Illustration by Eric Stampfli
On an unseasonably warm day in December 1964, 19-year-old Dick Elhardt, of Roseville, Minn., and his two best friends went for a joyride in his friends’ Austin Healy. It was the day before Elhardt was to be drafted, and they wanted to have some fun before he left for Vietnam.
The three friends were clean and sober when the driver overshot a curve, sending the trio over an embankment. The sports car landed upside down, killing the driver and pinning Elhardt half in and half out of the vehicle as it burst into flames. His other friend, who was thrown through the windshield, was able to pull Elhardt out from under the car and save his life.
Within days, however, gangrene set in and both of Elhardt’s legs were amputated above the knee; doctors said he received the worst third-degree burns they had ever seen. Since then, he has battled a cycle of substance abuse–pain medication, marijuana and alcohol–trying to mask the phantom pains in his legs, pain from his prosthetics and pain in his shoulders and wrists from using walking canes.
Numbers of Abusers
Scarce are the comprehensive studies or statistics on substance abuse among the disabled population–in fact the professionals we spoke with knew of none–though some rehabilitation facilities have surveyed injured individuals about their alcohol intake pre- and post-injury.
According to Wright State University’s Substance Abuse Resources and Disability Issues program in Dayton, Ohio, alcohol abuse rates for Americans with disabilities are twice as high as for those with no disability. John de Miranda, executive director of the National Association on Alcohol, Drugs and Disability of San Mateo, Calif., suggests that of the over 50 million Americans with disabilities, as many as 15 to 20 percent have a coexisting drug or alcohol problem–compared to the 10 to 12 percent of persons with substance abuse problems in the general population.
“Unfortunately, nobody has done a study to say there’s a general, robust percentage or number of people who have a particular substance disorder and a particular disability,” says Timothy Elliott, professor of the department of psychology, University of Alabama, Birmingham.
In addition to compromising a person’s health or rehab progress, using alcohol or drugs while disabled undermines the bodily system. It can contribute to or cause pressure sores, liver damage and broken bones from falls. It also creates depression, saps your strength and makes you generally less engaging and independent.
But possibly the most devastating effects on individuals with coexisting disabilities derive from the attitudes of those who surround them.
Elliott warns of doctors prescribing medicines for pain or muscle spasms without considering the patient’s substance patterns, putting them at risk for a variety of problems. Many treatment facilities go only as far as following ADA guidelines to be architecturally accessible but lack an “accessible” attitude whereby the chance for acceptance into and success in a recovery program is lowered. And when family, friends or medical experts hold attitudes such as “If I were like this, I’d drink or do drugs, too,” or “They don’t have much to enjoy, so why not let them have fun?” it only encourages, coddles, enables or leads to acceptance of substance abuse problems.
Elhardt’s recovery has been a seesaw of pain management and addiction, and the worst withdrawal side effects came from his pain medication, which included methadone treatment.
After the accident, Elhardt received morphine during his six months’ stay in the hospital. At home, he continued taking pain medication–sometimes quadrupling the dose–until it stopped relieving pain caused by prosthetics and phantom pain. To this day, his brain and nerves are still reacting to the burn trauma.
“After the hospital, I could get whatever medication I needed,” he says. “But within a couple of years my doctor said, ‘You just can’t take any more.'”
That’s when Elhardt, married with two sons, discovered that marijuana would relieve his pain. He smoked about a joint a day for 10 to 12 years until a newspaper article caught his eye.
“The article said that one Manhattan drink had the same effect of what in those days they called hypos,” he says. “I thought ‘Oh, wow,’ that’d be cheaper and easier to get. It worked pretty good.”
His initial habit was one or two Manhattans a night–a Manhattan is essentially a martini made with whiskey. It progressed to three and four a night, then to drinking until he passed out. By the mid-1980s it wasn’t about relieving pain anymore; all he cared about was getting the next drink. By the early 1990s he needed a drink in the morning before work to stop “the shakes” and “clear his head.”
“In 1993 I was sick and tired of being sick and tired and checked myself into a hospital detox,” Elhardt says. “I stayed sober for six months, then started drinking again. I justified it by saying it helped the pain.”
In 1995 Elhardt went through Hazelden’s rehab program in Center City, Minn., and has been sober since. However, he recently went back for treatment for pain meds abuse.
“I had surgery on both my shoulders,” Elhardt says. “After the last one, the doctor sent me home the next day. I use my shoulders a lot to transfer from my wheelchair; the surgeries were painful enough, but lifting myself made it worse.”
In order to get pain medicine, because of his past use Elhardt signed a contract with his doctor stating that he would only use what was prescribed; he wouldn’t go to other docs for prescriptions; and he would only use one drugstore to fill his prescription. He took Vicodin, then OxyContin, and then was put on Methadone and Dilaudid. He would quadruple his dosage for a couple of weeks, then cut back to less than prescribed to coast until he could get a refill. It became a full-blown addiction over a three-year period.
“Your body actually ‘creates pain’ to get more of the medication,” he says. “I’m an addict. I just can’t drink or take any pain medicine ever again.”
In September 2004 he again checked himself into Hazelden. He says that detoxing from the Methadone was worse than any other substance; he was told that it’s harder than getting off heroin.
“I only slept four hours the first week in Hazelden,” he says. “It took a couple of months before I could get to sleep. I was thrashing in bed, I experienced chills and couldn’t get warm, I had anxiety attacks; the drug gets so deep into your tissue and bones, it takes that long to leave your body.”
Changing the System
At 25, Deborah Larson of Allston, Mass., had finished her master’s degree and was beginning to work on her doctorate in physiological psychology. One night in his sleep, her father had a massive heart attack and died. Within 11 months, her mother also died of a heart attack. Larson, an only child, felt lonely and lost and started to drink and do drugs. Eventually, her abuse caused an epileptic seizure and she was brought to a hospital where she had a stroke, resulting in a brain injury.
After Larson had another epileptic seizure due to drinking alcohol while taking antiseizure medication, she sought help at the Granada House in Allston. Despite an obstacle to gaining admittance, Larson was accepted as an inpatient resident because of the grace of its executive director, Tom Reardon (now deceased).
“Granada was not necessarily a disabled-person provider,” Larson explains. “You had to pass a test: You had to get out of the building within a matter of seconds. Despite the fact that I could hardly walk and couldn’t read and couldn’t get out in a matter of seconds, Tom took me anyway.”
Four years later and well into recovery, Larson became executive director of the facility and has since become an advocate for changing attitudes and programs to create accessible treatment facilities where anyone can receive help. She is now 23 years sober.
“In most states–aside from Massachusetts, New Jersey, California, Arizona and Wisconsin–there’s not treatment available for people who are disabled, including big treatment centers like Hazelden, which became architecturally accessible just two years ago,” Larson said. “The Rehabilitation Act was passed in the 1970s, ADA in 1990, and still they’re breaking the law by being inaccessible; this includes 99 percent of most public substance abuse treatment facilities.”
According to Larson, local detox centers are more likely than residential longterm treatment or recovery homes to accept people with disabilities. She said in Massachusetts there are 52 treatment centers, 90 percent of which are architecturally accessible, yet Granada House treats 50 percent of the state’s disabled residents. Larson cites reasons of fear, laziness and non-enforcement of federal law on legislative and state levels.
“If a treatment facility were to say, ‘I’m not going to take you because you’re black,’ it would hit the newspapers, and the NAACP and everybody would be outraged,” Larson says. “We are