Alcohol-Related Disabilities and International Exchange
Information on the ADA and alcoholism, the role of alcohol in other cultures, and accommodating exchange participants who are recovering alcoholics.
Introduction
With alcohol problems ranking highest amongst young adults between the ages of 18-29 (31% of college students meet the criteria for alcohol abuse and 6% meet the criteria for dependence), many exchange organizations are discovering that the accommodations that can be provided to individuals in recovery can also assist with preventing alcohol abuse by other participants in study, volunteer, intern or teach abroad programs.
In This Tipsheet
- About Alcohol Abuse and Alcoholism
- The ADA and the Recovering Alcoholic
- Social Security and Alcohol Addiction as a Disability
- The Role of Alcohol in Other Cultures
- Planning Ahead and Providing Accommodations
- Other Resources
About Alcohol Abuse and Alcoholism
Alcohol abuse is characterized by a desire for alcohol and continued drinking even when alcohol related problems occur. The recovering alcoholic is an individual who has abused alcohol but has also reached the point where he/she has become physically dependent on the effects of alcohol. Recovering alcoholics may be using one of two models in their recovery 1) the total removal of alcohol from their lives, based on the disease model or 2) the integration model in which the individual uses alcohol moderately in family and social life situations.
Both recovery models may rely on physiological, psychological, and nutritional intervention. Physiological intervention may be in the form of medications or in the form of exercise. Nutritional intervention involves developing a healthy diet that consists of essential nutrients. Psychological intervention may be in the form of individual counseling, group meetings, sponsorship, and/or daily writings.
Psychological intervention addresses many of the factors that contribute to alcohol abuse and alcoholism:
- Social pressure
- Emotional stress
- Pain
- Depression
- Behaviors learned from friends, family, and peers
- Community factors such as the influence of cultural and religious traditions, the addition of new drinking patterns to existing traditional ones, the increased availability of alcohol and the declining price of alcohol
Since most exchange participants fall into the 18-29 year old age range and with alcohol often a predominant factor in developing friendships (i.e. going to the pub) or utilized symbolically in cultural traditions, pre-departure education about the destination country and its traditions is essential for the recovering alcoholic in order to develop necessary strategies to maintain his/her sobriety, develop friendships, and partake in cultural events.
The ADA and the Recovering Alcoholic
Generally, alcoholism (a term that applies to those still drinking and those in recovery) is recognized as a disease but is less known as a disability. The legal definition of a disability requires that the impairment substantially limit one or more major life activities such as self-care, employment or thinking.
A person who is an alcoholic may be covered by the ADA if he/she meets the legal definition of a person with a disability and is qualified to perform the essential functions of a job or activity. Note that in addition to alcoholism, an alcoholic may be dealing with dually diagnosed physical or psychiatric disabilities such as cancer, liver cirrhosis, immune system problems, brain damage or depression.
Denying an individual entry into an international exchange program based solely on the fact that the person is a recovering alcoholic is prohibited discrimination. However, if an individual is currently using alcohol or uses alcohol during a job or activity and that use adversely affects the individual's performance, then disciplinary action or removal from the program is possible, dependent on the alcohol/drug policies of the employer or exchange organization.
Although alcoholism has been categorized as a disability in some cases and legal protections are theoretically applicable to people who are alcoholics or recovering alcoholics, advocacy groups contend that due to their absence from the national coalition that passed the Americans with Disabilities Act and the Rehabilitation Act of 1973, civil rights issues and legal protections for alcoholics are very complex. Because of this complexity, NCDE encourages you to refer to the Disability Rights Education and Defense Fund for more detailed information.
Social Security and Alcohol Addiction as a Disability
Due to a 1996 amendment to the Social Security Act, alcohol addiction, by itself, cannot be the basis for a disability determination for social security benefits. On March 29, 1996, President Clinton signed the "Contract with America Advancement Act." Section 105 of the Act prohibits the receipt of Social Security Disability benefits or Supplemental Security Income benefits if drug addiction and/or alcoholism is material to the finding of disability. This means that if addiction is the person's only or primary disability, they are not eligible for benefits.
If a claimant has another source of disability and secondarily happens to be a drug or alcohol addict, the claimant is still eligible if the other source of disability meets Administration criteria. Further, if the claimant now has a disabling condition meeting Administration criteria caused by life-long addiction, the claimant may still be eligible. For example, if the claimant now has pancreatitis due to years of heavy drinking, the claimant can still collect.
For more information on eligibility for Social Security Disability Programs, contact the Disability Law Center toll free at (800) 317-2200 or at clientservice@disabilitylawcenter.com.
The Role of Alcohol in Other Cultures
In many cultures, alcohol is an important component of transitional rituals associated with birth, coming-of-age, marriage, and death. Alcoholic beverages and drugs are also used for medicinal purposes in various cultures. In parts of Latin America, drinking chicha (maize-beer) accompanies such life events as ear-piercing or hair-cutting ceremonies. Beverages such as wine are used in Christian and Jewish rituals and some drinks are even seen as symbols of national identity. Therefore, the rejection of national or traditional alcoholic beverages can be an emotive issue for recovering alcoholics during an international exchange program.
For individuals on overseas exchange programs, awareness of social expectations with regard to alcohol use, the types of alcohol commonly served and consumed, and culturally appropriate means of rejecting or moderating alcohol use while still fitting in socially is an important key to accommodation.
Take into Consideration:
- In some countries and cultures, there may be little understanding of U.S. recovery services or the models on which the services are based
- There may be gender or cultural considerations to the consumption of alcohol
- What constitutes a drug or alcohol addiction differs between cultures
- Beliefs regarding health, illness, and the significance of alcohol in treating illness differ from country to country
Note: Make sure that the participant is aware that in-country support groups and counselors may not speak English and may not use the recovery models that are common in the U.S. Individuals may need the assistance of a translator in health care/counseling situations so it helps to partner with health care providers with the same language background.
Planning Ahead and Providing Accommodations
When an individual self-identifies as a person in recovery, education abroad advisors should work in partnership with the individual, on-campus disability support services office, campus or community counselors, and/or others to identify and provide appropriate reasonable accommodations that take into consideration some of the tips below. This information can be integrated throughout pre-departure orientation activities and program materials to the benefit of all participants.
Provide information on laws, cultural attitudes and trends related to alcohol consumption, alcoholism and health care in the destination country, as well as disability-related laws:
- World Health Organization Global Status Report on Alcohol 2004 provides information on trends in adult per capita consumption as well as prevalence/drinking patterns data, information regarding traditional and/or locally brewed alcoholic beverages, unrecorded alcohol consumption, health and social problems, including morbidity and mortality from alcohol-related causes, and the social and economic costs of alcohol abuse, by country. Other WHO publications address alcohol and injury, alcohol use and sexual risk behavior, alcohol, gender and drinking problems, and more.
- Disability Rights Education and Defense Fund provides an index of disability laws in various countries
- The UK-based Institute of Alcohol Studies provides factsheets on a wide range of topics related to alcohol, including comparative data on alcohol consumption in EU countries
- International Center for Alcohol Policies has gathered information from over 100 countries around the world on the minimum ages to legally purchase and consume alcohol; this information is presented in a table which lists minimum legal purchase ages by beverage type (beer, wine and spirits)
Suggest that all participants complete a confidential online self-assessment that provides personalized feedback about an individual’s alcohol use. Examples include:
- E-CHUG is a confidential self-assessment tool designed to give students personalized feedback about their alcohol use. The assessment takes about 10 minutes to complete, is self-guided, and requires no face-to-face contact time with a counselor or administrator. E-CHUG is sponsored by Boynton Health Service and University Counseling and Consulting Services at the University of Minnesota.
- AlcoholScreening.org offers an online screening tool to assess drinking patterns. The website offers visitors free confidential online screenings to assess their drinking patterns, giving them personalized feedback and showing them if their alcohol consumption is likely to be within safe limits. AlcoholScreening.org was developed by Join Together, a project of the Boston University School of Public Health, and was launched in April 2001. The website also provides answers to frequently asked questions about alcohol and health consequences, and provides links to support resources and a database of local treatment programs.
Invite campus or community public health clinics and counseling centers to become involved in pre-departure orientation activities concerning counseling, medication, health, and stress reduction strategies. These professionals can also address the common misconception by some participants that being overseas will diminish physical, emotional, and psychiatric problems. Also, utilize The U.S. Department of Education’s Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention for assistance and training.
Work with overseas partners to identify and plan social activities and events that do not include or revolve around alcohol.
Review the Drug-Free Schools and Communities Act (DFSCA) with all participants as it is applicable to overseas programs, and provide participants with a copy of this information.
Assist individuals in locating online resources:
- Recovery Resources has links to publications and affiliate agencies and programs related to substance abuse and prevention.
- U.S. Department of Health and Human Services and SAMHSA's National Clearinghouse for Drug and Alcohol Information lists resources for alcohol prevention and treatment.
- Alcoholics Anonymous provides recovery information and publications, including on-line versions of the Big Book 4th Edition and Twelve Steps and Twelve Traditions, pamphlets aimed at young adults, links to International General Service Offices (GSOs), and more.
- Online Intergroup provides information about Alcoholics Anonymous, a calendar of local, regional, national and international AA events, a directory of online meetings in a variety of languages and online support from AA members, 24 hours a day, 7 days a week, for those who are experiencing a drinking problem.
- The Institute of Alcohol Studies provides online information about alcohol abuse prevention organizations throughout the United Kingdom.
Assist the individual to locate community groups in the destination country so that he/she can become involved in community service. Many volunteer groups are dedicated to alcohol education and prevention – contact the National Clearinghouse on Disability and Exchange for information on international volunteer opportunities.
Assist the individual in locating counselors in the destination country for one-on-one counseling or group session counseling. The American Psychological Association’s International Affairs Office maintains an online directory of international psychology associations.
Advise the student on how to transport any needed medications to the destination country.
For individuals with sponsors, make sure that the participant has access to email, telephone and/or Internet-based communication (e.g. Skype), text messaging and/or postal mail.
Design action plans for times of stress, homesickness, culture shock, and social and community events that involve alcohol.
Stress relief strategies for all participants may include:Exercise
Eat a healthy diet
Stay organized by making lists, prioritizing tasks and planning your day
Give yourself plenty of time to get to activities or to complete work or studies
Talk to friends, family or a professional about anxieties, problems or fears
Listen to music or relaxation tapes
Tense and relax muscles
Take frequent breaks
Learn to say 'no'
Be flexible
Rely on humor to relieve tension
Reduce or eliminate caffeine
Get massages
Get enough sleep
Practice breathing techniques
Soak in a hot bath
Meditate or pray
Do volunteer work
Keep a journal
Provide Suggestions for Turning Down Alcohol
- Individual says 'no thanks' with no explanation
- Individual says he/she is unable to drink alcohol due to the medications he/she is taking
- Individual states that he/she is allergic to alcohol
- Individual brings or fills a cup with a substance that can be mistaken for the alcoholic beverage (i.e. ginger ale for vodka)
For Study Abroad Programs:
Allow extra time for longer assignments
Allow the student to tape lectures
Have teachers do check-ins with the student
Use alternative methods of testing such as oral exams or allow the student to use noise reducing ear muffs or allow the student to test in a separate room
Allow frequent breaks
Make syllabi and class notes available to the student in advance
Assign a classmate as an assistant
Other Resources
Al-Anon Family Group Headquarters, Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454–5617
Phone: (757) 563–1600
Fax: (757) 563–1655
Email: WSO@al-anon.org
Al-Anon Family Group Headquarters, Inc. provides information and referrals to state and local Al-Anon support groups for adult friends and family members in an alcoholic person’s life. Al-Anon also provides referrals to Alateen groups, which offer support to young people whose lives have been affected by someone else’s drinking. The Al-Anon website includes a directory of Al-Anon information services in Canada, the United States, and Puerto Rico, which can provide up-to-date local meeting information. Individuals can also call 1-888-4AL-ANON (1-888-425-2666) Monday thru Friday, 8 am – 6 pm ET, for meeting information in Canada and the US.
International Al-Anon: Al-Anon/Alateen meetings are held in 115 countries. There are over 24,000 Al-Anon and over 2,300 Alateen groups worldwide which can be located via an online directory of Al-Anon information services/intergroups around the world.
Alcoholics Anonymous (AA) World Services, Inc.
475 Riverside Drive, 11th Floor
New York, NY 10115
Phone: (212) 870–3400
Fax: (212) 870–3003
Email: via AA’s website
Alcoholics Anonymous makes referrals to local AA groups and provides recovery information and publications, including the Big Book 4th Edition and Twelve Steps and Twelve Traditions. In the U.S. and Canada, look for "Alcoholics Anonymous" in any telephone directory for local AA office contact information. In most urban areas, a Central AA office, or "Intergroup," staffed mainly by volunteer AAs, will be happy to answer your questions and/or put you in touch with those who can. The AA website also includes links to International General Service Offices (GSOs).
National Council on Alcoholism and Drug Dependence, Inc. (NCADD)
244 East 58th Street, 4th Floor
New York, NY 10022
Phone: (212) 269–7797
Fax: (212) 269–7510
Email: national@ncadd.org
HOPE LINE: (800) NCA–CALL (24-hour Affiliate referral)
The National Council on Alcoholism and Drug Dependence, Inc. (NCADD) provides education, information, and referral services to the public. It advocates prevention, intervention, and treatment through a nationwide network of Affiliates. In addition, NCADD operates a toll-free Hope Line (800-NCA-CALL) for information and referral and a National Intervention Network (800-654-HOPE) to educate and assist the families and friends of addicted persons.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
5635 Fishers Lane, MSC 9304
Bethesda, MD 20892–9304
Phone: (301) 443–3860 (Communications/Public Information)
Fax: (301) 480–1726
Email: niaaaweb-r@exchange.nih.gov
NIAAA provides leadership in the national effort to reduce alcohol-related problems by:
- Conducting and supporting research in a wide range of scientific areas including genetics, neuroscience, epidemiology, health risks and benefits of alcohol consumption, prevention, and treatment
- Coordinating and collaborating with other research institutes and Federal Programs on alcohol-related issues
- Collaborating with international, national, state, and local institutions, organizations, agencies, and programs engaged in alcohol-related work
- Translating and disseminating research findings to health care providers, researchers, policymakers, and the public
The NIAAA website includes online pamphlets, factsheets, posters and other easy-to-read materials for the public, including educators, on a wide range of alcohol-related topics, including materials specifically designed to address underage and college drinking.
The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention
Education Development Center, Inc.
55 Chapel Street
Newton, Massachusetts 02458-1060
Phone: (800) 676-1730 - TDD Relay Friendly, Dial 711
Fax: (617) 928-1537
Email: HigherEdCtr@edc.org
The Higher Education Center helps campuses and communities address problems of alcohol, other drugs, and violence by identifying effective strategies and programs based upon the best prevention science. The Center provides training, technical assistance, and publications for the higher education community.
Volume 3, Number 1, 2005 Edition Article: "Last Call for U.S. Students Studying Abroad? Continuing Concerns About Alcohol Use and Abuse During Study Abroad," by Joel Epstein
For Recovering Alcoholics with Other Disabilities - review other Disability Specific Tipsheets provided by the National Clearinghouse on Disability and Exchange.
Although efforts have been made to ensure accuracy, MIUSA/NCDE cannot be held liable for inaccuracy, misinterpretation or complaints arising from these listings. Mention of an organization, company, service or resource should not be construed as an endorsement by MIUSA/NCDE. Please advise NCDE of any inaccuracies you may find.
