Can substance use lead to disability?
Functional ability includes physical, mental, sensory and cognitive capacities. Disability encompasses physical, mental, sensory and cognitive impairments. Someone with SUD may have a disability either as a result of the disorder or independently of it. Whether a disability occurs in a specific situation depends on both the person's functional ability and their surrounding environment. For example, in order for persons with cognitive impairment to be able to arrange a medical appointment, the booking process must be accessible and not entail barriers for them. Disabilities that hinder participation in society arise from the interplay between persons with impairments and environmental barriers (3). This is called a social relational model of disability and is applied in Norway and internationally (3, 5). The model integrates individual and social factors as well as the interaction between the person and their environment.
When assessing whether SUD leads to disability, the focus is on factors related to the individual. Does the person have physical, mental, sensory or cognitive impairments related to their SUD? However, the interaction between the person and their environment also plays a role. For example, a person may encounter barriers when trying to make an appointment with their general practitioner (GP) because the digitalisation of the health service requires digital literacy and access to digital tools and the personal electronic identification system BankID. Not everyone with SUD has access to these resources.
We believe that substance use and SUD can lead to disability because they affect the person's cognitive functioning, somatic and mental health, self-care, and interpersonal relationships. The lifespan of individuals with both SUD and a mental disorder, known as a co-occurring disorder (COD), as well as those with SUD but no mental disorder, is 10–20 years shorter than that of the general population (6–9). Trauma, lifestyle, living conditions, access to healthcare services and the specific substance use all contribute to health inequalities. At the core of this is the interplay between the person and their environment and how the person manages their daily life. Are they able to make use of somatic and mental health services? Do they have satisfactory housing? Are they part of a local community?
We believe that substance use and SUD can lead to disability because they affect the person's cognitive functioning, somatic and mental health, self-care, and interpersonal relationships
Whether SUD can be considered a disability has not yet been investigated. The Equality and Anti-Discrimination Ombud has pointed out that it is unclear whether SUD is encompassed in the term 'disability' (10). The Norwegian Institute for Human Rights recommends that the authorities assess the actual and legal need for discrimination protection for those with SUD and consider whether legislation and practices should be revised to strengthen this protection (2). If a person requires accommodation or other affirmative action to gain equal access to healthcare services, we believe it is discriminatory not to provide this. We therefore support an investigation into whether SUD should be understood as a disability and whether a lack of accommodation in the health service can be considered discriminatory.