SUBSTANCE ABUSE AND THE DEAF ADOLESCENT 

BY J. FREEMAN KING, ED.D.

A substance abuse disorder can be defined as the continued use of any substance for mood-altering purposes, regardless of the harmful consequences that might ensue. This type of disorder is characterized by a set of symptoms that indicate an individual continues to use a substance, even though its use is causing significant problems. Substance abuse impacts both hearing and deaf adolescents.

Symptoms of substance abuse include loss of control, social impairment, risky use, and physical effects. Loss of control means the adolescent cannot keep from using the substance. He/she might use the substance in increasing amounts, or for a longer period of time than prescribed; may want to stop using, or has tried to stop, but has not been successful; may spend time trying to obtain, use, or recover from the effects of the substance; or may experience an intense craving for the substance.

When the adolescent faces social consequences connected to substance abuse, this is referred to as social impairment. Examples of this are: 1) a repeated neglect, such as not meeting responsibilities at school, work, or home; 2) a continued use of substances even though the use causes arguments or getting into trouble with others; 3) and/or giving up or minimizing involvement in activities that used to be considered important.

It is risky use when he/she insists on using the substance, even in dangerous situations, and puts themselves at physical risk, i.e., drinking while driving, or may keep using the substance even though they are aware that abuse can cause physical or mental health problems.

A physical effect occurs when the substance abuse impacts the adolescent's body in predictable ways. Often it requires a greater amount of the substance to get the same high or even leads to experiencing withdrawal. Regardless of these physical symptoms being unpleasant, the adolescent uses the substance repeatedly in order to stop withdrawal symptoms.

Much research has been conducted on substance abuse among adolescents who are hearing, but few studies have been conducted on those who are deaf. There appears to be a number of reasons that contribute to the lack of prevalence data on deaf adolescents and substance abuse: 1) a scarcity of assessments that have been translated into American Sign Language (ASL); 2) a variety of communication preferences among the deaf population; 3) the availability of qualified, certified interpreters for substance abuse concepts; 4) the risk and fear among participants regarding the loss of confidentiality; and, 5) cultural difference (hearing vs. deaf) resulting in a distrust of researchers.

The data that does exist for deaf adolescents involved in substance abuse often relies on deduction or comparative evidence on small, restricted, or non-representative samples. It is possible that those who have more social interaction with hearing peers in order to "fit in," may use substances more frequently than do those with less interaction.

The situation is further complicated in that substance abuse disorders among hearing adolescents in the general population typically occur concurrently with mental health problems, i.e., conduct disorder, antisocial personality, major depression, and post-traumatic stress. Few studies include information on co-occurring disorders among deaf adolescents, although those that do, indicate similar to higher rates compared with their hearing peers. The recognition and understanding of substance abuse within the Deaf community tends to lag behind that of the hearing community.

Getting treatment and beginning a program of recovery can present many problems for deaf adoles lems for deaf adolescents. These problems are associated with assessment, treatment, and post-diagnosis care. There appears to be a negative stigma, resulting in the denial of the use of alcohol and other drugs within the Deaf community. Some of the barriers that exist include the treatment agencies' and providers' inadequate knowledge regarding the unique linguistic and cultural needs of deaf adolescents, lack of specialized treatment programs, lack of qualified/certified treatment settings, inaccessible video and print materials, and assessment tools that are in English rather than American Sign Language (ASL).

When a deaf adolescent is referred for treatment, the referral most appropriate would be to a specialized program designed specifically for deaf people, a program that is sensitive to cultural, linguistic, and communication issues that includes staff fluent in ASL and knowledgeable about Deaf culture. Deaf adolescents will typically feel most comfortable in a specialized treatment facility where they can communicate visually using American Sign Language (ASL). Assessments that are used are often administered via speech by an interviewer, or self-administered in written English. For many deaf adolescents, English is not their most accessible language. Therefore, administering a written English instrument to them is often not valid or reliable.

If a deaf adolescent is referred for treatment, the referral will most likely be to an integrated program (hearing and deaf individuals are blended into a program that is designed for the hearing population), as opposed to a specialized program that is designed specifically for deaf people. Deaf individuals will naturally feel more comfortable in a facility where they can communicate deeply and meaningfully and have access to other deaf people during recovery.

Regarding communication during treatment, it is instructive to realize the difference between the interpreted message (the utilization of an interpreter to facilitate communication) and direct, one-on-one communication in sign language. With limited communication among peers, deaf adolescents have minimal opportunities to benefit from peer support and to develop trust or rapport with the professionals who work on staff. Substance abuse disorders and the provision of culturally sensitive treatment for deaf people is often vaguely reported, and resources are often under-reported. This causes a dilemma for parents of deaf adolescents who are seeking assistance for their child. 

Despite the lack of reliable research information, the consensus among those involved in services for and education of the deaf adolescent, there appears to be a problem that approximates the number of hearing adolescents with a substance abuse problem. It is apparent that efforts more seriously focused on substance abuse among deaf adolescents needs to be addressed.

ABOUT THE AUTHOR:

J. Freeman King, Ed.D. is Professor, Deaf Education, Utah State University, based in Logan, Utah.