# Severe Alcohol Use Disorder in a Patient Who Is Deaf, Mute, and Having Limited Literacy: A Case Report and Review of Disability-Linked Substance Use Vulnerabilities

## TL;DR

A deaf, mute, and illiterate man with severe alcohol addiction required specialized care due to communication barriers and lack of adapted tools.

## Contribution

First report on detoxifying a deaf, mute, and illiterate patient with severe AUD, highlighting inclusive clinical needs.

## Key findings

- Standard AUD diagnostic tools are ineffective for patients with communication and literacy disabilities.
- Interpreter-facilitated therapy and family involvement were critical for successful detoxification.
- Disability-informed protocols are urgently needed to address equitable addiction care.

## Abstract

Alcohol use disorder (AUD) in individuals with communication and literacy disabilities is poorly recognized and rarely described in the literature. Standard diagnostic and withdrawal management tools are not adapted for deaf, mute, and illiterate patients, creating gaps in equitable care.

A 64-year-old man who was congenitally deaf, mute, and with limited literacy presented for protective-custody alcohol detoxification after decades of consuming 12-30 beers daily. Bereavement and loss of his primary caregiver triggered an escalation of use. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scoring was not feasible due to communication barriers. Management included a lorazepam taper, naltrexone initiation, mirtazapine for mood symptoms, and osteopathic manipulative treatment for somatic complaints. Interpreter-facilitated therapy and family involvement were central to stabilization.

This case highlights the need for culturally and linguistically adapted withdrawal tools, early interpreter involvement, and disability-informed addiction treatment. To our knowledge, this is among the first reports describing detoxification of a deaf, mute, and illiterate patient with severe AUD, underscoring the urgency of inclusive clinical protocols.