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Special Populations


Special Populations have Special Needs and Unique Obstacles to Treatment

Special populations are defined as groups whose needs may not be fully addressed by traditional addiction service providers. These include certain segments of our society based on age, ethnicity, gender, and geography.

Certain biological, psychological, and social factors can put any individual, regardless of age, gender, or ethnicity, at risk for addiction. These ‘at-risk’ populations have special challenges that can complicate treatment efforts.

Special populations can also by defined groups who feel they may not comfortably or safely access and use the standard resources offered in typical addiction prevention and treatment. Groups that fit into this category are typically employed in certain occupations such as armed forces, law enforcement, law, and medicine.

The Rationale for Customized Treatment for Special Populations

Treatment programming has been designed for special populations, which assumes that by recognizing shared characteristics attracting, motivating and retaining clients in treatment may be facilitated. However, little scientific research is available to prove that outcomes from programs designed for special populations are any better than their generic counterparts ¹.

(1) Source: Best Practices: Substance Abuse Treatment and Rehabilitation (1998) pg. 35, Gary Roberts, Alan Ogborne, Health Canada.


Special Populations have Structural and Functional Characteristics

Special populations in this article are grouped according to the method used by the Institute of Medicine which distinguishes between structural and functional characteristics ¹.

(1) Source: Broadening the Base of Treatment for Alcohol Problems (1990) Institute of Medicine, National Academy of Sciences.


Structural characteristics are those that define a population by a fixed characteristic (i.e. gender, race, or ethnicity) or a developmental characteristic (age).

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A. Age-Related Special Populations

A.1. adolescents – may develop problems with drugs and alcohol during their formative years between 12 and 18 years of age. However, there are specific groups of youth who are at higher risk for substance abuse and dependence. Those deemed at-risk include (1) runaway and street-involved youth ¹, (2) youth in the juvenile system ², (3) youth with a co-existing mental illness or learning disorder ³, (4) sexually-abused and exploited youth 4, (5) gay, lesbian, bisexual and questioning teens 5, and certain ethnic minorities (aboriginal, black, hispanic 6). Children of alcoholics or problematic drug users are also considered an at-risk youth population.

These various adolescent risk factors can be mutually reinforcing. For example, gay & lesbian youth are more like to experience violence which, in turn, can result in that youth becoming a runaway. These clusters of risk factors contribute to the development of substance abuse and addiction.

(1) Source: Laye, A., Poon, C., Weigel, M., & the McCreary Centre Society. (2001). No place to call home: A profile of street youth in British Columbia. Burnaby, BC: The McCreary Centre Society.

(2) Source: Murphy, A., Chittenden, M., & the MCreary Centre Society (2005). Time Out II: a Profile of BC Youth in Custody. Vancouver, BC: The McCreary Centre Society.

(3) Source: Brady, K., & Sinha, R. (2005). Co-occurring mental & substace use disorders: The Neurobiological effects of chronic stress. American Journal of Psychiatry, 162, 1483-1493.

(4) Source: DeBellis, M.D. (2001) Developmental traumatology: the psychobiological development of maltreated children and its implication for research, treatment, and policy. Development and Psychopathology, 13, 539-564.

(5) Source: Lampinen, T.M., McGhee, D., & Martin, I.M. (2006). Increased risk of “club” drug use among gay and bisexual high school students in British Columbia. Journal of Adolescent Health, 38- 458-461.

(6) See Ethnic Groups section below.

Source: Substance Abuse in Canada: Youth in Focus (2007) Canadian Centre on Substance Abuse (CCSA), pp. 14-19.

A.2. adults (adult children of alcoholics) – are four to six times as likely as the general population to develop alcohol problems ¹.  Various family environment factors that contribute to this risk include alcohol-specific family influences (modeling of parental drinking behavior, development of alcohol expectancies, and the family’s ethnic background) and alcohol-nonspecific risk factors (parental behavior when not drinking, and the family’s socioeconomic status).

For more information see the Help for Families & Partners section.

(1) Source: Prevalence of alcoholism among children of alcoholics. (1990) M. Russell.In Windle, M., and Searles, J., eds. Children of Alcoholics: Critical Perspectives, pp. 9-38.

Source: The Role of Family Influences in Development and Risk (1997) Deborah A. Ellis, Robert A. Zucker, and Hiram E. Fitzgerald, Alcohol Health & Research World, Volume 21, Number 3.

A.3. seniors – and addiction has been called the ‘hidden epidemic’ as physicians typically fail to connect alcoholism or prescription drug addiction with the problems typically associated with aging such as isolation, boredom or the loss of a spouse. As many as 1 in 6 Americans age 60 or older are alcohol dependent and one-third of these are due to problems associated with aging (called “late-onset alcoholics”) ¹.

Diagnosing drug addiction is just as difficult, because older Americans usually don’t use street drugs, but rather abuse their prescription medications ².

Prescription drugs interactions with alcohol can have serious health risks for seniors. One in four hospital admissions of seniors are a direct result of medication problems, including prescription drugs interactions ³.

Refer to the Canada Drug Rehab website for a directory of addiction treatment programs for seniors.

(1) Source: Inebriated elders: The problem of substance abuse among the elderly (2001) S. Abrams, The Elder Law Journal 9, pp. 229–241

(2) Source: Addiction Among Seniors Called ‘Hidden Epidemic’ (July 2003) Join Together.

(3) Source: Prescription Drug Interactions Today’s Senior.

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B. Ethnocultural Specific Special Populations

Race- and ethnic-specific populations share common socioeconomic factors, such as high rates of poverty, racism, lack of access to proper health care, unemployment, boredom, and sexual abuse that tend to be mutually reinforcing and contribute to higher incidence of drug and alcohol addiction. Canada has seen its multi-ethnic population grow by about 4 million people over the last two decades, which makes up 41% of the total population (1). Particularly at risk are from Aboriginal populations and the fast-growing Chinese and South Asian populations. A study, published in the Journal of Clinical Psychiatry suggests, some of these communities “may be more reluctant to seek help due to shame and stigma as well as cultural differences in the recognition and conceptualization of mental illness” and health care. (2)
For information on Aboriginal addiction treatment programs, visit


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C. Gender-Specific Special Populations

C.1 women – are considered a special population due to the unique way substance abuse impacts them and what causes addiction in women. For example, women experience the first signs of medical complications (liver disorders, hypertension, obesity, ulcers, etc.) ¹ from alcohol much sooner than men. The same is true of tobacco and benzodiazepines ².  Furthermore, women who drink excessively can experience changes in the menstrual cycle, menopause, and fetal development (see Pregnant Mothers below) ³, higher incidence of mental illness compared to men 4, higher risk of suicide ³, and eating disorders 5.

As possible causes for addiction, women in treatment tend to have a high rate of sexual abuse 6 and are tend to have past episodes of physical violence 7.

Women face special challenges when getting help for drug and alcohol addiction such as greater resistance from family and friends and more negative consequences associated with treatment entry (lack of child care, job loss, and family responsibilities) 8.  These challenges may partially explain why women in Canada represented only 20 percent of clients in treatment even though they make up half of the population and account for 36 percent of individuals reporting alcohol-related problems 9.

(1) Source: Schliebner C.T. (1994) .”Gender-sensitive therapy: An alternative for women in substance abuse treatment,” Journal of Substance Abuse Treatment, 11, 6: 511 – 515.

(2) Source: Addiction Research Foundation (1996). The Hidden Majority: A Guidebook on Alcohol and Other Drug Issues for Counsellors Who Work with Women. Toronto: Addiction Research Foundation.

(3) Source: Finkelstein, N., Kennedy, C., Thomas, K., & Kerns, M. (1997) Gender-specific substance abuse treatment. For the National Women’s Resource Center for the Prevention and Treatment of Alcohol, Tobacco, and Other Drug Abuse, The Center for Substance Abuse Prevention.

(4) Source: Halzer & Pryabech as cited in Beckman, Linda (1994b). “Treatment needs of women with alcohol problems,” Alcohol Health and Research World, 18, 3: 206 – 211.

(5) Source: Peverler & Fairburn as cited in McCrady, Barbara S. and Helen Raytek (1993). “Women and substance abuse: Treatment modalities and outcomes,” In Women and Substance Abuse. E. S. L.

(6) Source: Young, Enid (1990). “The role of incest issues in relapse,” Journal of Psychoactive Drugs, 22, 2: 249 – 258.

(7) Source: Thom, Betsy (1986). “Sex differences in help-seeking for alcohol problems Part 1. The Barriers to help-seeking,” British Journal Addiction, 81: 777 – 788.

(8) Source: Lightfoot, L., Adrian, M., Leigh, G., Thompson, J. (1996) Substance Abuse Prevention and Treatment for Women: A Review of the Scientific Literature. In M. Adrian, C. Lundy, M. Ehany (eds.), Women’s Use of Alcohol, Tobacco and Other Drugs in Canada, Addiction Research Foundation (ARF).

(9) Source: Canadian Profile (1999) Canadian Center on Substance Abuse and Centre for Addiction and Mental Health.

Source: Best Practices: Treatment and Rehabilitation for Women with Substance Use Problems (1998) Health Canada.

C.2. men – unlike women, men are rarely considered a special population and few studies have been conducted on the unique aspects of men with addictions. Some have argued that male-specific treatment is not necessary since treatment has typically been developed with a male bias ¹.  However, research has long shown that men have a higher risk of abusive anger, substance abuse, risky behavior, suicide, and a great resistance to seek treatment ².

Recognizing the special needs of men, the American Psychological Association created the Society for the Psychological Study of Men and Masculinity (SPSMM) in 1995 to “promote the critical study of how gender shapes and constricts men’s lives … and endeavors to erode constraining definitions of masculinity which historically have inhibited men’s development, their capacity to form meaningful relationships, and have contributed to the oppression of other people” ³.

In one of the few books on men and addiction, Jefferson Singer chronicled the life stories of men with addictions and their resulting crises of identity, “If a man suffering from chronic addiction cannot answer the question ‘Who am I?’ by saying ‘I am a dutiful son, a loving partner, a responsible father, a skilled worker, a citizen of my community, a loyal friend, a member of my religious group,’ then a pervasive sense of meaninglessness sets in 4.”

Author Herb Goldberg, points out that, while women have benefited from the feminist movement, no such movement is in sight for men. Meanwhile, men struggle with the multiple roles of partner, father, and worker and struggle with an inner solitude that is evidenced by a lack of male friends compared to their female counterparts, (2) a reluctance to ask for help or show weakness, (3) an inability to express emotions, be playful or spontaneous, etc. 5. This emotional disconnect may partly explain why men resort to anger, violence and substance abuse more frequently than women.

(1) Source: Finkelstein, N., Kennedy, C., Thomas, K., & Kerns, M. (1997) Gender-specific substance abuse treatment. For the National Women’s Resource Center for the Prevention and Treatment of Alcohol, Tobacco, and Other Drug Abuse, The Center for Substance Abuse Prevention.

(2) Source: Men: A Different Depression (July 2005) American Psychological Association.

(3) Source: The Society for the Psychological Study of Men and Masculinity: Ten Years of History (2006) Frederic Rabinowitz, American Psychological Association.

(4) Source: Message in a Bottle: Stories of Men and Addiction (1997) Jefferson A. Singer.

(5) The Hazards of Being Male: Surviving the Myth of Masculine Privilege (1976) Herb Goldberg.


Functional characteristics are those social, clinical or legal conditions which are shared by a certain group (co-existing mental illness, being incarcerated, having a similar occupation, etc.).

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D. Occupation-Specific Special Populations

Occupation-specific populations are distinguished not by their struggle to secure addiction treatment since, typically, these occupations pay well with good benefit plans. What sets this group apart is the way risk factors or social status associated with their occupation contributes to problematic alcohol or drug use or their reluctance to seek help.

D.1. military

-active duty

Military personnel often use alcohol in an attempt to cope with stress, boredom, loneliness, and the lack of other recreational activities ¹. Furthermore, male and female military personnel have much higher rates of binge drinking than the civilian population. Researchers claim that “ritualized drinking,” operational stress and the macho culture contribute to excessive drinking. The prevalence of binge drinking is most noticeable with female service women where nine percent report severe alcohol problems compared to one percent of female civilians.  Military leadership is ambivalent to binge drinking because of time-honoured rituals that are considered critical to social cohesion among the ranks ².

Mental health problems, particularly post-traumatic stress disorder (PTSD), is higher in deployed armed forces than in the civilian population. With British, Canadian and American armed forces overstretched in both Afghanistan and Iraq, prolonged deployment with uncertain home return dates is leading to higher incidence of mental health problems and is placing a strain on families ³.

While most research on substance abuse in the military pertains to alcohol, drug use among military ranks is increasing and leading to further depletion of military personnel. The military has a zero-tolerance policy on drug use and conducts regular drug testing 4.

(1) Source: Alcohol Use and Preventing Alcohol-Related Problems Among Young Adults in the Military Genevieve Ames, Carol Cunradi, National Institute of Alcohol Abuse and Alcoholism.

(2) Source: Hazardous’ alcohol abuse in Armed Forces (May 2007) Richard Gray, UK Telegraph.

(3) Source: Overstretched Armed Forces Leading to Mental Health Problems  (August 2007) ScienceDaily.

(4) Source: Drug-taking troops provoke army crisis (March 2007) Lorna Martin, The UK Observer).


Researchers have found that the majority of military veterans tend to do well after leaving and are in full-time employment. However, those with mental health problems do not seem to improve after returning to civilian life and are more likely to end up socially excluded (e.g. homeless), unemployed, single, and more prone to violence ¹. Many veterans suffer from both addiction and post-traumatic stress disorder (PTSD). In fact, the 1988 National Vietnam Veterans Readjustment Study ² reported that almost 75% of male veterans with PTSD had a lifetime alcohol abuse/dependence disorder.

Veterans are more difficult to locate than active-duty service men and women for treatment. Also, getting treatment for veterans is less of a priority for the military and the veterans themselves do not share the risk of discharge that motivates active-duty service personnel to get help.

(1) What happens to British veterans when they leave the armed forces? (March 2005) Amy Iversen et al.  Kings Centre for Military Health Research, The European Journal of Public Health 15(2):175-184.

(2) Source: Kulka, R.A., Schlenger, W.E., Fairbank, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R. and Weiss, D.S. (1988). National Vietnam veterans readjustment study: Contractual report of findings, (pp. VI-33). North Carolina: Research Triangle Institute.

D.2. law enforcement – shares the same occupational stressors (PTSD) ¹ that contribute to addiction among the ranks of military service personnel. Like military personnel, police officers with emotional problems may not seek treatment for fear of being considered weak in a culture that prides itself on strength and authority. Shift work, similar to tours of duty, can strain relationships. Finally, police officers and military personnel both have constant access to firearms which researchers have found can lead to higher rates of suicide ².

It all adds up to a special population that is at-risk for divorce, alcoholism, other emotional and health problems ³ and if not treated, suicide 4.

(1) Source: Tarrier, N., & Gregg, L. (2004). Suicide risk in civilian PTSD patients-predictors of suicidal ideation, planning and attempts. Social Psychiatry and Psychiatric Epidemiology, 39(8), 655-661.

(2) Source: Miller, M., Azrael, D., & Hemenway, D. (2004). The epidemiology of case fatality rates for suicide in the Northeast. Annals of Emergency Medicine, 43(6), 723-730.

(3) Source: Ayres, R. M. (1990). Preventing law enforcement stress: The organization’s role. Washington, DC: Bureau of Justice Statistics.

(4) Source: Mohandie, K., & Hatcher, C. (1999). Suicide and violence risk in law enforcement: Practical guidelines for risk assessment, prevention, and intervention. Behavioral Sciences and the Law, 17(3), 357-376.

Source: Suicide Prevention Resource Center – Law Enforcement Personnel

D.3. lawyers – the high rate of alcohol and drug dependency among lawyers has often been explained by the narrow specialization, long hours, intense competition and other pressures on modern legal practice. Others assert that attorneys are often trapped in worlds that give them power, prestige, and affluence at the expense of personal satisfaction and creative fulfillment ¹.

High rates of alcoholism within the legal profession has motivated many bar associations across North America to establish lawyers assistance programs (LAPs) to help identify, educate and rehabilitate attorneys.

(1) Source: How Lawyers Lose Their Way: A Profession Fails Its Creative Minds (2005) Jean Stefancic, Richard Delgado.

Source: Drug and Alcohol Abuse & Addiction in the Legal Profession Legal Profession Assistance Conference.

D.4. medical professionals – In a 1972 study, noted alcoholism expert George Vaillant reported that doctors were more likely to experience problems with drugs and alcohol than the general population and believed that there is a “medical personality” ¹. This trait is commonly reflected in physicians seeking assistance for addiction and includes perfectionism, obsessive and rigid self-control, and a lack of healthy coping skills. Inevitably, this extreme dedication to their patients can result in problems at home and the problematic use of drugs and alcohol ². Physicians also have easy access to opioids, such as fentanyl, which are particularly addictive ³.

Physicians are often hesitant to reach out because of a fear of losing their medical license and like other at-risk occupations, may also fear the impact of their reputation that reporting an addiction would have among their peers and patients.

(1) Source:  Vaillant G, et al. Some psychologic vulnerabilities of physicians. NEJM 1972;287:372-375

(2) Source: Physician Substance Abuse and Addiction: Recognition, Intervention, and Recovery (October 2002) Michael Kaufmann, OMA Physician Health Program.

(3) Source: A study found that although only 5.6% of licensed physicians in Florida were anesthesiologists, they accounted for nearly 25% of reported substance abuse or dependence.  Journal of Addictive Diseases (2006) Vol. 25, No.1, pp. 15-21.

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E. Geography-Specific Special Populations

E.1. rural and frontier – are geographically isolated individuals who have limited access to addiction treatment resources such as mental health and drug abuse specialists, psychiatrists, psychologists, and social workers. Poverty, geographic isolation, and cultural differences further limit the amount and quality of mental health care and drug abuse prevention and treatment services available to individuals in rural and frontier areas.  This means that rural residents often enter care later in the course of their illness than their urban peers, enter care with more serious symptoms, and require more intensive and expensive treatment.  Primary care physicians are often the only providers of mental health and drug abuse services in rural communities, and many of them have not been trained and/or do not have the time to adequately treat these illnesses ¹.

According to SAMHSA’s 2005 National Survey on Drug Use and Health, adolescents in rural America are more likely than urban youth to binge drink. Methamphetamine and oxycodone are also a big problem.

(1) Source: Research on Rural Mental Health and Drug Abuse Disorders (July 2006) National Institutes of Health (NIH).

E.2. inner cities – The term “inner city” is typically used to describe a residential area where poverty and crime rates are higher than other parts of town. The term finds its roots in the mass exodus of many middle and high-income residents to the suburbs. The loss of taxes caused many inner city communities to fall into disrepair ¹.

Many are drawn to the inner cities in search of drugs. Fortunately, for many, they still have homes and families outside of the inner city. Others, however, are drawn to the inner cities and stay there. These are the at-risk populations described below such as injection drug users, dually diagnosed, the homeless and sex workers. Certain ethnic groups tend to be disproportionately represented in the inner city.

Various government and faith-based organizations tend to concentrate social services in these areas but multiple, mutually reinforcing biological, psychological and social risk factors present in those that live in the inner city tend to make rehabilitation difficult.

(1) Source: Inner City Wikipedia.

(2) Source: Aboriginal People in Manitoba 2000 (2000) Manitoba Aboriginal and Northern Affairs.

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An at-risk population is a population with a common identified risk factor or risk-exposure that poses a threat to health ¹. At-risk populations tend to have a higher incidence of the health threat than the general population. The risk factors included in this section are those that often lead to substance abuse with the exception of the sections on injection drug users (at risk for HIV/AIDS, hepatitis) and pregnant mothers (at risk for damage to the unborn fetus) are also discussed.

In keeping with the Biopsychosocial model of addiction, this section classifies risk factors based on biological, psychological, and social characteristics. These risk factors coexist and interact with one another.

Refer to the Canada Drug Rehab website for a directory of addiction treatment programs for pregnant mothers who drink alcohol (FASD),injection drug users (IDU),lesbian, gay, bisexual & transgender (GLBT),homeless, and

sex workers.

(1) Source: Definition of Population-Based Practice (March 2003) Minnesota Department of Health, Center for Public Health Nursing.

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F.1. Biological Risk Factors

F.1.1. pregnant mothers – who drink are creating a biological risk factor for their unborn child.  Known as Fetal Alcohol Syndrome Disorder (FASD), children who are diagnosed with this condition often can experience growth deficiencies, brain damage, facial abnormalities, skeletal abnormalities, heart defects, internal organ problems, vision and hearing problems, and learning and behavioral problems.

FASD includes Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). FAE is a milder form of FAS. FAE has fewer symptoms than a child who suffers from FAS. FAE does not normally result in abnormalities to appearance ¹.

Mothers who have other risk factors or belong to certain ethnic groups (such as black and aboriginals ²) have a disproportionate representation compared to the general population.

Fortunately, most governments recognize the economic and social consequences of children who develop FASD and take a variety of approaches to help mothers during and the unborn child during the gestation period and during the development stage that follows child birth.

Unborn children are also at risk when their mothers ingest other drugs such as crack cocaine. While the ‘crack baby’ epidemic of the 1980s has since been questioned ³, researchers have found that “newborns who were exposed to crack looked like normal babies but didn’t act like them. Cocaine-exposed infants were more jittery, had more muscle tension, and were harder to move because they were stiff.” The same study observed that crack babies also displayed patterns of both excitability and lethargy, appeared to be more stressed and failed to follow certain stimuli, such as a rattle or bell, compared to unexposed infants 4.

For a list of services in Canada visit the Pregnant Mothers Who Drink Alcohol Programs section in

(1) Source: Fetal Alcohol Spectrum Disorder (FASD) The Aboriginal Youth Network, Health Canada.

(2) Source: Alcohol and Minorities (January 1994) Alcohol Alert, National Institute on Alcohol Abuse and Alcoholism (NIAAA), No. 23, PH 347.

(3) Source: The Myth of the ‘Crack Babies’ (January 1992) Boston Sunday Globe, pg. 69.

(4) Source: Maternal exposure to crack cocaine produces stressed newborns Scott J. Turner, George Street Journal, Brown University.

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F.1.2. injection drug users

“Drug abuse behavior plays the single largest role in the spread of HIV Infection in the United States today” ¹

Injection drug users have long been targeted by public health initiatives because of the recognized vulnerability of this population to blood-borne illness such as HIV/AIDS and hepatitis B & C. Worldwide, roughly one-tenth of new HIV infections result from needle sharing 2 while in Canada the rate is closer to 20 percent 3.

Typically, injection drug users are a hard-to-reach population so harm reduction approaches are often used as an alternative to abstinence through addiction treatment, often considered by the addicted individual as unattainable or undesirable. Furthermore, a barrier to the use of treatment by injection drug

users is the fact that services often do not how to deal with the problem of addiction and HIV/AIDS together 4.

Many injection drug users in Canada have other risk factors and often live in inner city neighborhoods, are aboriginal, or spend time in prison settings 4.

Injection drug users typically use heroin, cocaine, or a combination of heroin and cocaine known as “speedballing” 5.

(1) Source: National Institute on Drug Abuse, March 2005.

(2) Source: 2006 Report on the global AIDS epidemic (2006) UNAIDS

(3) Source: Care, Treatment and Support for Injection Drug Users Living with HITS/AIDS (1997) Health Canada.

(4) Source: Best Practices: Substance Abuse Treatment and Rehabilitation (1999) Health Canada, pp. 47-49, Gary Roberts, Alan Ogborne.

(5) Source: Speedball Wikipedia.

F.1.3. chronic pain – Many individuals (though not all) with chronic pain conditions are often known as ‘accidental addicts’ ¹ because their progression to substance addiction is due to taking medications for the appropriate treatment of physiological pain rather than for the escape or mood-altering reasons found in the traditional addictive disorders. The medications used to treat chronic pain, however, are typically opiates such as OxyContin™ and Vicodin™, benzodiazepines, and muscle relaxants which, can lead to physical dependence, abuse, pseudo-addiction or even addiction. Individuals with chronic pain and co-existing addiction often share a similar physical dependence to drugs but can have a different psychological reaction.  Although people with chronic pain sometimes use their medications to help them relieve the psychological/emotional components of their pain; people with a straight addictive disorder are using their drugs for much different emotional reasons².

(1) Source: The Accidental Addict (1994) Di Porritt, Di Russell.

(2) Source: Managing Pain and Coexisting Disorders (2007) Stephen Grinstead.

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F.2. Psychological Risk Factors

-psychiatric disorders (dual diagnosis) – Individuals with co-existing addiction and mental illness are considered an at risk population. Persons with severe mental illness, such as schizophrenia and bipolar disorder, are particularly at risk for substance abuse ¹.

Those with co-occurring addiction and mental illness have also been found to have (1) higher relapse and hospitalization rates, (2) higher incidence of depression, suicide, and violence, (3) greater housing instability, (4) non-compliance with medications, (5) increased vulnerability to HIV/AIDS infection, and (6) higher service utilization costs ².

Some provinces (i.e. British Columbia ³) and states have integrated the administration and delivery of mental health and addiction services. Other provinces, however, continue to keep separate agencies for addiction and mental health 4.

(1) Source: Regier, D.A., Farmer, M.E., Rae, D.S., Lock-E, B.Z., Keith, S.J., Judd, L.L., Goodwin, F.K. (1990) Comorbidity of Mental Disorders with Alcohol and Other Drug Abuse. Journal of the American Medical Association, 264, 2511-2518.

(2) Source: Meuser, K.T., Drake, R.E., Miles, K.M. (1996) The Course and Treatment of Substance Use Disorder in Persons with Severe Mental Illness. In Treatment of Drug-Dependent Individuals with Comorbid Mental Disorders. National Institute of Drug Abuse Research Monograph Series #172.

(3) Source: Mental Health and Addictions Government of British Columbia.

(4) Note: the province of Alberta has Alberta Alcohol and Drug Abuse Commission (AADAC) for addiction and the Alberta Mental Health Board (AMHB) for mental health.

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F.3. Social Risk Factors

F.3.1. homeless – are considered a special population more than just because they lack housing. A cluster of issues make this population at high-risk for addiction including chronic medical conditions, physical disability, criminality and patterns of social isolation. Limited housing resources, unemployment, and deinstitutionalization of the mentally ill have also been attributed to homelessness ¹. Alcohol and drug abuse is considered the most prevalent health condition among today’s homeless ² with some research indicating that at least 10 percent of America’s homeless have current drug problems and an additional 40 percent have current alcohol problems ³.

Many homeless shelters do not admit people judged to be intoxicated 4.

In two separate studies in Canada, 61% of homeless adults reported suicidal thoughts and 34% reported a suicide attempt during their lifetime 5, while 46% of youth reported having attempted suicide at least once 6.

(1) Source: Research on the Homeless with Alcohol Problems (May 1992) National Institute of Mental Health.

(2) Source: Delivering Health Care to the Homeless (May 2003) Inner City Health Project, Ottawa.

(3) Source: Alcohol and Drug Abuse and Mental Health Problems Among Homeless Persons: A Review of the Literature, 1980-1990 (1991) Pamela J. Fischer, National Institute of Mental Health.

(4) Source: How Should Shelters Respond to Alcohol-Related Violence? (1987) Julie Thompson, Alcohol Health and Research World, pp. 60-61.

(5) Source: The association between homelessness and suicidal ideation and behaviors: Results of a cross-sectional survey (2002) Suicide and Life-Threatening Behavior,

32(4), 418-427, Eynan, R., Langley, J., Tolomiczenko, G., Rhodes, A. E., Links, P., Wasylenki, D., & Goering, P.

(6) Source: The walls were closing in, and we were trapped:A qualitative analysis of street youth suicide (2004) Youth & Society, Kidd, S.A., 36(1), 30-55.

F.3.2. Sex Workers – are considered a special population due to the high prevalence homicide, suicide, drug- and alcohol-related problems, HIV infection and accidents – in that order ¹. Many turn to sex work to escape poverty, mental illness, homelessness and a history of childhood abuse. Drug abuse can be the start of problems at school or home, or it can develop after a life of sex work begins ².

A “two-tier” sex trade has been identified in Canada: “a licensed off-street trade, and a black market [on-street] trade.” The off-street trade is licensed and regulated and relatively safe from client abuse and police prosecution while the on-street sex workers battle both clients and police ³.

In a survey in Victoria, BC, by the advocacy group PEERS, of 57 street workers, eighty percent surveyed have experienced addiction with 50 percent reporting current addiction. Cocaine and heroin were the most common drugs of choice 4.

(1) Source: Mortality in a long-term open cohort of prostitute women (2004) American Journal of  Epidemiology, 59:778-85, Potterat JJ, Brewer DD, Muth SQ, Rothenberg RB, Woodhouse DE, Muth JB, et al.

(2) Source: Prostitution Laws: Health Risks and Hypocrisy (July 2004) Canadian Medical Association Journal, 171 (2).

(3) Source: Reconvening the federal committee on prostitution law reform (July 2004) John Lowman, Canadian Medical Association Journal, 171(2).

(4) Source: Survey reveals diversity of PEERS clients (2007) Prostitutes Empowerment Education and Resource Society.

F.3.3. gay, lesbian, bisexual, transgender (GLBT) – is considered at-risk for addiction because of higher prevalence of alcohol, tobacco, and other drug use than the general population, lower abstinence rates, higher rates of substance abuse problems, and a higher likelihood of heavy drinking later in life ¹.

The US-based Substance Abuse Mental Health Services Administration (SAMHSA) lists six substance abuse-specific risk factors for LGBT adolescents including a (1) sense of self as worthless or bad, (2) lack of connectedness to supportive adults and peers, (3) lack of alternative ways to view “differentness,” (4) lack of access to role models, (5) lack of opportunities to socialize with other gays/lesbians except bars, and (6) the risk of contracting HIV ².

(1) Source: Alcohol, Tobacco & Other Drug Problems & Lesbian, Gay, Bisexual, Transgender (LGBT) Individuals (July 2002) National Association of Lesbian and Gay Addiction Professionals (NALGAP).

(2) Source: Preventing Alcohol and Other Drug Problems in the Lesbian and Gay Community (1995) “Alive With Pleasure,” a SAMHSA/CSAP-funded conference.

F.3.4. offenders – Individuals incarcerated in jail or prison are considered at risk for drug abuse due to the high prevalence of drug use among offender populations. Upon admission to federal custody, federal offenders ¹ in Canada have a prevalence rate of 70 percent for having a substance abuse problem, with almost half (34 percent) admitting to injection drug use ².

Compared to the general population, offenders also have a high incidence of blood-borne infections such as HIV/AIDS and hepatitis C. In an Ontario study, injection drug use was the most important risk factor for HIV and hepatic C virus infections where the rate of HIV infection was 11 times higher among adult offenders and with hepatitis C infection 22 times higher than the general population 4. Currently, needle exchange programs are not available in correctional institutions in Canada, despite the high rates of injection drug use, HIV/AIDS, and hepatitis C ³.

Offenders are also at risk due to the high potential for violence associated with trafficking. Gangs and organized crime groups are on the rise in communities across Canada and also within prison populations ². Drug offenders comprise about one quarter of the total offender population ³.

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For information on driving under the influence (DUI) offenders, see the Alcohol Consumption section in Harm Reduction.

(1) Note: federal offenders in Canada serve 2 or more years in federal penitentiaries while those under provincial/territorial jurisdiction serve less than two years.

(2) Source: Drugs in federal corrections – The issues and challenges (January 2001) Fraser McVie, Correctional Service of Canada, Forum on Corrections Resarch, Focusing on Alcohol and Drugs, Volume 13, Number 3.

(3) Source: Offenders Overview Canadian Centre on Substance Abuse (CCSA).

(4) Source: The Risk to Public Health From Injection Drug Use Among Prison Inmates (August 2007) Dr. Liviana Calzavara adapted from Prevalence of HIV and hepatitis C virus infections among inmates of Ontario remand facilities (July 2007) Canadian Medical Association Journal (CMAJ), 177(3), Liviana Calzavara, Nancy Ramuscak, Ann N. Burchell, Carol Swantee, Ted Myers, Peter Ford, Margaret Fearon, Sue Raymond.

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If you or someone you know fits one of the special population descriptions listed above please refer to the Specialized Client Group Rehab Programs section  in for a service provider in your community.



Printed Resources – General Information on Special Populations

Alcoholism & Substance Abuse in Special Populations (1989) is a guide to treatment and prevention for high-risk populations. Gary Lawson, Ann W. Lawson.

Diversity Issues in Substance Abuse Treatment and Research(2003) examines the development of policy with particular emphasis on special population communities. Concludes with guidelines for the integration of diversity considerations into treatment programs. Sana Loue.

Substance Abuse Prevention in Multicultural Communities(1998)researches innovative, community-based programs designed to increase knowledge of effective, substance abuse prevention strategies for high risk multicultural youth. Jeanette Valentine, Judith A. De Jong, Nancy J. Kennedy (Eds.).

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Printed Resources – Aboriginals as a Special Population

Addictions and Healing in Aboriginal Country(2003) establishes a framework for understanding the issues pertinent to Indigenous addictions to alcohol, drugs and gambling, and its aftermath in one community. Gregory Phillips, Australian Institute of Aboriginal Studies and Torres Strait Islander Studies.

Crazywater: Native Voices on Addiction and Recovery (1994) is the result of three years spent gathering and editing testimony from hundreds of native people in Canada and the United States. Tells the story about the impact of alcohol on native lives and cultures. Brian Maracle.

Dealing With Alcohol: Indigenous Usage in Australia, New Zealand, and Canada(1998) is described in the words of aboriginals themselves, and the authors draw on extensive fieldwork which document the health, economic, social and cultural consequences of misuse. Sherry Saggers, Dennis Gray.

Drinking and Sobriety among the Lakota Sioux (2006) introduces an indigenous model for treating alcohol abuse. Describes how treatments are ineffective when researchers, policy makers, and professionals do not use a tribal-specific approach to addiction. Beatrice Medicine.

Fighting Firewater Fictions: Moving Beyond the Disease Model of Alcoholism (2004) is for anybody working in, or seeking to understand, aboriginal communities that are experiencing problems with alcoholism. Richard Thatcher.

From Hunting to Drinking: The Devastating Effects of Alcohol on an Australian Aboriginal Community(2002) reveals the social change witnessed over a period of 30 years by an anthropologist on Mornington Island, off the North Queensland Coast, Australia. Documents the devastating effects that alcohol has had on this community. David McKnight.

Indigenous Australia and Alcohol Policy: Meeting Difference with Indifference (2004) give a unique perspective on approaches to problem drinking among Aboriginal people, the role that cultural difference has played. Maggie Brady.

Printed Resources – Chronic Pain Patients as a Special Population

The Accidental Addict (1994) is a “must have” book for anyone considering coming off their sleeping pills or tranquilizers or in the process of coming off. Di Porritt, Di Russell.

Addiction by Prescription: One Woman’s Triumph and Fight for Change (2001) Joan Gadsby.

Managing Pain and Coexisting Disorders (2007) Stephen Grinstead.

When PainKillers Become Dangerous: What Everyone Needs to Know About OxyContin and Other Prescription Drugs (2004) warns that painkilling drugs are extremely effective in relieving physical, emotional, and psychological distress but also extremely addictive. Drew Pinsky.

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Printed Resources – Gay, Lesbian, Bisexual, Transgender (GLBT) as a Special Population

Alcoholism & Homosexuality: Directions for Counseling and Therapy (1981) is devoted to theoretical, empirical, and historical research on homosexuality, heterosexuality, sexual identity, social sex roles, and the sexual relationship of both men and women. Thomas O. Ziebold, John E. Mongeon (Eds.).

Counseling Lesbian, Gay, Bisexual, and Transgender Substance Abusers: Dual Identities (2002) is a manual for counsellors who work with the LBGT population. Dana G. Finnegan, Emily B. McNally.

Alcoholism and Addiction in Homsexuals: Etiology, Prevalence & Treatment (December 1995) JD Y. Roy

Gay and Sober: Directions for Counseling and Therapy (1985) features leading professionals discussing new approaches showing measured success in treating gay and lesbian populations. Thomas O. Ziebold, John E. Mongeon.

Suicide Tuesday: Gay Men and the Crystal Meth Scare (2005) offers a critical look on the history of crystal meth, its alleged link to HIV transmission, the gay community’s response to the reported epidemic, as well as the media’s role. Duncan Osborne.

Tweakers: How Crystal Meth is Ravaging Gay America (2005) examines how crystal-meth abuse is reaching epidemic levels among gay men, and how almost one-third of the new cases of HIV are caused by the decreased mental capacity associated with crystal. Tweakers get a quick, cheap high, an exhilarating loss of inhibition and increased stamina at the price of permanent behavioral changes, brain damage and death. Frank Sanello.

Printed Resources – Hispanics as a Special Population

A Hispanic-Latino Family Approach to Substance Abuse Prevention(1998) examines issues of Hispanic/Latino family, culture, and society as they relate to the design and evaluation of alcohol and drug problem prevention programs. Jose Szapocznik (Ed.), Center for Substance Abuse Prevention (CSAP), Cultural Competence Series Volume 2.

Latinos and Alcohol Use/Abuse Revisited: Advances and Challenges for Prevention and Treatment Programs(2005) brings into sharp focus how present and future demographic shifts in the Latino population are being felt in alcohol problems across the United States. Includes case studies and in-depth research to clearly illustrate the practical steps various culturally competent programs recommend to effectively deal with alcohol use, prevention, and treatment for Latinos.Melvin Delgado.

Substance Abusing Latinos: Current Research on Epidemiology, Prevention, and Treatment(2005) presents the latest research on the epidemic of substance abuse now afflicting the Latino community. The research is used to focus on the latest advances of substance abuse prevention and treatment programs. Mario R. De La Rosa, Lori K. Holleran, Shulamith Lala Ashenberg Straussner (Eds.).

Printed Resources – Injection Drug Users as a Special Population

AIDS: Sexual Behavior and Intravenous Drug Use (1989) addresses the difficult health, social, and political issues that shapes attitudes and policies in the fight against AIDS. Charles F. Turner, Committee on AIDS Research.

HIV/AIDS and the Drug Culture: Shattered Lives (1998) looks at the lifestyle and culture of the HIV/AIDS intravenous drug user. Elizabeth Hagan, Joan Gormley.

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Printed Resources – Lawyers as a Special Population

How Lawyers Lose Their Way: A Profession Fails Its Creative Minds (2005) diagnoses the cause of the pervasive unhappiness among practicing lawyers. Jean Stefancic, Richard Delgado.

The Lawyer’s Myth (2001) offers thoughts towards a new vision of professionalism by examining how lawyers can develop more balanced lives and find a moral purpose for being a professional. Walter Bennett.


Printed Resources – Medical Professionals as a Special Population

Achievement and Addiction: A Guide to the Treatment of Professionals (1995) encompasses recent advances in the addiction treatment field and targets them to a population of high achievers. Edgar P. Nace.


Printed Resources – Men as a Special Population

I Don’t Want to Talk About It: Overcome the Secret Legacy of Male Depression (2000) discusses how men attempting to escape depression fuel many of the problems we think of as typically male – difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage. Terence Real.

Men’s Healing: A Toolbox for Life (2008) is a book written about male-only treatment for addiction and the unique needs of men with addictions. Alan Lyme, David J. Powell, Stephen Andrew.

Message in a Bottle: Stories of Men and Addiction (1997) shares the stories of alcoholics whom he helped treat, detailing how traditional treatments for addiction fail to meet the needs of men. Jefferson A. Singer.

Touchstones: A Book of Daily Meditations for Men (1986) begin with quotations from sources as varied as William Shakespeare, Wendell Berry, Michael Spinks, and Woody Allen and conclude with affirmations that underscore the lessons of intimacy, integrity, and spirituality. David Spohn.

Wisdom to Know: More Daily Meditations for Men(2005) serves as a practical and spiritual compass for men making their way along the often-tumultuous recovery journey. Hazelden Foundation.

Printed Resources – Military as a Special Population

Transcend: A Treatment Program for Veterans with Post-Traumatic Stress and Substance Abuse Disorders is comprised of educational, skill building, and psychotherapy process components. Includes a therapist manual and client workbook. Beverly Donovan, Edgardo Padin-Rivera, Richard A. McCormick.

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Printed Resources – Offenders as a Special Population

Arresting Addictions: Drug Education and Relapse Prevention in Corrections (2002) is a drug education and relapse prevention program for substance abuse specialists and counselors. Derived from the authors’ nearly 35 years of combined experience working with prison inmates in drug abuse treatment, this manual helps counselors introduce inmates to treatment, motivate them, and help them avoid relapse. Robert B. Alexander, George John Pratsinak.

Counselor’s Manual for Relapse Prevention with Chemically Dependent Criminal Offenders(1996) is intended for use by people who are interested in working with criminal offenders who are chemically dependent. Technical Assistance Publication (TAP) 19, Terence T. Gorski, John M. Kelley, DHHS Publication (SMA) 96-3115.

Partners in Change: The 12-Step Referral Handbook for Probation, Parole & Community Corrections (1996) enables parole officers to maximize the effectiveness of community support group referrals, overcome offender objections, and assess compliance and progress by educating corrections professionals in the foundation, organization, and substance of Twelve Step support groups.

Remaking Relapse Prevention with Sex Offenders: A Sourcebook (2000) provides clinicians with the most current, practical, usable information about working with sex offenders to prevent relapse of sexual behavior.  D. Richard Laws, Stephen M. Hudson, Tony Ward.

Substance Abuse Treatment with Correctional Clients: Practical Implications for Institutional and Community Settings (2005) provides key research findings and policy implications for treating alcohol- and drug-addicted correctional clients. Addresses a range of critical issues associated with delivering treatment in institutional and community settings. Barbara Sims.

Treating Addicted Offenders: A Continuum of Effective Practices (2007) details on how different jurisdictions are implementing innovative programs, which screening protocols are most effective, new findings on treatment readiness, therapeutic community programming, aftercare programs, etc. Kevin Knight, David Farabee, Civic Research Institute.

Treating Substance Abusers in Correctional Contexts: New Understandings, New Modalities (2003) analyzes the shift in policy and attitude away from two decades of the harsh punishment that characterized the war on drugs toward a more treatment-oriented “medicalization” of the problem. Nathaniel J. Pallone.

Printed Resources – Prostitutes as a Special Population

In My Skin: A Memoir(2007)tells the true story of one young woman’s descent into heroin addiction and prostitution, and the long arduous struggle to reclaim her life. Kate Holden.

Printed Resources – Rural and Frontier Residents as a Special Population

Rural Substance Abuse: State of Knowledge and Issues (1997)  Elizabeth B. Robertson (Ed.), National Institute on Drug Abuse (NIDA), Research Monograph 168, NIH Publication 97-4177.

Printed Resources – Seniors as a Special Population

Aging and Addiction: Helping Older Adults Overcome Alcohol or Medication Dependence(2002) provides a respectful, definitive guide for recognizing and addressing substance abuse among older adults. Carol Colleran, Debra Jay.

Alcohol and the Elderly: A Comprehensive Bibliography(1980) has more than 1,200 references related to alcohol consumption by the elderly, generally fifty-five years and above. Grace M. Barnes, Ernest L. Abel, Charles A.S. Ernst.

Alcohol Problems in Older Adults: Prevention and Management (2001) provides state-of-the-art, practical materials to detect, prevent, and intervene with older adults who are at-risk and problem drinkers. Kristen Lawton Barry, David W. Oslin, Frederic C. Blow.

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Printed Resources – Women as a Special Population

Best Practices: Treatment and Rehabilitation for Women with Substance Use Problems contains a selected bibliography of women-specific addiction information. Health Canada.

The Fight Within: A Story of Women in Recovery (2005) relays the human side of addiction and its consequences. Using narrative as a counseling tool, female clients collaborate with a group facilitator to process their own stories, which appear as a collection of writings. Norma Miller.

Goodbye Hangovers, Hello Life: Self-Help for Women(2003) the founder of Women for Sobriety explains the self-help system she devised to cure herself of alcoholism and discusses the special problems of the woman alcoholic. Jean Kirkpatrick.

The Handbook of Addiction Treatment for Women(2002) offers a historical context on the issue of women and addiction, examines the myriad challenges of the female addict, and includes recommendations for choosing a course of treatment. Shulamith Lala Ashenberg, Stephanie Brown.

Highs and Lows: Canadian Perspectives on Women and Substance Use (December 2007) Centre for Addiction Mental Health ISBN 978-0-88868-534-6.

A Place Called Self: Women, Sobriety, and Radical Transformation (2004) helps readers unravel painful truths and confusing feelings in their newfound sobriety. Stephanie Brown, Yvonne Pearson.

Recovering Women: Feminisms and the Representation of Addiction(2000) analyzes women’s addiction and recovery from a feminist perspective. Melissa Pearl Friedling.

Social and Behavioral Aspects of Female Alcoholism: An Annotated Bibliography (1980) includes 488 annotated references to journal articles about the social and behavioral aspects of female alcoholism divided into 9 subject categories. Paul H. Chalfant, Brent S. Roper.

Substance and Shadow: Women and Addiction in the United States (1999) Stephen R. Kandall

Substance Use Among Women: A Reference and Resource Guideis a compilation of theoretical, empirical, and clinical knowledge concerning key topics associated with substance use among women. Ann M. Pagliaro, Louis A. Pagliaro.

Substance Use Among Women in the United States (1997) Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA).

A Woman’s Spirit: More Meditations for Women(1994) is a collection of wise, compassionate daily meditations for women now living a sober life and seeking spiritual fulfillment. James Jennings, Karen Casey.

Women and Alcohol: Contemporary and Historical Perspectives (1997) records the widespread and persisting ambivalence or hostility in many cultures towards the relation of women with alcohol by reference to religious and social pressures, gender roles and stereotypes. Moira Plant.

A Woman’s Way through the Twelve Steps (2000) is a workbook designed to help a woman find her own path through the twelve steps. Stephanie S. Covington.

Women, Sex & Addiction: A search for love & power (1989) shows women how they can learn to experience their sexuality as a source of love and positive power and sex as an expression that honors the soul as well as the body. Charlotte David-Kasl.

Women Under the Influence (2006) documents the physical and emotional effects of substance abuse in girls and women and explores the role of advertising and entertainment industries in popularizing various substances of abuse. Joseph A. Califano.

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Online Resources – Aboriginals and Addiction Treatment

Aboriginal Alcohol & Drug Programs –

Online Resources – Aboriginals and Drug Policy

See the Drug Policy section.

Online Resources – Adolescents and Addiction Treatment


Best Practices: Treatment and Rehabilitation for Youth with Substance Use Problems (2001) identifies elements of best practice in the treatment and rehabilitation of youth with substance use problems. Health Canada. Cat. No. H49-154/2001E


See the School Drug Abuse section for youth prevention information.



Online Resources – General Information on Gay, Lesbian, Bisexual and Trans-Gender as a Special Population

National Association of Lesbian & Gay Addiction Professionals (NALGAP)

The Social Construction of a Gay Drug: Methamphetamine Use Among Gay and Bisexual Males in Los Angeles (1997) examines sexual and drug-related behaviors of gay/bisexual men who use methamphetamine as part of their sexual activities. Cathy J. Reback, City of Los Angeles, AIDS Coordinator. provides safer drug use information for people partying in Toronto’s gay nightclub and party scene. is a website for gay men who use crystal meth.

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Online Resources – Gay, Lesbian, Bisexual, and Trans-Gendered (GLBT) and Addiction Treatment

Asking the Right Questions 2: Talking with Clients About Sexual Orientation and Gender Identity in Mental Health, Counselling and Addiction Settings (2007) is a manual that will help therapists/counsellors create an environment where lesbian, gay, bisexual, transgendered, transsexual, two-spirit, intersex, and queer (LGBTTTIQ) clients feel comfortable indentifying themselves as such. Angela M. Barbara, Gloria Chaim, and Farzana Doctor, Center for Addiction and Mental Health, ISBN 978-0-88868-541-4.

Breaking the Grip: Treating Crystal Methamphetamine Addiction Among Gay & Bisexual Men (November 2006) is a study to provide guidance to healthcare providers, medical and public health institutions about how to best respond to treating gay men for methamphetamine dependence. Gay & Lesbian Medical Association.

Engaging Transgender Substance Users in Substance Use Treatment (November 2002) describes the Transgender Recovery Program, a residential substance use treatment program for male-to-female transgender women receiving substance use treatment and mental health services at San Francisco’s Walden House. Jean Oggins, The International Journal of Transgenderism, Volume 6, Number 2.

Getting Off: For Gay and Bisexual Male Methamphetamine Users(2005) Steven Shoptaw, Friends Research Institute.

Guidelines for Psychotherapy with Lesbian, Gay, & Bisexual Clients(2008) provides practitioners with (1) a frame of reference for the treatment of LGBT clients, and (2) basic information and further references in the areas of assessment, intervention, identity, relationships, and the education and training of psychologists. American Psychological Association.

LGTB Health Matters: An Education & Training Resource for Health and Social Service Sectors(January 2006) has been developed as a convenient and practical resource for educators of health and social services personnel. LGBT Health Matters.

Outpatient Management of Crystal Methamphetamine Dependence Among Gay and Bisexual Men: How Can it Be Done? (2006) Petros Levounis, Joseph S. Ruggiero, Primary Psychiatry.

A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals (2001) seeks to inform administrators and clinicians about appropriate diagnosis and treatment approaches that will help ensure the development or enhancement of effective lesbian, gay, bisexual, and transgender (LGBT) -sensitive programs. Center for Substance Abuse Treatment (CSAT), DHHS Publication No. SMA 01-3498.

Quick Guide: for Administrators (2007) is a companion guide to A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals. Center for Substance Abuse Treatment (CSAT).

Quick Guide: for Clinicians (2007) is a companion guide to A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals. Center for Substance Abuse Treatment (CSAT).

Online Resources – Homeless as a Special Population

Characteristics of Homeless Female Admissions to Substance Abuse Treatment: 2002 (October 2004) Drug and Alcohol Services Information System (DASIS). The DASIS Report. Substance Abuse and Mental Health Services Administration (SAMHSA).

Delivering Health Care to the Homeless (May 2003) Inner City Health Project, Ottawa.

Models and Practices in Service Integration and Coordination for Women who are Homeless or At-Risk of Homelessness: an Inventory of Initiatives (October 2003) is an inventory of promising models and practices in service integration and coordination for women who are homeless or at-risk of homelessness. Inner City Health Research Unit, St. Michael’s Hospital. Ontario Women’s Health Council.

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Online Resources – Injection Drug Users as a Special Population


Drugs, Alcohol and HIV/AIDS: A Consumer Guide(2006) is a 2-page color brochure that explains the increased risk of HIV transmission among people who abuse substances and stresses the importance of seeking treatment for both substance use and HIV/AIDS. DHHS Publication 07-4127.

Hepatitis C Virus (HCV) infection and illicit drug use (2005) is intended to provide a brief summary of key empirical facts on the various research, program and policy links between HCV and illicit drug use in Canada. Canadian Centre on Substance Abuse (CCSA).

HIV and Drug Abuse explains the link between drug abuse and the spread of HIV infection.

HIV/AIDS and Injection Drug Use: A National Action Plan (July 2001) is the report of the National Task Fore on HIV, AIDS and Injection Drug Use. Canadian Foundation for Drug Policy.

HIV/AIDS: Is Your Adult Client at Risk? Pocket Counseling Tool(2005) is a pocket tool with 24 questions and talking points that substance abuse treatment providers can review with their clients to determine if the client is engaging in HIV/AIDS risk behaviors. Substance Abuse and Mental Health Services Administration (SAMHSA). DHHS Publication 05-4003.

NIDA Research Report: HIV/AIDS (March 2006) highlights the scope of HIV/AIDS in the US, populations most affected, and how we can counter these trends. National Institute on Drug Abuse (NIDA). NIH Publication 06-5760.

Sex Differences in Injecting Practices and Hepatitis C: A Systematic Review of the Literature(July 2004) focuses on the influence of gender on an individual’s initiation, ongoing involvement, sharing behaviour, and cleaning/disinfecting behaviour in injection drug use by examining current literature available. Public Health Agency of Canada.

Online Resources – Law Enforcement as a Special Population

Nebraska State Patrol Mourns Troopers Death (September 2002) tells the story of a 12-year veteran police office who took his own life, leaving a wife and 7 children. Terence T. Gorski.

The Need for Police EAP Programs (September 2002) calls for more employee assistance programs for police officers who often suffer in silence in the name of keeping our streets safe. Terence T. Gorski.

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Online Resources – Men as a Special Population

Helping Yourself Heal: A Recovering Man’s Guide to Coping with Childhood Abuse Issues (2004)is to help male clients in addiction treatment become aware of the pervasiveness of childhood abuse and neglect among people with substance use disorders. Substance Abuse and Mental Health Services Administration (SAMHSA). DHHS Publication 07-4134.

Online Resources – Military as a Special Population

Healing Combat Trauma: Resources for and about combat trauma has a focus on effective medical, psychological and legal care. The slant is apolitical.

The Mental Health Self-Assessment Program is a series of questions designed for military families and service members to help them review their situation with regard to mental health and addiction. For American military only. Screening For Mental Health, Inc.

National Center for Posttraumatic Stress Disorder is part of the US Department of Veterans Affairs.

Resources for Returning Veterans and their Families Substance Abuse & Mental Health Services Administration (SAMHSA).

Seeking Safety and Transcend (Summer 1999) are two programs designed to treat veterans with co-existing PTSD and addiction. Clinical Quarterly, National Center for Post-Traumatic Stress Disorder, Vol. 8, Issue 3.

For additional research on US veterans see the Veterans section of the Office of Applied Studies website, Substance Abuse and Mental Health Services Administration (SAMHSA).

For additional information on co-existing trauma and addiction see the Trauma section in Dual Diagnosis.

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Online Resources – Offenders as a Special Population

Alcohol and Drug Treatment: How It Works, and How It Can Help You (2007) is a brochure that informs people involved in the criminal justice system and their families. DHHS Publication No. [SMA] 07-4292.

TIP 12: Combining Substance Abuse Treatment with Intermediate Sanctions for Adults in the Criminal Justice System (1994) addresses the use of intermediate sanctions with offenders whose crimes are related to their substance abuse. Robert G. Aukerman, Peggy McGarry, Substance Abuse and Mental Health Services Administration (SAMHSA).

Counselor’s Manual for Relapse Prevention with Chemically Dependent Criminal Offenders (TAP 19) (1996) is intended for use by people who are interested in working with criminal offenders who are chemically dependent. It focuses on chemical dependency and the criminal offender. Terence T. Gorski, John M. Kelley, Center for Substance Abuse Treatment. Technical Assistance Publication (TAP) Series 19. DHHS Publication No. (SMA) 96-3115.

Drug Use, HIV, and the Criminal Justice System (August 2001) discusses the issue of drug users in the criminal justice system. It explains the importance of this setting in reaching drug users with HIV prevention messages and interventions and looks at some of the challenges involved. Center for Disease Control.

Drug Users and the Structure of the Criminal Justice System (August 2001) reveals the number of injection and other drug users in the criminal justice system has skyrocketed in recent years. The corrections setting presents opportunities for many inmates to obtain education, testing, and treatment services. Center for Disease Control (CDC).

Helping Inmates Return to the Community (August 2001) discusses the great challenge of having newly released inmates avoid a return to drug use and crime. Corrections and communities are recommended to provide good transition services to help inmates return successfully to their communities.

Proportions of Crimes Associated with Alcohol and Other Drugs in Canada (April 2002) is a study aimed at estimating (1) the strength of the associations among different types of crimes and the use and abuse of psychoactive substances and (2) the share of crimes in Canada that can be attributed to the use and abuse of alcohol and drugs. Kai Pernanen, Marie-Marthe Cousineau, Serge Brochu, Canadian Centre on Substance Abuse (CCSA).

Substance Abuse in Corrections FAQs (2004) is intended to provide current, objective, and empirically-based information to guide the discussion on substance abuse in corrections in Canada. Canadian Centre on Substance Abuse (CCSA).

Substance Abuse Treatment for Drug Users in the Criminal Justice System(August 2001) documents that about 80 percent of inmates in correctional facilities have substance abuse problems. Substance abuse treatment in correctional institutions can help them. Many facilities provide treatment and education interventions, but significant gaps remain. Center for Disease Control (CDC).

TIP 30: Continuity of Offender Treatment for Substance Use Disorders from Institution to Community (1998) presents guidelines for ensuring continuity of care as offenders with substance use disorders from incarceration to the community. The guidelines are for treatment providers in prisons, jails, community corrections, and other institutions, as well as community providers. Gary Field, Substance Abuse and Mental Health Services Administration (SAMHSA).

For more information on injection drug use see the Harm Reduction section or the Heroin section.

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Online Resources – General Information on Pregnant Mothers as a Special Population

Alcohol, Other Drugs, and Pregnancy(2003) Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-2723-9.

Alcohol and Pregnancy: Preventing FASD(2003) Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-2716-6.

Alcohol and Your Pregnancy (2005) is a hand out that explains the risks of alchol and FASD. CDC

Drinking and Your Pregnancy (2006) National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIH Publication 96-4101.

Effects Series: Alcohol(2004) shows what happens when pregnant mothers drink. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3297-6.

Fetal Drug Effects covers not only alcohol’s effect on the unborn fetus but also cocaine, marijuana, tobacco, and opiates. Intoxicon International.

I’m Pregnant … Can I Take This? Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN

Questions and Answers: Alcohol, Other Drugs, Smoking, and Pregnancy(2003) Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-2719-0.

What is Fetal Alcohol Spectrum Disorder (FASD)? (2004) Alberta Alcohol and Drug Abuse Commission. ISBN 0-7732-0835-4.

Online Resources – Pregnant Mothers and Hallucinogens

Effects Series: Hallucinogens(2004) explains the effects of hallucinogens on the mother and the fetus during pregnancy and after birth. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3301-8.

For more information on hallucinogens see the Hallucinogens section.

Online Resources – Pregnant Mothers and Marijuana

Effects Series: Cannabis(2004) explains the effects of marijuana on the mother and the fetus during pregnancy and after birth. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3299-2.

For more information on cannabis see the Marijuana section.

Online Resources – Pregnant Mothers and Medical Consequences

Effects Series: Amphetamines(2004) explains the effects of amphetamines on the mother and the fetus during pregnancy and after birth. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3298-4.

For more information on amphetamines see the Crystal Meth section.

Effect Series: Cocaine(2004) explains the effects of cocaine on the mother and the fetus during pregnancy and after birth. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3300-X.

For more information on cocaine see the Cocaine section.

Online Resources – Pregnant Mothers as Offenders in Correctional Settings


Fetal Alcohol Syndrome in the Canadian Corrections System  (September 2003) reports few diagnosed cases of FAS and multiple unmet needs to screen, identify, and manage offenders with FAS. Larry Burd, Rachael H. Selfridge, Marilyn G. Klug, Tim Juelson,

Online Resources – Pregnant Mothers and their Partners


Information for Partners of Pregnant Women (2003) Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-2718-2.

Online Resources – Pregnant Mothers and Pain Killers


Effects Series: Opioids(2004) explains the effects of pain killers on the mother and the fetus during pregnancy and after birth. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3302-6.

For more information on pain killers see the Pain Killers section.

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Online Resources – Pregnant Mothers and Research


Alcoholism: Science Made Easy (2004) has a section specific to pregnancy, prenatal exposure, and parenting. Addiction Technology Transfer Center (ATTC).

Estimating the rate of FASD and FAS in Canada(2004) shows that 9 in every 1000 babies born in Canada have FASD. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3305-0.

For additional research on pregnant mothers see the Women and Substance Use section of the Office of Applied Studies website.

Online Resources – Pregnant Mothers and Tobacco


Effects Series: Tobacco(2004) explains the effects of tobacco on the mother and the fetus during pregnancy and after birth. Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-3303-4.

Smoking and Pregnancy (2003) Alberta Alcohol and Drug Abuse Commission (AADAC). ISBN 0-7785-2717-4.

Smoking and Pregnancy: A Survey of Knowledge, Attitudes, and Behaviour 1992-1999(1999) presents the main results from the latest survey commissioned by the HEA and also, where appropriate, makes references to developing trends. Lesley. A. Owen, Gemma L. Penn, Health Education Authority, UK. ISBN 0-7521-1770-X.

For more information on tobacco see the Tobacco section.

Online Resources – Pregnant Mothers and Treatment


Substance Use Treatment among Women of Childrearing Age (October 2007) shows statistics for women aged 18 to 49 who were admitted for addiction treatment. National Survey on Drug Use and Health. The NSDUH Report.

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Online Resources – General Information on Rural and Frontier Residents as a Special Population


The National Rural Alcohol and Drug Abuse Netwrok Awards for Excellence (2004) Technical Assistance Pubication (TAP) 20. Substance Abuse and Mental Health Services Administration (SAMHSA)  DHHS Publication 06-4183.

Rural and Remote Areas: Effective Approaches to Delivering Integrated Care for Drug Users (June 2005) provides information, evidence, and examples to support future development of relevant service provision for drug users in rural and remote areas. Scottish Executive Effective Interventions Unit.

Rural Substance Abuse: Overcoming Barriers to Prevention and Treatment (July/August 2007) SAMHSA News, Volume 15, Number 4.

Online Resources – Treatment of Rural and Frontier Populations as a Special Population


Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas (1995) Technical Assistance Publication (TAP) 17. Substance Abuse and Mental Health Services Administration (SAMHSA). DHHS Publication 95-3054.


Treating Opiate Dependence in Rural Communities: A Guide for Developing Community Resources (November 2003) is a guide for rural communities wishing to develop local treatment and recovery services for opiate dependent people. Northwest Frontier Addiction Technology Transfer Center Network (ATTC).

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Websites Specific to Seniors as a Special Population


Alcohol and Seniors

Online Resources – General Information on Seniors as a Special Population


The ABCs – Drugs and Seniors (July 2007) examines medication use by seniors. Alberta Alcohol and Drug Abuse Commission (AADAC).

Alcohol and Older People(2006) recommends moderation for adults aged 65 years and older. Educ’alcool.

As You Age … A Guide to Aging, Medicines, and Alcohol(May 2004) highlights information about medications and alcohol and how they affect the bodies of older adults. Center for Substance Abuse Treatment (CSAT) Publication no. PHD1082.

Information for Seniors (2005) is a hand-out informing seniors how alcohol can affect them. Clinical Tools, Inc.

Online Resources – Seniors and Addiction Prevention


A Guide for Developing a Substance Abuse Awareness Program for Older Adults (2006) is designed for providers and professionals working with seniors and is an introduction to substance abuse awareness for seniors. CentralEastAddictionTechnologyTransferCenter.

Online Resources – Seniors and Addiction Screening


Alcohol Use Among Older Adults Pocket Screening Instruments (2001) contains facts about the use of alcohol by older adults for use by health service professionals. Substance Abuse and Mental Health Services Administration (SAMHSA) DHHS Publication No. 02-3621.

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Online Resources – Seniors and Addiction Treatment


Best Practices: Treatment and Rehabilitation for Seniors with Substance Use Problems (2002) identifies best practices in treatment and rehabilitation for seniors with substance use problems. It includes issues related to the accessibility and provision of services. Health Canada. Cat. H46-2/03/295E.


Older Adults in Substance Abuse Treatment: 2005 (November 2007) shows a growing number of seniors entering drug treatment. Drug and Alcohol Services Information System (DASIS).

Responding to Older Adults with Substance Use, Mental Health and Gambling Challenges(2006) is a guide for workers and volunteers. Centre for Addiction and Mental Health (CAMH).


Substance Abuse Relapse Prevention for Older Adults: A Group Treatment Approach (2005) presents a relapse-prevention approach that uses the cognitive-behavioral and self-management intervention in a counselor-led group treatment setting to help older adults overcome substance use disorders. Designed for counselors. Substance Abuse and Mental Health Services Administration (SAMHSA). DHHS Publication 05-4053.

Online Resources – Seniors and Prescription Drugs


Aging, Medicine and Alcohol (2001) contains information for seniors on alcohol use and medication-related problems and steps older adults can take to avoid problems resulting from mixing medications and alcohol. Substance Abuse and Mental Health Services Administration (SAMHSA). DHHS Publication 02-3619.


Medication Matters: How you can help seniors use medication safelyis designed to help health professionals give seniors the information they need to use medication safely. Health Canada.


Medication Use Safety Training for Seniors (MUST) program is designed as an interactive initiative to promote safe and appropriate medicine use by enabling older adults to avoid medication misuse, recognize and manage common side effects, and improving medicine use knowledge.

Substance Abuse in Older Adults (2005) is designed to help professionals working with older adults recognize substance use disorders. Three one-hour modules cover topics such as prevention, assessment, diagnosing substance abuse and treatment options. Mid-Atlantic ATTC.

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Websites Specific to Women

BC Centre of Excellence for Women’s Health

Women for Sobriety, Inc.

Online Resources – General Information on Women as a Special Population


Girls, Women and Substance Use (2005) summarizes the ways in which substance use and addiction differ for girls and women, and the implications of those differences for policy, research, systems, and services. Canadian Centre on Substance Abuse (CCSA), BC Centre of Excellence for Women’s Health.


Women’s Addiction and Treatment Through a Historical Lens(2002) examines the history of women’s use and abuse of alcohol and other drugs and points out how women’s substance abuse treatment in the US has been affected by gender and racial bias, economic factors, and ignorance by treatment providers. Shulamith Lala Ashenberg Straussner and Patricia Rose Attia. Chapter 1 in The Handbook of Addiction Treatment for Women.


Women and Alcohol (2007) Centre for Addiction and Mental Health. ISBN 978-0-88868-578-0.

Online Resources – Women as Offenders

Women, Injection Drug Use, and the Criminal Justice System (August 2001) shows that women inmates have consistently higher rates of drug use and HIV infection than do male inmates. The needs and circumstances of women in prison and jail require increased emphasis and tailored interventions. Center for Disease Control (CDC).

Online Resources – Women and Treatment

Best Practices: Early Intervention, Outreach and Community Linkages for Women with Substance Use Problems (2006) presents best practice guidelines related to early intervention, outreach and community linkages for women with substance use problems. Health Canada. Cat. H128-1/06/460E

Counseling the Female Alcoholic: Examining Motivational Techniques within the Therapeutic Relationship ( ) helps clinicians help their clients through the difficult and painful process of confronting their alcoholism. Describes ways of building trust, rapport and compassion between the counselor and the female clients. Judith Goodman.


Summary Report – Workshop on Best Practices: Treatment and Rehabilitation for Women with Substance Use Problems (2003) highlights the finding of a national workshop of professionals working with women with substance use problems held in Ottawa June 6 and 7, 2002. Cat. H46-2/03-316E.


Helping Yourself Heal (Women’s Guide) (2003) is for use in addiction treatment settings. It helps female clients become aware of the pervasiveness of childhood abuse and neglect among people with substance use disorders. Substance Abuse and Mental Health Services Administration (SAMHSA). DHHS Publication No. 03-3789.

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Video Resources – Injection Drug Users as a Special Population

HIV/AIDS among Injection Drug Users is a discussion on prevention interventions to reduce incidents of HIV and Viral Hepatitis among injection drug users. Stephanie Strathdee, University of California Television.

Injection Drug Use and HIV Prevention Phil Johnson, Carle Clinic.

Video Resources – Pregnant Mothers as a Special Population

Recovering Hope – Mothers Speak out about Fetal Alcohol Spectrum Disorders (April 2006) presents eight women telling their own story about how alcohol use in pregnancy affected their children. Substance Abuse and Mental Health Services Administration (SAMHSA). DVD249.

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