Introduction
Demographic information indicate that 6% of
the general population is considered to be hard of hearing
with one out of every 14 individuals identifying themselves
as having difficulty hearing (Schein, 1974). If Deaf people
represent one half of one percent of the U.S. population,
there should be 4,000 Deaf people in drug or alcohol treatment
on any given day (McCrone, 1994). There appears to be no evidence
of this occurring.
Communication Obstacles
Communication difficulties often exist in family
systems with a Deaf member, since 90% of all parents of Deaf
children are hearing (Schein, 1974) and may not be able to
communicate with their children. Parents and children belong
to different cultures; hearing parents may fear "losing
their child to the Deaf community" because they are unable
to adequately communicate with their children. As the child
becomes older, and visits become less frequent, the communication
gaps widen. This lack of communication may put a Deaf child
at a higher risk for potential substance abuse problems. As
the child grows up, the family may overlook classic symptoms
of chemical dependency and attribute them to the fact that
the person is Deaf or hard of hearing.
Deaf people are part of a linguistic minority
whose primary language is American Sign Language(ASL). When
communicating with a Deaf individual, the use of lip reading
without the use of American Sign Language is not adequate
because of the large number of words that look alike on the
lips. In tests, using simple sentences, Deaf people recognize
perhaps three or four words in every sample that is used.
Sit in front of a television set with the sound turned off
and see if you can comprehend what is being spoken. The majority
of what is being said would not be understood since only 20%
of all speech is visible on the lips(Jeffers and Barley, 1971).
This is what a Deaf individual is faced with on a daily basis.
Lipreading is not a feasible communication option for the
majority of Deaf individuals!
ASL is a visually and spatially grounded language
that does not provide a direct "translation" of
English forms and the concepts represented by English vocabulary
and syntax. Thus, knowledge about chemical dependency is not
communicated very well in the Deaf community. For example,
some key concepts and terms in chemical dependency treatment
simply do not exist in the Deaf culture. In treatment settings
designed for the mainstream, language and communication are
both barriers to participation among Deaf and hard of hearing
individuals. Good communication is essential in both the educational-therapeutic
and peer interaction dimension of a well-designed program.
People who are Deaf or hard of hearing are referred
to as having a hidden disability. The disability does not
become evident until the person begins to communicate. It
is assumed by the hearing community, that if a person wears
a hearing aid, then all listening and hearing problems are
solved. Unfortunately, this is not true. Many Deaf and hard
of hearing individuals are excluded from normal conversations
because others do not realize that they cannot hear even with
a hearing aid. Deaf and hard of hearing addicts may be isolated
from society because of their chemical use and their deafness.
They must overcome not only the effects of deafness but also
of a disease which encourages isolation.
Risk Factors
Many Deaf and hard of hearing young people grow
up in families and attend schools where their language isolates
them from the normal information flow. The availability of
information on substance abuse and treatment is fragmentary,
haphazard and slow. Essential to prevention, assessment and
treatment is having materials and approaches to these chemical
dependency topics. For those persons who use ASL or another
manual language, it is necessary that these materials and
approaches are presented in ways that are readily processed.
Currently, the written and visual materials that address this
knowledge gap are inadequate and often written at a level
the Deaf child cannot understand. Those that are available
are not systematically distributed or used.
Deaf adolescents may experience a higher level
of stress in their lives than adolescents who can hear. As
a result, these adolescents may turn to drinking and drug
use to reduce stress and/or fit in with hearing students and
peers. Unfortunately, very few studies have been conducted
to identify the variables that predict drinking and drug use
among deaf adolescents. Dick (1996) found the following school
and peer related variables to be predictors of Deaf and hard
of hearing adolescents use of alcohol and marijuana:
1.) School grades were the most salient predictor of marijuana
use and respondents with poor grades used marijuana more frequently
than those with higher grades; 2.) Deaf and hard of hearing
adolescents who attended main-streamed schools and had high
numbers of hearing friends at school reported higher rates
of alcohol use than those with smaller numbers of hearing
friends at school.
Assessment Considerations
When Deaf or hard of hearing individuals are
in need of a chemical dependency assessment, often they are
interviewed by a hearing person who is not fluent in American
Sign Language. There have been incidents where an assessor
attempts to complete the interview process by writing back
and forth to the Deaf person or expecting him/her to read
lips. Both of these approaches are unreliable as well as being
culturally and ethically inappropriate! This is due in part
to the fact that Deaf or hard of hearing individuals being
assessed may not be familiar with the language used by the
assessor. If the assessor is not fluent in ASL, an interpreter
needs to be used to effectively convey communication during
the interview process. The addition of a third party will
most likely change the dynamics of the assessment and possibly
the validity of the interview session if the interpreter is
not fully qualified. There are few interpreter training programs
in the United States that focus on the specialized substance
abuse vocabulary necessary when assessing Deaf and hard of
hearing individuals. It is imperative that any assessor utilizing
an interpreter makes sure to use a fully certified and qualified
interpreter.
Treatment Considerations
Suppose that you are a person who speaks and
writes only in the English Language and you are in need of
chemical dependency treatment. The only program available
to you is one where all staff speak and write in a foreign
language. It would be extremely difficult to get the information
needed from the treatment program and most likely, the experience
would be negative for you. Unfortunately, many Deaf and hard
of hearing individuals are faced with this dilemma when they
enter a hearing treatment program where communication is not
accessible to them.
The substance abuse treatment field has recognized
the importance of addressing drug and alcohol dependency with
approaches that are sensitive to clients cultural needs
that respect and utilize the primary language of the client
population. The substance abuse profession is beginning to
identify the Deaf and hard of hearing community as a community
in need of specialized treatment approaches.
Often a Deaf or hard of hearing person is admitted
to a treatment program designed to serve hearing people and
is provided access to that program via the services of sign
language interpreters. When Deaf clients are main-streamed
with a group of hearing patients, they may not be able to
express themselves articulately enough to communicate clearly
with different individuals and the group. If a sign language
interpreter is not available, the leader of the group may
try to communicate with the person through pencil and paper,
trying to explain some of the issues. Without the presence
of the interpreter, the deaf individual misses out on all
the information shared during the therapeutic group and may
get feedback from their facilitator that they were not paying
attention or that they only hear what they want to hear. Most
of the time an interpreter is not provided 24 hours a day
but is only made available to the client on a very limited
basis. The absence of an interpreter precludes Deaf and hard
of hearing individuals equal access to staff as well as severely
restricting their interactions with other clients (i.e. meal
times, free time, etc.) Such interactions are a key part of
the treatment process. The optimal placement for Deaf and
hard of hearing individuals is with staff who are fluent in
ASL and sensitive to Deaf culture.
The most therapeutic process of treatment is
not necessarily the groups and lectures, but rather the interaction
and fellowship that occurs among peers in their free time.
Deaf and hard of hearing clients often feel that they miss
out on this interaction and fellowship. When Deaf clients
must depend solely on the support of interpreters, the sense
of bonding is vague and the emotional impact is usually lost
because interaction is through a third person. Sometimes an
interpreter is unfamiliar with chemical dependency treatment
and recovery language. The stage of recovery can be highly
emotional, stressful and very intense. When misinterpretations
occur, it becomes frustrating for all involved and can even
on occasion be harmful to the client. Interpreter training
programs need to add vocabulary related to chemical dependency
to their already existing curricula.
A Model Program
There are very few national inpatient treatment
programs that are designed specifically to work with Deaf
and hard of hearing individuals. One of these programs is
the Minnesota Chemical Dependency Program for Deaf and Hard
of Hearing Individuals(MCDPDHHI). This program utilizes a
12-step philosophy and uses treatment approaches that are
provided by a staff fluent in ASL and knowledgeable about
Deaf culture. The MCDPDHHI currently receives federal funding
from the Department of Education to provide training in the
area of substance abuse and Deafness to professionals on a
national basis. From 1990-95, this Program received federal
funding from the Center for Substance Abuse Treatment to be
a model program. Instead of utilizing primarily reading and
writing in treatment, language barriers are removed by focusing
on the use of drawing for treatment assignments. All written
materials have been modified to meet the individual needs
of the client and video taped materials are presented using
sign language, voice and captioning. The Program also provides
complete access to all clients by utilizing assistive listening
devices, TTYs(telecommunication devices for the Deaf),
flashing light signals and decoders.
Guthmann (1996) studied the treatment outcomes
of 100 individuals who completed treatment at the MCDPDHHI.
The clients were followed for one year following treatment
to determine which variables had the greatest impact upon
treatment outcomes. The study found that the variables having
the greatest impact on the ability to maintain sobriety after
treatment completion were attendance at Twelve Step meetings,
the ability to talk to family about sobriety and being employed.
Of Deaf and hard of hearing clients entering the MCDPDHHI,
75% were unemployed and the research indicated that there
was a strong relationship between abstinence and employment.
There is a need to make vocational rehabilitation a strong
component of inpatient treatment and the aftercare that follows.
In the study that was completed in 1996, Guthmann found similarities
in the characteristics of what contributes to overall success
in recovery for Deaf, hard of hearing and hearing individuals.
This indicates that if the chemical dependency treatment provided
to a Deaf and hard of hearing individual is accessible, the
variables that are necessary to maintain sobriety are similar
in the hearing and Deaf populations.
Obstacles to Treatment and Recovery
The Deaf and hard of hearing community is a
small, closeknit group who tend to view substance abuse very
negatively. If you have a bad habit you are perceived
as a bad person who puts the well-being and public
image of the group in jeopardy. This shame interacting with
the cultural, linguistic and educational isolation of Deaf
and hard of hearing people, leads to reluctance to acknowledge
drug and alcohol abuse. There is a negative stigma associated
with those individuals in the Deaf community who are addicts.
Another problem encountered is the "deaf
grapevine" within the Deaf and hard of hearing community.
The idea of confidentiality is less cherished among Deaf and
hard of hearing individuals than it is among the hearing.
The relationship of confidentiality and its importance to
recovery is almost as difficult to comprehend and accept as
the concept that addiction is a disease which is treatable.
Thus, the grapevine serves to reinforce the addicted individuals
need to keep his or her problem a secret.
When a Deaf or hard of hearing person completes
treatment, there are few recovering individuals fluent in
ASL or Deaf and hard of hearing that are capable of being
sponsors. When thinking of reaching out for help, confidentiality
is a fear and a concern. This lack of a sense of community
makes Deaf and hard of hearing people feel even more isolated.
If confidentiality cannot be respected within a small closeknit
community it makes Deaf and hard of hearing people more apprehensive
of the outside world.
The major problem faced by Deaf and hard of
hearing substance abusers as well as by Deaf and hard of hearing
people in general is communication. AAs basic slogan,
"Call before you pick up your first drink," poses
a real problem for Deaf and hard of hearing addicts. Only
a limited number of treatment programs have accessible telephones(
telecommunication devices/ TTYs) and few treatment centers
own this equipment. Moreover, this may threaten the confidentiality
and the integrity of the therapeutic relationship. Interpreters
are often mistrusted either because of preconceptions, because
they are hearing or because the interpreter is known to the
client.
A common suggestion in recovery is to avoid
old acquaintances (people, places and things) that provided
reinforcers for the substance abuse. Their circle of Deaf
and hard of hearing friends is limited; therefore, they will
have a tendency to associate with previous friends who may
still be using chemicals or be placed in the same stressful
situations again, putting the client at risk of returning
to a life of chemical dependency. Many Deaf and hard of hearing
people, attempting recovery, will relapse because of loneliness.
There is also a lack of options in recovery
related programs, services and opportunities for Deaf and
hard of hearing people. Only a few chemical dependency related
services, programs and self-help groups are available that
are accessible through interpreters. This compares to countless
numbers of services and programs that are freely accessible
to all those who are hearing and non-disabled. The Americans
with Disabilities Act(ADA) which was passed by the legislature
a few years ago, was important because it prohibits discrimination
in state, local and private sector services whether or not
these programs get federal funding. Title III of the ADA prohibits
discrimination against people with disabilities in privately
owned public accommodations such as private drug and alcohol
treatment facilities. Obviously, despite this act, discrimination
occurs every day to Deaf and hard of hearing people since
needed services are primarily offered in settings that are
not fully accessible.
Conclusion
In order for Deaf and hard of hearing individuals
to have a reasonable chance of being successful in a recovery
program, a number of things must first occur: 1.) there is
a need for accessible Twelve Step groups; 2.) education/prevention
services should be provided to Deaf and hard of hearing persons
of all ages; 3.) there is a need for accessible outpatient,
inpatient and aftercare services; 4.) training opportunities
about specialized treatment considerations should be offered
to professionals working in the field of chemical dependency;
5.) more interpreter training programs are needed that offer
specialized training in the area of chemical dependency; 6.)
there is a need for more chemical dependency counselors who
are fluent in American Sign Language; 7.) additional research
is needed in the area of chemical dependency and the prevalence
within the Deaf and hard of hearing community; 8.) and there
is a need for vocational rehabilitation counselors to work
closely with chemical dependency treatment programs.
For persons who are Deaf or hard of hearing,
the principles of addiction are the same as they are for hearing
people, yet these individuals are currently unable to fully
access the resources available to hearing individuals. Deaf
and hard of hearing individuals are at a severe disadvantage
in receiving and realizing long-term benefits from treatment
for chemical dependency, since treatment efforts are typically
not grounded in culturally specific knowledge. Ideally, individuals
who successfully complete a alcohol/drug treatment program
should be able to return to the environment that they lived
in prior to entering a treatment program. However, that environment
must include a sober living option, family/friend support,
professionals trained to work with clients on aftercare issues
and accessible Twelve Step meetings. This kind of environment
is unavailable for the majority of Deaf and hard of hearing
individuals. Because Deaf and hard of hearing people make
up a low incidence population, professionals and the recovering
community need to work together on a state, regional and national
basis to make sure that accessible services are being provided
for Deaf and hard of hearing individuals.
References
Dick, J. (1996). Signing for a high: a study
of alcohol and drug use by deaf and hard of hearing adolescents.
Rutgers University, New Brunswick, New Jersey. Dissertation
Abstracts International, 57(6A), p. 2675.
Guthmann, D. (1996). An Analysis of Variables
that Impact Treatment Outcomes of Chemically Dependent Deaf
and Hard of Hearing Individuals. University of Minnesota,
Minneapolis, Minnesota. Dissertations Abstracts International,
56(7A), pp. 2638.
Jeffers, J. & Barley, M. (1971). Speechreading
(lipreading), Springfield, Illinois: Charles C. Thomas.
McCrone, W. (1994). A two Year Report Card
on Title I of the American Disabilities Act: Implications
for Rehabilitation Counseling with Deaf People. Journal
of American Deafness and Rehabilitation Association, 28(2),
1-20.
Schein, J. (1974). The Deaf Population
of the United States. National Association of the Deaf,
Silver Springs, Maryland.
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