# Intersecting challenges: Substance use and mental health disparities across self-reported disability status

## TL;DR

People with disabilities face higher rates of substance use and mental health issues, along with more barriers to treatment, compared to those without disabilities.

## Contribution

The first quantitative study to compare substance use and mental health outcomes between people with and without disabilities using structured survey data.

## Key findings

- People with disabilities had significantly higher odds of using cannabis, alcohol, and stimulants in the past 30 days.
- PWD reported higher rates of depression, anxiety, and suicide attempts, as well as more barriers to treatment and overdoses.
- PWD were more likely to be older, unemployed, insured, and of color compared to non-disabled participants.

## Abstract

Substance use and substance use disorders (SUD) disproportionately affect people with disabilities (PWD), yet PWD remain under-represented in addiction treatment literature. While recent work has begun to address SUD prevalence and recovery service gaps, little is known about how disability status shapes substance use outcomes. The present study is the first to our knowledge to investigate how recovery, mental health comorbidities, and barriers to care differ across disability status using structured survey data from people who use substances.

333 participants who use substances and provided information about their disability status in the baseline survey for a digital intervention study were included in the analysis (MeanAge: 41.1 (10.6); 58.0 % female; 68.2 % White). Bivariate analyses—independent sample t-tests and Chi-Square tests—were conducted to examine differences across disability status in recent substance use patterns, mental health comorbidities, recovery history, and barriers to treatment. Multivariable regression models were used to assess associations between disability status and variables of interest, adjusting for socio-demographic covariates.

Of the participants, 34.2 % reported having a disability (n = 114). PWD were more likely to be of color, unemployed, insured, and older, compared to those without disabilities (n = 219; ps ≤0.001). Regression analyses indicated that PWD had significantly higher odds of using cannabis, alcohol, stimulants, and other drugs over past 30-day (aORs ranged 2.22–2.30). PWD also had higher odds of endorsing depression, anxiety, and lifetime suicide attempts (aORs ranged from 2.39 (anxiety) to 3.38 (depression)). Additionally, PWD perceived more barriers to substance use treatment (β: 0.55 (0.24)) and reported more overdoses (aOR (95 % CI): 2.60 (1.49, 4.54)) and prior recovery attempts (aOR: 2.69 (1.55, 4.68)), compared to those without disabilities.

This study is among the first to use quantitative survey data to assess and compare substance use and treatment engagement among PWD and their non-disabled peers. Findings underscore urgent equity gaps in SUD treatment systems and the importance of incorporating disability-informed frameworks in clinical assessments and recovery services. These insights complement recent qualitative findings and emphasize the need for inclusive, accessible, and person-centered care approaches in substance use health services and research.