahead.

Between three and 12 million people have a less severe form of visual impairment.

Those numbers are expected to double by 2050 as the population ages. Aging is a major cause of blindness.

As for how many people with seriously impaired vision also have a substance use disorder (SUD) or addiction, researchers disagree. They don’t even agree on whether such a sensory disability (or any disability) makes you more likely to develop a substance use disorder. Some studies say yes, but they deal with disabilities as a whole, physical and intellectual, and in many cases are 20 years old.

The cost of people with vision loss who also have an untreated SUD has been estimated to cost the economy, directly and indirectly, $35 billion. That makes it not just a personal tragedy but a public health problem as well.

Whatever the number, with SUDs and vision problems increasing, there is a clear need for addiction rehab for the blind. It doesn’t look like it is widely or adequately available.

Are the Blind Welcome in Rehab?

It’s easier to understand how to ensure that buildings and services are physically accessible for people in wheelchairs: are there ramps, are the door frames wide enough, are there functioning elevators? Those accommodations aren’t much help to those with sensory disabilities.

The Americans with Disabilities Act and the Affordable Care Act’s Essential Health Benefits are supposed to guarantee that even if people are totally blind, they should be able to receive SUD treatment. Often they don’t, not because rehab staff and owners are bad people, but because such assistance is not their area of expertise.

Vocational rehabilitation (VR) counselors are not routinely trained in the care of people with SUDs, and SUD treatment providers are not often trained in the special needs of blind clients. When a SUD treatment facility isn’t prepared to accommodate the sight-impaired client, recovery from the SUD is less likely.

SUDs aren’t always recognized by VR staff members or acknowledged by clients. Even advocates for the disabled such as the Center for Deaf-Blind Persons devote most of their resources to the deaf, not the blind. Its website includes an Alcoholics Anonymous newsletter on “Making Alcoholics Anonymous Accessible to Those with Special Needs,” but there’s no similar document for the blind.

Google words such as “blind” and “rehab” and you’ll likely find more services to help the newly blind learn to cope with being blind than to treat a SUD, but both services are needed. When the disability and the SUD are not treated at the same time, the outcomes are worse for both. Another reason to treat both conditions at the same time is that they may be connected.

If vocational rehabilitation counselors for the blind know the signs and symptoms of substance use disorder, then they can treat it or refer the client to someone who can.

Are Blindness and Substance Use Connected?

Substance use disorder may have led to behavior that caused the blindness. The cause of the blindness may have led to pain or trauma that triggered the substance use as a coping mechanism. In rare cases, drinking alcohol (especially if tainted with methanol) can cause blindness.

The blind are more liable to fall and injure themselves. Chronic and acute pain can lead to substance use and abuse. Depression or anxiety about finding a job, a place to live, or just dealing with day-to-day activities such as transportation arrangements could lead to a SUD.

Blind people also have more strokes as well as problems learning, remembering, and making decisions. They also have a lower quality of life. All of these factors can lead to SUDs or be caused by SUDs.

Making Rehab Accessible to the Blind

When individuals with mobility problems are released from the hospital, often home inspections are required to make sure they can maneuver in their homes and do the things necessary to take care of themselves. A similar process at treatment centers for substance use disorders could ensure that there are no structural barriers, architectural or communication, stopping clients with vision loss from benefiting from their programs.

Those with blindness, either due to accident or illness, need more than ramps or signs in braille to make a facility accessible. Only about 5% of people living with blindness can read braille.

Signs must have large, raised letters. Walkways must not have obstructions. Rehab materials must be available in a form that the clients can use, whether braille or audio.

Clients must be allowed to bring along their guide dogs, too, except when doing so would “fundamentally alter the particular activity or jeopardize the safe operation of the program.”

It’s not that rehabs don’t want to be accessible. It’s that they are not as accessible as they think. A few simple accommodations can make their facilities and addiction treatment programs more user-friendly to those with impaired vision. If you have any additional questions feel free to check out our frequently asked questions page, it’s jam packed with answers to all of your rehab related questions.