(58) Denied at the Door: Accessibility of Substance Use Treatment Facilities

Background & Introduction: People living with spinal cord injury (SCI) face elevated risk of substance use disorder (SUD) yet often encounter barriers when seeking appropriate treatment. While disability rights laws and clinical standards support equal access to care, the real-world accessibility of residential SUD treatment programs for wheelchair users remains unclear. Prior research suggests treatment facilities may deny admission to individuals with physical disabilities at high rates, but contemporary, multi-state evidence on admission outcomes and reasons for denial is limited. This study evaluates both physical and programmatic accessibility of residential SUD treatment programs for a medically stable wheelchair-using individual with SCI, with attention to denial frequency, facility-reported barriers, and geographic variation across Western states.

Methods: We conducted an audit (“secret shopper”) study in which trained investigators posed as a family member of a medically stable 25-year-old man with SCI who uses a wheelchair and sought admission for residential treatment for alcohol use disorder. Residential SUD treatment programs were identified using the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator across 11 Western U.S. states (AZ, CA, CO, ID, MT, NV, NM, OR, UT, WA, WY). Investigators placed up to three calls per program between August 1, 2025 and January 22, 2026. Programs were classified as accepting admission, denying admission, or providing an indeterminate response. For programs accepting admission, wheelchair accessibility was assessed by facility report; reasons for denial were documented. Data were recorded in REDCap and summarized using descriptive statistics overall and by state.

Results: Investigators contacted 391 residential SUD treatment programs; 224 responded (57.3% response rate). Among responding programs, 95 accepted admission (42.4%), 105 denied admission (46.9%), and 24 provided an indeterminate response (10.7%). In other words, nearly one in two responding programs declined admission for a medically stable wheelchair-using person with SCI seeking residential SUD care.
Among programs that accepted admission (n=95), 89 reported wheelchair-accessible facilities (93.7%). Among programs that denied admission (n=105), the most common facility-reported barrier was lack of wheelchair accessibility (n=60; 57.1%). Additional reasons included clinical “mismatch” (n=38; 36.2%) and other reasons (n=28; 26.7%); categories were not mutually exclusive because some programs cited multiple barriers. Admission acceptance varied markedly by state, ranging from 11% in Montana to 78% in Nevada, indicating substantial geographic variability in access to residential SUD treatment for wheelchair users.

Conclusion & Discussion: In this multi-state audit of residential SUD treatment programs, fewer than half of responding programs were willing or able to admit a wheelchair-using patient with SCI. Denials were common and frequently attributed to physical inaccessibility and program-level exclusion, highlighting persistent gaps in treatment readiness despite longstanding accessibility expectations. These barriers have critical clinical implications: inability to access timely residential treatment may contribute to worsening medical and psychiatric comorbidities, higher risk of hospitalization, and preventable secondary complications among individuals with SCI. Limitations include reliance on facility self-report, potential nonresponse bias, and restriction to programs listed in the SAMHSA locator in Western states. Findings support the need for stronger accessibility enforcement, program-level adaptations, and expanded equitable access to residential SUD treatment for people living with SCI.

References: Bombardier, C. H., Azuero, C. B., Fann, J. R., Kautz, D. D., Richards, J. S., & Sabharwal, S. (2021). Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Topics in spinal cord injury rehabilitation, 27(2), 152–224. https://doi.org/10.46292/sci2702-152
Graupensperger, S., Corey, J. J., Turrisi, R. J., & Evans, M. B. (2019). Individuals with spinal cord injury have greater odds of substance use disorders than non-sci comparisons. Drug and alcohol dependence, 205, 107608. https://doi.org/10.1016/j.drugalcdep.2019.107608
West S. L. (2007). The accessibility of substance abuse treatment facilities in the United States for persons with disabilities. Journal of substance abuse treatment, 33(1), 1–5. https://doi.org/10.1016/j.jsat.2006.11.001