U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

CSAT’s 

Knowledge Application Program 

KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for 

People With Physical and Cognitive 

Disabilities 

KAP Keys
 For Clinicians
 

Based on TIP 29 

Substance Use Disorder 

Treatment for People with 

Physical and 

Cognitive 

Disabilities 
KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for People With Physical 

and Cognitive Disabilities 

Introduction 

-

mation. 

These Kap Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration. These KAP Keys are 

based entirely on TIP 29 and are designed to meet the needs 

of the busy clinician for concise, easily accessed "how-to" infor

For more information on the topics in these KAP Keys, readers 

are referred to TIP 29. 

Other Treatment Improvement Protocols (TIPs) 

that are relevant to these KAP Keys: 

TIP 9, Assessment and Treatment of Patients With Coexisting 

Mental Illness and Alcohol and Other Drug Abuse (1994) 

BKD134 

TIP 15, Treatment for HIV-Infected Alcohol and Other Drug 

Abusers (1995) BKD163 

TIP 24, A Guide to Substance Abuse Services for Primary Care 

Clinicians (1997) BKD234 

TIP 27, Comprehensive Case Management for Substance 

Abuse Treatment (1998) BKD251 

TIP 34, Brief Interventions and Brief Therapies for Substance 

Abuse (1999) BKD341 

TIP 35, Enhancing Motivation for Change in Substance Abuse 

Treatment (1999) BKD342 

TIP 37, Substance Abuse Treatment for Persons With HIV/AIDS 

(2000) BKD359 
KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for People With Physical 

and Cognitive Disabilities 

Educational and Health Survey 1 

Please answer the following questions keeping in mind that we 

are trying to get to know you better and to identify areas that 

may create difficulty for you in treatment if we don't know 

about them. 

1. Do you have a disability or have you ever been told that you 

have a disability? 

___ Yes ___ No 

2. Are you currently under the care of a doctor or other medical 

care professional? 

___ Yes ___ No 

3. Do you take medications? 

___ Yes ___ No 

4. Do you have difficulty hearing in group settings (e.g., 

theaters, classrooms, family dinners)? 

___ Yes ___ No 

5. Do you frequently need people to repeat what they have 

said to you? 

___ Yes ___ No 

6. Have people complained that you don't hear or don't listen 

to them? 

___ Yes ___ No 

7. Do you wear glasses or contact lenses? 

___ Yes ___ No 

8. Do you have difficulty seeing things that are far away or very 

close? 

___ Yes ___ No 

9. Do you have frequent eye pain or headaches? 

___ Yes ___ No 

10. Have you ever hit your head and lost consciousness? 

___ Yes ___ No 

11. Have you ever received health or disability benefits? 

___ Yes ___ No 

12. Have you ever been unemployed for a long period of time? 

___ Yes ___ No 

13. Have you ever been fired from a job, asked to leave a job, 

or passed over for a promotion? 

___ Yes ___ No 

14. Did you ever have special classes or tutoring in school? 

___ Yes ___ No 

Continued on Back 
KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for People With Physical 

and Cognitive Disabilities 

15. In a school or work setting, do you like to learn or learn 

best by 

___ Listening to someone talk 

___ Watching someone perform a task
 

___ Reading on your own
 

___ Performing tasks yourself
 

___ Discussing things with another person
 

___ Discussing things with a group of people 

16. Have you had problems or difficulty with any of the following? 

___ Getting your point across to others 

___ Sitting still 

___ Focusing on the task at hand for more than several 

minutes at a time 

___ Understanding the point that others are making to you 

or what others are saying to you 

___ Communicating your feelings or thoughts to others 

17. Have you ever had problems with or been bothered by any 

of the following? 

___ Controlling anger 

___ Remembering things 

___ Following instructions (verbal, written, or demonstrated) 

___ Concentrating 

___ Becoming tired easily 

___ Getting along with others 

18. Have you ever had problems or been bothered by any of 

the following? 

___ Depression
 

___ Anxiety
 

___ Forgetfulness
 

___ Sleep problems
 

___ Nervousness
 

___ Muscle tension or soreness
 

___ Uncontrolled worry
 

___ Excessive worry
 

___ Irritability
 

___ Restlessness (feeling on edge)
 

___ Mind "going blank"
 

___ Rapid heart rate
 

___ Pounding in chest
 

___ Heart burn or stomach pain
 

___ Uncontrolled feelings of happiness or euphoria 
2 

KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for People With Physical 

and Cognitive Disabilities 

Potential Community Resources 

to Assist with Treatment 

All Disabilities 

Centers for Independent Living 

United Way 

Vocational rehabilitation agencies 

State disability councils 

Learning Disability (LD) 

Local or national Learning Disabilities Association 

Community, school, or university LD program 

Community mental health centers 

Literacy council 

Developmental Disability (DD) 

School or community DD program 

Parent organizations 

Goodwill Industries 

Special Olympics 

Blind or Visual Impairment 

Vocational rehabilitation providers 

Senior citizens' center 

Public library 

Society for the Blind 

Lion's Club 

Deaf and Hard of Hearing 

Agencies for the deaf 

Vocational rehabilitation providers 

Senior citizens' centers 

State chapters for the Registry of Interpreters for the Deaf 

Commission for the Deaf and Hard of Hearing (located in 

numerous states) 

Spinal Cord Injury 

Hospital rehabilitation programs 

Paralyzed Veterans of America 

Hospital or pain management program 

United Cerebral Palsy 

Developed by D. Moore and J. A. Ford for the Rehabilitation 

Research and Training Center on Drugs and Disability (RRTC). 
KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for People With Physical 

and Cognitive Disabilities 

Questions for Counselors to 

Think About 

3 

• What books about people with disabilities did I read as a 

child? 

• What view of people with disabilities do I get from the 

media? 

• What scholarly information have I read concerning people 

with disabilities? 

• What experience have I had with significant others who are 

disabled? 

• Who else from the Disability Community have I had contact 

with? 

• What are my issues, hot spots, fears, and stereotypes concerning disabilities? 

Benefits of Modifying Programs to Accommodate 

Persons With Disabilities 

• Improved treatment completion rates 

• New service population 

• Legal compliance insulates program from liability 

• Many grants and contracts are contingent upon Americans 

With Disabilities Act compliance 

• Different funding sources available for a new population 

base 

• Niche area or specialty area for the program 

• Communities need to have this service available 

• Expand scope of approaches and services to use with all 

clients 

• Broader connection to disability agencies and the Disability 

Community provides political benefit 

People's Understanding and Acceptance 

of a Coexisting Disability 

People vary in how well they understand or accept their own disabilities. Some persons entering treatment for substance use 

disorders know what interventions their disabilities require. 

Others do not. Some people appreciate and benefit from accommodations to their disability, whereas others may be reluctant to 

acknowledge that some condition limits their functional capacity. 

The following are some of the factors that affect a person's willingness to accept the realities of her disability: 

• The severity, duration, or specific functional limitations of the 

disability 

Continued on Back 
KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for People With Physical 

and Cognitive Disabilities 

• Societal reaction to and expectations of the person with a 

disability 

• The developmental stage at time of the disability's onset 

• Access to resources and societal mobility 

• -

ability 

A history of risk-taking behaviors prior to the onset of the dis

• A history of having used substances to cope with a disability 

• -

ability issues 

Recurring and episodic forms of personal grieving due to dis

• The amount of independence resulting from a person's 

lifestyle and personality 

• Age (generally, younger people are more willing to eventually 

accept their disability) 

• Marital status (married people are more willing to accept disability than single or unattached) 

• Income (the greater someone's income, the more willing he 

is to accept disability) 

Source: Chart modified from Li and Moore 1998 
4 

KAP KEYS Based on TIP 29 

Substance Use Disorder Treatment for People With Physical 

and Cognitive Disabilities 

Physical Access Can Be 

Readily Achieved 

-

Under the Americans with Disabilities Act, privately operated 

alcohol and drug programs should remove architectural (or 

physical) barriers to program areas in existing facilities where it 

is readily achievable to do so. Readily achievable is defined by 

the Department of Justice as "easily accomplishable and able 

to be carried out without much difficulty or expense." The regu

lation contains a list of 20 examples of modifications that may 

be readily achievable: 

1. Installing ramps 

2. Making curb cuts in sidewalks and entrances 

3. Repositioning shelves 

4. Rearranging tables, chairs, vending machines, display racks, 

and other furniture 

5. Repositioning telephones 

6. Adding raised markings on elevator control buttons 

7. Installing flashing alarm lights 

8. Widening doors 

9. Installing offset hinges to widen doorways 

10. -

ble path 

 Eliminating a turnstile or providing an alternative accessi

11. Installing accessible door hardware 

12. Rearranging toilet partitions to increase maneuvering 

space 

13. Insulating lavatory pipes under sinks to prevent burns 

14. Installing a raised toilet seat 

15. Installing a full-length bathroom mirror 

16. Repositioning the paper towel dispenser in a bathroom 

17. Creating designated accessible parking spaces 

18. Installing an accessible paper cup dispenser at an existing 

inaccessible water fountain 

19. Removing high pile, low density carpeting 

20. Installing vehicle hand controls 

The list is intended to be illustrative. Each of these modifications 

will be readily achievable in many instances, but not in all. 
Ordering Information
 

TIP 29 

Substance Use Disorder Treatment 

For People With Physical and Cognitive
 

Disabilities
 

Easy Ways to Obtain Free Copies 

of All TIP Products 

1. Call SAMHSA’s National Clearinghouse for Alcohol and 

Drug Information (NCADI) at 800-729-6686, 

TDD (hearing impaired) 800-487-4889. 

2. Visit CSAT’s Web site at www.csat.samhsa.gov 

Do not reproduce or distribute this publication for a fee without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services. 

DHHS Publication No. (SMA) 01-3593 

Printed 2001