Hidden & Social Disabilities / Addictions KNR 270 Carter, Van Andel, & Robb, 2003

Hidden & Social Disabilities / Addictions

KNR 270Carter, Van Andel, & Robb, 2003

Definitions

Hidden People don’t know or believe person has disability Sometimes blamed for their disability

Social Array of nonspecific characteristics that affect

personal lives & social relationships Carter, Van Andel, & Robb, 2003

HIV/AIDS, Eating Disorders, Addictions

Questions to Consider

What limitations might the person experience?

How will these limitations affect recreation performance?

What accommodations are available to reduce or eliminate these barriers?

General Recreation vs. Therapeutic Recreation

Intervention Intervene once a condition is present

Prevention Prevent condition before it happens, correct at

early stages, or prevent it from getting worse Promote healthy behaviors

HIV/AIDS HIV (161, 976 Americans)

Human immunodeficiency virus Virus that causes AIDS

AIDS (344,178 Americans) Acquired immunodeficiency syndrome Transmitted through blood-to-blood & sexual contact

Sexual intercourse Sharing needles or injection equipment HIV infected women to babies before or during birth,

or through breast feeding Lifespan illness Lots of stigma & discrimination

Acquired HIV/AIDS Stages

Stage 1(HIV infection) Most people don’t know they are infected Asymptomatic (symptom-free) Has begun to attack white blood cells Results in antibodies that can be detected by

blood test 2 weeks to 3 months after infection


Stage 2 (HIV disease) Experience rapid weight loss, diarrhea, fevers of

unknown origin, chronic fatigue, shortness of breath, night sweats, skin rashes, coughing, susceptibility to infections, white coating on tongue, swollen lymph glands, extreme tiredness


Stage 3 (AIDS) Disintegration of immune system, presence of

opportunistic diseases, pneumonia, Kaposis sarcoma (cancer)

Loss of vision, decreased cognitive abilities, dementia, seizures, psychological problems

Death

Considerations / Accommodations Access to refrigerator to store food supplements or

medications Access to restroom Accommodations for vision impairments (remember

Disability Concerns tour) Accessibility (e.g., ramps, parking, etc.) Rest breaks Provide written instructions Support groups/activities Make people feel welcomed and supported Include family and friends in activities

Related Considerations / Accommodations

Reduce stress or teach stress management Confidentiality Others???? Universal precautions

Likely to continue participating in sport & recreation for health benefits

Not all will disclose their status Also for Hepatitis B virus (causes liver disease) Preplanning is key

Universal Precautions

Use for all participants regardless of health status

Applies to blood or other body fluids with visible blood Includes semen & vaginal secretions,

cerebrospinal fluid Does not include feces, nasal secretions, sputum,

saliva, sweat, tears, urine, or vomitus unless contains visible blood

Treat all blood /fluids as if hazardous


Use protective barriers Disposable gloves, gowns, protective eye ware

Waste Management Clean blood spills using bleach & water solution

(1:10) Do not pick up broken glass with bare hands Store towels & clothes in biohazard bags for

cleaning or dispose of properly Dispose of protective barriers properly


Wash hands immediately with soap and hot water

Report potential exposure to supervisor immediately

Seek medical attention as necessary

Pre-Event Planning

Cover all wounds with air-tight dressing to withstand rigors of play

Have equipped first aid kits All staff trained in universal precautions

During Event

Participants should bring open wounds to attention of staff

Staff should remain alert for bleeding & call attention to participant

Remove bleeding participants from event Participants should not return until bleeding is

controlled, cleaned, treated, and securely bandaged Change clothes

DeRosa, 2003

Eating Disorders

More than 5 million Americans affected Females & males Athletes: gymnasts, figure skaters, wrestlers

Types? Anorexia nervosa Binge-eating Compulsive eating disorder Bulimia nervosa Obesity

Anorexia Nervosa

Willful periods of dieting that can lead to starvation

90% are females Prevalence rate 12-18 y/o = 1/250 Self esteem directly connected to body shape

and weight Weight loss is viewed as achievement or

indication of self-discipline

Anorexia Nervosa

4 criteria Refusal to gain or maintain body weight at or

above normal, 15% below ideal weight Intense fear of weight gain Disturbance in body perception (feels fat even

though emaciated) In females, absence of at least 3 menstrual cycles

Binge-Eating

Recurrent, out-of-control episodes of eating large amounts of food

Eat whether hungry or not Eat past being comfortably full Can lead to obesity or bulimia nervosa High risk for depression or anxiety disorders

Compulsive Eating Disorder

Incapable of controlling how much or how often eat

Eat fast Eat nearly nonstop throughout the day Over-indulge in sugary foods to elevate mood If not eat foods crave, may have severe

withdrawal symptoms

Bulimia Nervosa

Frequent periods of overeating 3,500-5,000 calories in 1 sitting

Followed by Self-induce vomiting Use of diuretics, laxatives, or enemas Fasting Compulsive exercise

15-20% of college age women

Bulimia Nervosa

4 criteria Recurrent binge eating Inappropriate compensatory behavior Minimum of 2 binge-eating episodes a week for at

least 3 months Inappropriate evaluation of self by shape & weight

Obesity

Are at greater risk for High blood pressure Stroke High cholesterol Heart disease Diabetes Gallbladder disease Upper respiratory problems Arthritis


Expressive, creative, and experiential activities Wellness programs

Relaxation Stress management Nutritional education Lifetime healthy patterns of exercise

Observe for unusual rituals around food or excessive exercise

Role model desired relationships between food, exercise, and leisure


Leader should be nonjudgmental and supportive Sets expectations Discussions about weight, diet, and appearance is

minimized Assist to increase self esteem Go Girls program (National Eating Disorders

Association) National Eating Disorders Awareness Week Others????

Addictions

Alcohol

Drugs

Gambling

Alcohol and Drug Use Alcohol most commonly consumed substance for users 12 and

over Nearly 15 million Americans abuse alcohol or are alcoholic 9.1% of Americans addicted to alcohol and drugs

Are primary contributors to homelessness, criminality, spread of HIV, child abuse, & development of antisocial personality disorders, depression or anxiety disorders

Contribute to more deaths, disabilities, & illnesses than any other preventable health condition ¼ highway accidents 40% of traffic fatalities

Use often occurs during leisure

Terms

Dependence Cluster of cognitive, behavioral, & physiological

symptoms that indicate continual use, resulting in tolerance, withdrawal, & compulsive substance-taking behavior.

Use continues despite knowledge of effects on daily functions & decline in functions like work

Tolerance Need for increased amounts to achieve

intoxication

Terms

Withdrawal Behavior change resulting from substance decline in body Often results in consumption to relieve or avoid unpleasant

physiological & cognitive effects

Abuse Results from repeated use Causes failure in role obligations, multiple legal, social, and

interpersonal problems, & potential for physically harmful situations

Less likely to have signs of tolerance or withdrawal from not using

Terms

Addiction Continued involvement associated with acquiring,

using, & recovering from substance’s effects Tendency to revert to use after attempts to quit or

withdraw Final step in progression from drug use through

tolerance to abuse then dependency and eventually addiction

Alcohol Questions

I drink to relieve feelings of stress when I’m under pressure.

Whenever I have a reason to celebrate – for example, a job promotion, birthday, or anniversary – drinking is one of the first things I make a point of doing.

I sometimes drink heavily after a disappointment or rough day.

Alcohol Questions

I experience memory blackouts during or after drinking.

I sometimes stay drunk for more than a few days at a time.

I use alcohol to build my self-confidence. I have missed school due to alcohol. Do you feel more at ease on a date when you are

drinking? I drink to get drunk. I drink to get together with my friends.

Binge DrinkingNational Institute on Alcohol Abuse & Alcholism

Men: 5 drinks in a 2-hour period

Women: 4 drinks in a 2-hour period

Can lead to alcohol poisoning Excessive vomiting Passing out

ISU Drinking Statistics2006 ISU Core Alcohol and Drug Survey

ISU 81.4% consumed alcohol

in past 30 days 38% consumed alcohol

at least 3 times or more a week

9.2 drinks was average per week

28.2% reported being hurt or injured as a result of drinking in their lifetime

Nationwide 71.4%

23.5%

5.8 drinks

15.6%

Alcohol

Also tend to be dependent on or abuse other substances

Initial mood & behavioral changes with a blood alcohol level of .05% Equivalent to 150 lb. person consuming 2 drinks in

succession

Can lead to Cirrhosis of liver, heart disease, sexual dysfunction,

irreversible brain & nervous system damage, gastrointestinal irritations, and FAS for infants of mothers who drink

4 Symptoms of Alcoholism

Craving Strong need or compulsion to drink

Loss of control Inability to limit drinking on any given occasion

Physical dependence Withdrawal symptoms, such as nausea, sweating,

shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking

Tolerance Need to drink greater amounts in order to “get high”

Drug Addiction

2003 National Survey on Drug Use and Health 6.8 million addicted to drugs

4.2 million used marijuana Average age of first use is 14

1.5 million used cocaine 1.5 million used pain relievers

Drug use can change brain metabolism and activity Includes use of illegal drugs and the illegal use of

prescription drugs

Drug Use at ISU

20.1% are current marijuana smokers 16.0% used other drugs in the past year

Amphetamines, cocaine ISU Alcohol and Drug Survey Results, 2004

Drugs

Amphetamines Chronic use results in mood changes,

malnutrition, hostility & aggressiveness, hallucinations, suicidal ideation, heart problems, social isolation

Caffeine Increased amounts associated with cardiac

arrhythmia & exacerbation of anxiety symptoms

Drugs Cannabis

Marijuana Most widely used illicit substance in world Can lead to impaired memory, learning problems, problems with

judgment, & motor performance, emphysema, weight gain 45% of teenagers try before finish HS

Cocaine Crack is highly concentrated form of cocaine, 10 times more

powerful Rush-crash cycle Can lead to depression, seizures, respiratory problems, cardiac

failure, strokes Adults age 26 and older have highest user rate

Drugs

Hallucinogens LSD, mescaline, etc. Use can impair thinking processes & memory,

abnormal perceptions Inhalants

Gasoline, glue, paint, paint thinner, etc. Use can lead to memory loss, fatigue, depression,

brain damage, coma Often first drug young children use (17% of 10th

graders)

Drugs

Nicotine Smokers are more likely to be heavy drinkers &

Illicit drug users May forgo social & recreation activities because

they occur in smoke-free setting Can lead to coronary heart disease, cancer,

chronic obstructive pulmonary disease (COPD)

Drugs

Opioids Narcotics like heroin, morphine Can develop tremors, seizures, impaired memory,

collapsed veins, liver diseases, unconsciousness, coma, death

Phencyclidine (PCP) Angel dust Can lead to loss of coordination, memory loss,

apathy, hallucinations, seizures, respiratory depression

Drugs

Sedatives Sleeping pills, for anxiety Can impair motor function, memory,

concentration, judgment, delusions, tremors, depression, suicidal attempts

Polysubstance dependence Use 3 or more substances (excluding caffeine &

nicotine) but do not rely on one as a dominant drug

Drugs

Other Steroids (anabolic)

Can cause liver tumors, cancer, high blood pressure, shrinking testicles and breast development in males, growth of facial hair and menstrual changes in females

Over-the-counter drugs Prescription medications

OxyContin, Demerol, Vicodin, Valium, Xanax, Ritaline Can lead to paranoia, irregular heart beat, high body

temperatures

Drugs

Methamphetamine Speed, meth, crystal Can lead to psychotic behavior, hallucinations, stroke Nearly 12 million Americans have tried

Club drugs Used by teens & young adults at all night dance parties Ecstasy (MDMA) Can be added unobtrusively to beverages to intoxicate or

for sexual assaults


Fitness programs Nutrition Cardio

Stress management Coping skills program Leisure education

Healthy activities Resources New leisure partners Participating without using


Adventure/challenge experiences Do not serve or include alcohol in events Role model

Don’t talk about how you partied over the weekend

Do not use beer sponsors Others???

Gambling Questions

Have you ever lost time from work/school due to gambling?

Have you ever felt remorse after gambling? Have you ever gambled to get money t pay

debts or solve financial difficulties? After losing, do you feel you must return as

soon as possible to win back your losses? After winning, do you have a strong urge to

return and win more?

Gambling

Readily available Legalized gambling is one of the fastest growing industries

in the US

For most it is harmless form of entertainment 4-6% become pathological gamblers

Adolescents have a high risk of becoming gamblers

As gambling increases, people spend less time with family, may steal money from family, may have problems at work or steal from work

Custer’s 6 Types of Gamblers

Professional gamblers Make their living by gambling, are not addicted

Antisocial gamblers Uses gambling as a way to get money by illegal

means (playing with marked cards, etc.) Casual social gamblers

Used as recreation, entertainment, distraction Does not interfere with family, social, or other

obligations

Custer’s 6 Types of Gamblers

Serious social gamblers Major source of entertainment Compared to a “golf nut”

Relief and escape gamblers Relief from anxiety, depression, anger, boredom,

loneliness Compulsive gamblers

Most important thing in their life

Progression of Gambling Addiction

Winning phase Experience big win or series of wins Results in unreasonable optimism that winning

will continue Leads to great excitement Increase amounts of bets

Progression of Gambling Addiction

Losing phase Start gambling alone, thinking constantly about

gambling, borrow money Start lying to family & friends Begin to “chase” their losses

Depression phase Marked increase in time gambling Leads to remorse, alienating family & friends Suicidal thoughts, arrest, divorce, emotional

breakdown

Pathological Gambling

Persistent, maladaptive gambling that disrupts personal, family, work, or education pursuits

May be preoccupied with gambling Reliving past experiences Planning nest gambling venture Thinking about ways to get money with which to

gamble Could include gambling online

Pathological Gambling expressed in 5 or more of following

Needs to put increasing amounts of money into play to get desired excitement

Has repeatedly tried (and failed) to control or stop gambling

Feels restless or irritable when trying to control gambling

Uses gambling to escape from problems Often tries to recoup loses

Pathological Gambling expressed in 5 or more of following (cont)

Lies to cover up extent of gambling Has stolen to finance gambling Has jeopardized a job or important

relationship Has had to rely on other for money to relieve

the consequences of gambling Is preoccupied with gambling


Consider when appropriate to use games of chance in programs

Stress management Other????

Documents

Hidden & Social Disabilities / Addictions KNR 270 Carter, Van Andel, & Robb, 2003