Katherine A. Sandberg
with assistance from Kim Korwin, Pam Beiknap and Amy Mathews
Introduction
Rehabilitation counselors who serve Deaf and
Hard of Hearing clients who may have substance abuse problems,
have unique opportunities in the area of prevention, intervention
and aftercare. Because of the complex nature of hearing loss,
service providers who become skilled at working with this
group of people will likely draw more and more on this population
for their case load. The Deaf/Hard of Hearing client is limited
in his or her access to many resources, and he/she may tend
to rely more heavily on those professionals who do have an
understanding of their particular needs. Also, rehabilitation
service providers frequently serve as an intermediary between
the deaf client and other agencies. An example would be the
Vocational Rehabilitation counselor who may mediate between
a Deaf/Hard of Hearing employee and employer. Not only does
the Deaf/Hard of Hearing client utilize rehabilitation professionals
in a variety of roles but other agencies often rely on Vocational
Rehabilitation counselors as their community link.
The issue of substance abuse is one that permeates
virtually everyone in this country. Individuals who are Deaf/Hard
of Hearing are affected by substance abuse just like hearing
people. Although research has been scarce, the assumption
has been made that this population maintains at least the
level of addiction found in the general population. That is,
current thinking is that at least one in ten Deaf/Hard of
Hearing individuals faces difficulties related to the use
and abuse of mood altering chemicals. Because of the relationship
described above, rehabilitation workers may be in a unique
position to detect signs of alcohol or other drug abuse and
to assist in the referral process.
Signs and Symptoms
The following are some common signs and symptoms
of a substance abuse problem that might be detected in a client.
While the presence of one or two indicators should not be
used to diagnose a client as chemically dependent, a combination
of symptoms or a pattern that emerges can be very helpful
in identifying a substance abuse problem. Frequently, much
of this information can be gleaned in routine questioning
done with all clients as a part of the service provision.
Physical
frequent unexplained illnes
ssudden weight loss/gain
injuries (as from the fights or accidents)
generally unhealthy appearance
unusual sinus or dental problems
memory loss
hangovers |
Work/School
unexplained absences
pattern of absences or lateness
declining performance
inconsistant performance
under the influence
problems with boss/co-workers
series of job/school problems |
Social
isolation, lack of friends
different friends
socialization around use
blaming others for problems
loss of relationships |
Legal
fights, assaults
DWI or DUI charges
burglary charges
breaking and entering
restraining orders |
Financial
overdue bills
legal fines, tickets
borrowing/stealing money
owe money to others
gambling activity |
Emotional/Spiritual
feelings of shame or guilt
feelings of embarrassment
loss of control
pattern of poor judgement
unresolved grief issues |
Again, remember that none of these signs by
itself is sufficient to indicate an alcohol or other drug
problem. However, taken in combination and balanced with other
information about the client, these signs can point to a potential
problem and a solution. Discrepancies in a client's story
can also be helpful clues. In other words, words and actions
that don't match or contradicting information can be signs
that the client may need an assessment or some determination
of the reasons for the inconsistencies.
Finally, the manner in which this information
is dealt with can also contribute to how likely it will be
to lead to help for the client. Service providers who are
able to work with and question clients in a non-judgmental
and creative manner have a better chance of eliciting responses
from the client. Although the provider may well have an advantage
over the client (such as the ability to grant or withhold
support), a non-threatening approach will yield better results.
Vocational Implications of Substance Use/Abuse
In addition to the general signs and symptoms
described above, the use of alcohol and other drugs or related
criminal activity can have direct vocational implications
for the individual. If the individual has lost employment
because of his/her use of chemicals, this impacts on his/her
availability for employment and results in poor employment
history this making future job seeking attempts less likely
to be successful. Crimes committed under the influence of
alcohol or other drugs are also likely to have this kind of
impact. When the individual's production is affected by his/her
use (either use at work or after effects of the use), it can
impair the worker's ability to think clearly, problem solve,
tolerate pressure, deal with fellow workers, be free from
safety hazards or work at an acceptable speed.
VR Counselor Concerns
The following are some common concerns held
by Vocational Rehabilitation counselors who are working with
clients who are deaf or hard of hearing and who have substance
abuse issues:
-
Length of sobriety to require prior to making
an eligibility decision and/or beginning a training or
placement plan.
-
Determining the functional limitations and
vocational implications of the substance abuse.
-
Determining the most appropriate type of
treatment or intervention services for the client.
-
Determining if treatment and VR services
will be provided concurrently or if completion of treatment
will be a prerequisite for VR service provision.
-
Establishing appropriate means of monitoring
the maintenance of sobriety for the purposes of evaluation
of progress and attainment of objectives.
How each of these concerns is addressed will
vary based on the needs of the client, the judgement of the
counselor and the latitude given by the agency involved. Ideally,
counselors will seek out colleagues in both the treatment
and vocational rehabilitation fields for help and support
in making difficult decisions.
The Referral Process
The Vocational Rehabilitation counselor who
discovers clues or signs that point to a substance abuse problem
is likely to feel overwhelmed unless he/she is acquainted
with some kind of referral process. Although the specifics
may vary depending on the community or agency, generally the
first step would be to undertake a formal assessment of the
client's chemical use. Because funding sources and local procedures
will vary, there is no one source for such an assessment.
In some states treatment funds are allocated on a county basis
thus making counties responsible for assessing needs. When
dealing with insurance funding, each company will have its
own process for designating an assessor and admission criteria.
However, local providers in substance abuse services should
be able to help in obtaining an assessment. State agencies
dealing with chemical dependency or substance abuse can also
assist in this process. The role of the rehabilitation service
provider will vary depending on the scope of the responsibilities
of the position but the provider can probably at least recommend
an assessment when appropriate and provide some resources
for the client to utilize.
Those service providers who are in a position
to do so may also want to help acquaint assessors with the
particular needs of the Deaf/Hard of Hearing client as they
relate to the assessment tool and procedure. Such information
as the need for an interpreter when being assessed by someone
not fluent in sign language or the client's potential underexposure
to substance abuse "lingo" (such as blackout, tolerance,
D.U.I.) can be helpful in providing a valid assessment. Any
cultural or linguistic information that can be communicated
to the assessor will add to the validity of the assessment.
If a client is determined to be in need of treatment
services, rehabilitation professionals may also be in a position
to recommend appropriate placements that are sensitive to
the special communication needs of this group. A services
checklist, included at the end of this article, can be helpful
in identifying what services best meet the needs of the particular
client. Rehabilitation workers who work with Deaf/Hard of
Hearing clients also frequendy serve as the referral source
to the treatment program. With proper release of information
forms completed from the client, much of the referral process
can be completed over the phone to the program. Typically
clinical information about the client's substance use and
related consequences combined with personal data such as name,
address, birthdate, social security number and so on are sufficient
to complete the referral process.
Keeping in Contact DuringTreatment
For rehabilitation counselors who will continue
working with the client upon completion of treatment, keeping
in contact with the treatment program and monitoring progress
can be very beneficial to the client. Rehabilitation professionals
who are familiar with the philosophy of treatment programs
they utilize have a good basis for understanding the client's
treatment experience. Periodic updates about the client's
progress through the program, barriers the client faces, anticipated
discharge date and aftercare recommendations allow the rehabilitation
worker to be in a position to serve the client well upon his/her
return.
Rehabilitation workers, with client relationships
and some history with the client can help treatment staff
and the client to anticipate some of the difficulties in ongoing
recovery after treatment. The rehabilitation professional
may also be in a better position than treatment program staff
to identify support services in the communitv which can be
utilized by the client.
Aftercare Considerations
Rehabilitation workers can be an important recovery
link for clients leaving treatment and returning to the community.
Understanding the treatment process. serving as a guide to
local resources and acting in a supportive capacity can all
be key pieces for a client's continued sobriety. An aftercare
plan is typically formulated at the treatment center, which
should be a joint effort between staff and client. The client's
involvement in formulating the aftercare plan can help him/her
feel invested in following through with the plan. Rehabilitation
counselors who have maintained contact with the treatment
program should be given a copy of the aftercare plan. This
enables the worker to help the client in his/her follow up
with the plan as well as helping them problem solve about
any difficulties as they arise.
Because services for deaf persons in recovery
typically lag behind what is available for others in a given
area, the rehabilitation counselor may be in a position to
educate community resources and to help the client advocate
for him/herself. Lack of accessibility to Twelve Step meetings,
support groups, relapse groups, halfway houses, or sober living
environments remains a barrier in many communities. The sharing
of resources and energy may result in the beginning of recognizing
the needs of deaf people in recovery and improved resources
for this group of people. Obtaining a sponsor, also typically
part of the aftercare recommendations, may also be hampered
by the lack of deaf sponsors. However, clients need to be
challenged to make some compromises for the sake of their
ongoing sobriety. Clients can utilize hearing sponsors with
many years of sobriety and communicate via the TDD, message
relay services, interpreters, etc. Finally, the rehabilitation
professional who: acknowledges the changes a deaf person in
recovery is trying to make; is committed to helping the recovering
deaf client get his/her needs met; and is cognizant of the
fact that the recovering person's goal is progress not perfection
can be a key component in the recovery process for Deaf/Hard
of Hearing individuals who chose to live a sober life.
For more informanon about chemical dependency
treatment of deaf and hard of hearing persons, please contact
the Minnesota Chemical Dependency Program for Deaf and Hard
of Hearing. The Program serves deaf and hard of hearing persons
from throughout the United States and Canada and has been
recognized as a model program through the awarding of a federal
grant from the Office for Treatment Improvement. The Program
may be contacted by voice or TDD at this toll free number:
1-800-282-3323.
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