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Center for Substance Abuse Treatment. Substance Use Disorder Treatment For People With Physical and Cognitive Disabilities. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1998. (Treatment Improvement Protocol (TIP) Series, No. 29.)

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Appendix D—Alcohol and Drug Programs and The Americans With Disabilities Act

by Bill Bruckman, Victoria Thornton Bruckner, and Christine Calabrese

This appendix reproduces in full the compliance guide published by Pacific Research and Training Alliance and has been reprinted with the permission of the authors and publisher.

The Alcohol, Drug, and Disability Technical Assistance Project

Pacific Research and Training Alliance's Alcohol and Drug and Disability Technical Assistance Project is one of ten projects funded by the California Department of Alcohol and Drug Programs (ADP) for underserved populations. The Project provides assistance statewide to programs and communities that will have long lasting impact and permanently improve the quality of alcohol and other drug services available to individuals with disabilities.

Pacific Research and Training Alliance (PRTA) was founded in 1990. PRTA promotes community-driven approaches to eliminate social barriers so that every person has the opportunity to participate fully in society. Other PRTA Projects include the Lesbian, Gay, Bisexual, and Transgender Technical Assistance Project, also funded by California ADP, and Living Out Loud, a substance abuse prevention project for at-risk girls, funded by the federal Center on Substance Abuse Prevention.

440 Grand Avenue, Suite 401, Oakland, CA 94610-5085Voice: (510) 465-0547 * TDD (510) 465-2888 * FAX (510) 465-0505_ Copyright 1996, Pacific Research and Training Alliance

This document is largely based upon the United States Department of Justice ADA Technical Assistance Manual, a compliance guide for generic public accommodations. Other public documents quoted in this publication are the U.S. Department of Justice ADA Handbook and ADA Title III Fact Sheet. Publications developed by the Resource Center on Substance Abuse Prevention and Disability in Washington, D.C., are also quoted herein. Individuals who contributed to the development of this publication include Nancy Ferreyra of Pacific Research and Training Alliance, David Abramson of the Alameda County Department of Behavioral Care Alcohol and Drug Division, and Guy Thomas of the Berkeley Center for Independent Living.

The requirements of the ADA are subject to various and possibly contradictory interpretations. The editors, therefore, used their reasonable professional efforts and judgments to interpret the Act and official U.S. Department of Justice technical assistance documents as they apply to alcohol and drug programs. The contents of this publication are presented with no warranty either expressed or implied, and Pacific Research and Training Alliance and the editors assume no legal responsibility for the information contained herein. Neither is liability assumed for the outcome of decisions, contracts, commitments or obligations made on the basis of this publication. All alcohol and drug program names used in this document are fictitious--any resemblance to actual alcohol and drug program names is purely coincidental.


Who This Publication Is For and Why It Has Been Written

This guide is written for owners, administrators, and staff of private alcohol and drug treatment programs. Private alcohol and drug treatment programs are any programs which are not directly operated by government agencies (i.e. ADP, county or city governments). They include both non-profit and for-profit programs. They also include programs that contract and receive funds from ADP or local governments.

The purpose of this manual is to help you understand the process of coming into compliance with The Americans With Disabilities Act so that your program can become accessible to persons with disabilities.

What Is the ADA?

The Americans With Disabilities Act of 1990 is the first federal law initiated and championed by persons with disabilities. Unlike prior laws and regulations, the ADA puts the onus of accommodation on society rather than the individual with a disability.

The ADA guarantees equal opportunity for individuals with disabilities in public and private sector services and in employment. It is a comprehensive anti-discrimination law which extends to virtually all sectors of society and every aspect of daily living. The ADA is a federal civil rights act which provides the same basic civil rights protections to persons with disabilities as afforded all other Americans.

The ADA is organized into five titles.

  • Title I: Employment--Employers with 15 or more employees must ensure that their employment practices do not discriminate against qualified people with disabilities. (In California, this applies to employers who have 5 or more employees.) Title I provides protection for job applicants and employees during all phases of employment, including the application process, interviewing, hiring, employment itself, and discharge from employment. Employers must also reasonably accommodate the disabilities of qualified applicants and employees, unless an undue hardship would result.
  • Title II: State and local government services--Requires that public programs and services be made accessible to persons with disabilities. Mandates nondiscrimination on the basis of disability in policy, practice and procedure. Prescribes a self-evaluation process, and requires that architectural and communications barriers be removed to the extent required to provide full access to program services.
  • Title III: Public accommodations--Title III requires places of public accommodation to be accessible to, and usable by, people with disabilities. Places of public accommodation are all private businesses and privately owned and operated programs that offer goods and services to the general public. Title III entities must not discriminate by excluding people with disabilities, treating them separately, or requiring them to participate in separate programs. Reasonable modifications must be made to policies, practices, and procedures so that people with disabilities may participate. Auxiliary aids and services that ensure effective communication with people with disabilities must also be provided so long as they do not create an undue burden or fundamentally alter the services that the program offers.
  • New construction must be barrier free. In existing buildings, architectural barriers to disability access must be removed when it is readily achievable. "Readily achievable" means "easily accomplishable and able to be carried out without much difficulty or expense." Programs must review possible readily achievable barrier removal on an ongoing basis, typically annually or with each new program budget.
  • Title IV: Telecommunications--Title IV has mandated the establishment of a national network of telecommunication relay services that is accessible to people who have hearing and speech disabilities. It also requires captioning of all federally funded television public service announcements.
  • Title V: Nonretaliation, and other provisions--Title V explicitly prohibits retaliation against people exercising their rights under the ADA. It sets forth specific responsibilities for the adoption of enforcement regulations by federal agencies. It also includes a number of miscellaneous provisions.

The ADA includes a set of architectural standards called the Americans With Disabilities Act Accessibility Guidelines (ADAAG). All Title II and Title III entities must comply with ADAAG requirements for new construction and alteration building projects. In California, public and private building projects must also comply with state accessibility regulations (Title 24). Title 24 has recently been revised to incorporate specifications found in the ADAAG. The Equal Employment Opportunity Commission and the U.S. Department of Justice have been designated as the lead ADA enforcement agencies. The Architectural and Transportation Barriers Compliance Board develops accessibility guidelines (architectural standards) for enforcement of the Act.

Who Is an Individual With a Disability?

The ADA has established the following definition of disability:

An individual with a disability is a person who has a physical or mental impairment that substantially limits one or more "major life activities," has a record of such an impairment, or is regarded as having such an impairment. 1

Major life activities are essential functions such as personal care tasks, manual tasks, walking, seeing, hearing, speaking, breathing, thinking, learning, and working.

In 1990, 43 million persons living in the United States were counted as eligible for protection under the ADA. 2 Still more Americans will become either temporarily or permanently disabled during their lifetimes and will claim their rights under the Act. It has been estimated that today, nearly 17 percent of the populace of California has a disability as defined by the ADA.

Of special importance to privately operated drug treatment programs is the following excerpt from the Department of Justice ADA Title III Technical Assistance Manual:

Title III prohibits discrimination against drug addicts based solely on the fact that they previously illegally used controlled substances. Protected individuals include persons who have successfully completed a supervised drug rehabilitation program or have otherwise been rehabilitated successfully and who are not engaging in current illegal use of drugs. Additionally, discrimination is prohibited against an individual who is currently participating in a supervised rehabilitation program and is not engaging in current illegal use of drugs. Finally, a person who is erroneously regarded as engaging in current illegal use of drugs is protected. 3

It should be noted, however, that drug testing is permitted under Title III and that individuals who engage in the illegal use of drugs are not protected by the ADA when an action is taken on the basis of their current illegal use of drugs. (See sections titled, "Can we refuse services to individuals currently engaging in illegal use of drugs?" and "Is drug testing permitted?".)

What Does the ADA Require of Privately Operated Alcohol and Drug Programs?

Alcohol and drug programs operated by private agencies (whether or not they receive Federal, State, or local funding) are considered places of public accommodation under the ADA and are therefore subject to Title III requirements. The remainder of this manual discusses the requirements of Title III of the ADA in detail so that providers can gain understanding of how to comply with Title III.

The Civil Rights Division of the U.S. Department of Justice has provided the following overview of the responsibilities of Title III entities. Under the ADA, a privately operated alcohol or drug program must:

  • Provide services to people with disabilities in an integrated setting, unless separate or different measures are necessary to ensure equal opportunity.
  • Eliminate unnecessary eligibility standards or rules that deny individuals with disabilities an equal opportunity to enjoy the activities, benefits, and services of alcohol and drug programs.
  • Make reasonable modifications in policies, practices, and procedures that deny equal access to individuals with disabilities, unless a fundamental alteration in the nature of the program would result.
  • Furnish auxiliary aids when necessary to ensure effective communication, unless an undue burden or fundamental alteration would result.
  • Remove architectural and structural communication barriers in existing facilities where readily achievable.
  • Provide ... alternative ... [means of delivering services] when removal of barriers is not readily achievable.
  • Provide equivalent transportation services and purchase accessible vehicles in certain circumstances. [If the program provides transportation to its clients, equivalent accessible transportation for clients with disabilities must be provided.]
  • Maintain accessible features of facilities and equipment.
  • Design and construct new facilities and, when undertaking alterations, alter existing facilities in accordance with the Americans With Disabilities Act Accessibility Guidelines issued by the Architectural and Transportation Barriers Compliance Board and incorporated in the final Department of Justice Title III regulation. 4

Four Steps Toward ADA Compliance

Privately operated alcohol and drug programs must take action to overcome four fundamental groups of barriers in order to comply with ADA requirements and provide people with disabilities an equal opportunity to benefit from services. They are as follows:

  1. Attitudinal barriers
  2. Discriminatory policies, practices, and procedures
  3. Communication barriers
  4. Architectural barriers

The remainder of this booklet will elaborate upon actions to take to facilitate the removal of these four groups of barriers.

Step One: Changing Attitudes That Prevent Access to Alcohol and Drug Programs for Persons With Disabilities

An attitudinal barrier to substance abuse intervention and treatment can be defined as a way of thinking or feeling that results in limiting the potential of people with disabilities to function independently within society and to be "treatable" and recognized as wanting help with their substance abuse problems. 5

How Important Is Disability Related Training for Alcohol and Drug Staff?

There are many unique issues in the provision of alcohol and drug rehabilitation services to persons with disabilities.

In order to make ADA compliance efforts truly successful, alcohol and drug program staff must have the skills and the willingness to respond to the needs of clients with disabilities. Staff training is key to overcoming attitudinal barriers that prevent people with disabilities from receiving equally effective alcohol and drug treatment services.

Disability-awareness training should include efforts to ensure that staff members: 1) overcome their fears and stereotyping of people with disabilities; 2) learn the rights of people with disabilities and the responsibilities of alcohol and drug programs under the ADA; and 3) develop skills and resources to provide equally effective services to people with disabilities.

People with disabilities who are familiar with the ADA and alcohol and drug programs can provide the best initial training for alcohol and drug program staff. Pacific Research and Training Alliance (PRTA) is one organization that provides such specialized services. Your local independent living center should also be an excellent resource for meeting persons with disabilities who can provide pertinent training and technical assistance. Ongoing training of new staff can include the use of videos. "J.R.'s Story" is a video that elaborates on many of the unique issues faced by a client with a disability who eventually seeks chemical dependency treatment. Contact PRTA regarding training services, for a list of independent living centers in California, and for information on how to borrow or purchase this and other videos.

Negative myths about disability tend to lessen opportunities for people with and without disabilities to have social contact with each other. It is crucial that providers who attend disability awareness training have the opportunity to meet and ask questions of people with a wide variety of disabilities, especially people with disabilities who are in recovery. Panel discussions often provide the best opportunity for this dialogue and serve as a possible springboard for further contact and cooperation.

High quality disability awareness training should be led by facilitators who have the skills to create an environment in which people feel free to discuss the fears that they have and the stereotypes that they still may hold. Pacific Research and Training Alliance can supply an appropriately trained consultant with extensive experience in delivering disability awareness training to audiences of alcohol and other drug (AOD) providers and staff.

In addition, fact sheets about issues related to substance use and abuse by people with various disabilities are available from the Resource Center for Substance Abuse Prevention and Disability in Washington, D.C. These fact sheets compare myths and facts about people with many types of disabilities and discuss strategies for overcoming attitudinal barriers that prevent people with disabilities from accessing AOD services. They also discuss some of the typical reasonable accommodations for many disabilities. Pacific Research and Training Alliance (PRTA) can furnish information about how to order these fact sheets. PRTA has also developed many other educational materials and curricula on the subject of disability and chemical dependency.

All of these written materials are an invaluable addition to any disability awareness training. They include many references and resources for further reading that is important for both program administrators and staff.

How Serious Is the Problem of AOD Abuse Among People With Disabilities?

Persons with disabilities currently seek alcohol and drug services in small numbers, yet they are at a higher risk for alcohol and drug addiction. Studies have shown that alcohol and drug abuse rates for people with disabilities may range from 15 to 30 percent of all persons with disabilities; rates for people with certain disabilities such as spinal cord and head injury exceed 50 percent. 6

People without disabilities commonly do not think of people with disabilities as having chemical dependency problems. However, these problems are widespread, and if ignored, they worsen.

There are many reasons why people with disabilities do not avail themselves of alcohol and drug treatment services. These range from individual difficulties such as lack of social skills or chronic pain to societal problems such as lack of targeted outreach, lack of transportation, and inaccessible facilities. Many of these problems can be resolved during the alcohol and drug program's initial ADA compliance effort. Other issues can be addressed by working closely with each individual with a disability and with disability advocacy organizations.

Do We Have To Comply With the ADA Even If We Have Never Served a Person Who Is Disabled?

The intention of the ADA is to bring people with disabilities into the mainstream of American society. The ADA requires that individual agencies make their programs accessible and it is the clear responsibility of alcohol and drug programs to seek out clients with disabilities.

The following actions have proved effective in creating a client base of people with disabilities:

  1. Institute an ongoing campaign to publicize your program to people with disabilities. Send disability-specific program information to local advocacy agencies for persons with disabilities, including the Department of Rehabilitation, campus disabled student services offices, independent living centers, and rehabilitation hospitals and clinics.
    Also include advocacy groups for parents of children with disabilities, and advocacy organizations for people with specific disabilities, such as arthritis, cerebral palsy, multiple sclerosis, muscular dystrophy, and vision and hearing disabilities. Don't forget your local mental health association, and local veterans and seniors groups. Your local United Way may be able to help you to locate these organizations. Wherever possible, develop outreach materials in formats which are accessible to people with disabilities, such as in large print, on audiocassette, or on computer disk. Also arrange for any outreach videos to be captioned for people with hearing impairments.
  2. Establish links with organizations in your community that provide advocacy and services to people with disabilities, such as independent living centers. Invite their representatives to speak at staff meetings and send your staff to speak at their events.
  3. Actively seek qualified persons with disabilities when searching for advisory board members.
  4. Actively seek qualified persons with disabilities when hiring new staff members.
  5. Develop prevention and treatment services that target specific populations of persons with disabilities. Some possibilities include the following:
    1. Providing some initial information or counseling services in disability-specific settings.
      EXAMPLE 1: Arrange to give a talk or facilitate a rap group on alcohol and drug issues at an independent living center or a rehabilitation hospital.
      EXAMPLE 2: Offer drop-in peer counseling on alcohol and drug issues at an accessible community center. Air radio public service announcements about this service and send written announcements about this peer counseling to independent living centers and other disability advocacy groups.
    2. Working with local Alcoholics Anonymous and Narcotics Anonymous groups to make meetings accessible.
      EXAMPLE 1: Help locate resources to fund sign language interpreting at a local AA meeting.
      EXAMPLE 2: Assist a local NA group to find an accessible meeting site.

Step Two: Revising Policies, Practices, and Procedures To Ensure Access

Access for people with disabilities is often thought of in terms of physical access to the built environment. Most people understand the need for ramps, curb cuts, and parking spaces for people with disabilities. What many do not consider are the nonphysical barriers to people with disabilities--policies, practices, and procedures that discriminate or tend to discriminate on the basis of disability. We can't see these "administrative barriers" but they have as much impact on people with disabilities as physical ones.

The ADA sets forth a substantial number of requirements to protect people with disabilities from administrative barriers. It is necessary for alcohol and drug programs to review existing policies, practices, and procedures and adopt new ones in order to avoid discrimination and ensure compliance with ADA Title III requirements. The administrative review should be performed by the program director or another individual who is thoroughly familiar with the program and has the authority to effect policy changes.

The following section is intended to answer questions that you may have about specific policies, practices, and procedures relevant to alcohol and drug program operation.

Admitting People With Disabilities Into Your Program

Discriminating against people with disabilities often occurs during first contact. Therefore, an important first step is to review admissions policies, practices, and procedures. Drug and alcohol program admissions includes recruitment, referral, screening, and intake of clients with disabilities--everything that occurs prior to receipt of services or participation in the program.

May We Refuse To Admit People With Disabilities?

Programs may not refuse to admit people solely based upon disability. Blanket policies, practices, and procedures that prohibit the participation of people with disabilities are discriminatory.

May We Decide To Restrict the Participation of People With Certain Disabilities?

No. Alcohol and drug programs should not presume that an individual or class of individuals with a disability can or cannot participate in any aspect of a program. An important step in ensuring nondiscrimination on the basis of disability is to establish procedures by which each individual is evaluated based upon his or her unique needs and abilities.

Even if architectural or communications barriers seemingly prevent program access for people with certain disabilities, the program must give each individual with a disability an opportunity to determine for him- or herself whether he or she can function within the program's constraints.

EXAMPLE: A program, named Awake, has no funds to hire staff with special training in communicating with people who have had strokes. The program cannot, however, refuse to admit people with severe speech impairments caused by a stroke based upon this constraint. An individual with a severe speech impairment caused by a stroke must be apprised of the program's limitations, and other programs seemingly more suited to his or her needs may be suggested, but the individual can still opt to participate in the Awake program.

Can We Limit the Number or Proportion of People With Disabilities Admitted to Our Program?

No. Quotas are prohibited under the ADA.

EXAMPLE: A program cannot limit the number of deaf persons that it serves in a given year based upon the desire to limit sign language interpreting costs.

If architectural, financial, or other constraints limit the number of people with disabilities that a program can serve at any given time, the program must make every effort to ensure that individuals with disabilities are provided with other options for services such as a referral to a comparable program. The individual with a disability should be apprised of all options and his or her preference for placement must be given primary consideration.

EXAMPLE: A residential recovery program has only one wheelchair-accessible bedroom that is currently occupied. A person who uses a wheelchair but can walk short distances may opt to enter the program immediately even though the wheelchair-accessible bedroom is not available. A person who is quadriplegic may, however, require a referral to an alternate accessible program.

What If a Person's Disability Makes Him or Her Unable To Meet Our Eligibility Requirements?

Alcohol and drug programs may require that people with disabilities meet essential eligibility criteria in order to participate in programs and services, and they may refuse services to individuals with disabilities who cannot meet these admission requirements. Programs must, however, demonstrate that these requirements are essential and that no person with a disability is unnecessarily excluded or limited from participation in programs and services.

Essential requirements are those requirements that are fundamental to the nature of a program or activity.

EXAMPLE 1: A program cannot require that clients present a valid driver's license in order to receive services because the ability to drive is not essential to alcohol and drug recovery. Other forms of identification, such as a social security card or birth certificate, should be accepted in lieu of a driver's license.EXAMPLE 2: A methadone maintenance program is approached by a blind woman who is a crack cocaine user. The woman has no history of using heroin or other opiates. The program may deny her its services because they are specifically designed for heroin users. The program should refer her to other treatment services for crack cocaine users.

The Department of Justice does not consider it discriminatory for a program with a specialty in a particular area to refer an individual with a disability to a different program if:

  • The individual is seeking a service or treatment outside the referring program's area of expertise; and
  • The program would make a similar referral for an individual who does not have a disability. 7 For example, a private agency provides recovery meetings for Latino immigrants. A person who uses a wheelchair but is not a Latino immigrant asks to attend the meetings. The agency may refer the individual to another agency that provides accessible meetings.

May We Require Further Information or Documentation From Persons With Certain Disabilities?

Programs cannot require that people with certain disabilities provide information not required of other applicants. Eligibility for participation may not be determined based upon disability unless the program or service is specifically designated for people with disabilities.

EXAMPLE: A program cannot require that an applicant with HIV provide medical records or disclose health information that is not required of other applicants.

What Is "Illegal Use of Drugs"?

According to the Department of Justice, "illegal use of drugs means the use of one or more drugs, the possession or distribution of which is unlawful under the Controlled Substances Act. It does not include use of controlled substances pursuant to a valid prescription or other uses that are authorized by the Controlled Substances Act or other federal law. Alcohol is not a controlled substance, but alcoholism is a disability." 8

What Is "Current Use"?

The Department of Justice defines current use as "the illegal use of controlled substances that occurred recently enough to justify a reasonable belief that a person's drug use is current or that continuing use is a real and ongoing problem. Therefore, a private entity should review carefully all the facts surrounding its belief that an individual is currently taking illegal drugs to ensure that its belief is a reasonable one." 9

Can We Refuse Services to Individuals Currently Engaging in Illegal Use of Drugs?

The Department of Justice offers the following guidance in regard to the illegal use of drugs by those seeking drug rehabilitation services:

Drug addiction is an impairment under the ADA. A public accommodation generally, however, may base a decision to withhold services or benefits in most cases on the fact that an addict is engaged in the current and illegal use of drugs.Although individuals currently using illegal drugs are not protected from discrimination, the ADA does prohibit denial of health services, or services provided in connection with drug rehabilitation, to an individual on the basis of current illegal use of drugs, if the individual is otherwise entitled to such services.Because abstention from the [illegal] use of drugs is an essential condition for participation in some drug rehabilitation programs, and may be a necessary requirement in inpatient or residential settings, a drug rehabilitation or treatment program may deny participation to individuals who use drugs [illegally] while they are in the program. 10 EXAMPLE: It would be inappropriate for a crack cocaine detoxification program to refuse to admit an individual because she is illegally using crack cocaine. A residential alcohol and drug treatment program may, however, expel an individual for illegal use of drugs in its treatment center.

Is Drug Testing Permitted Under the ADA?

Yes. The Department of Justice has indicated that, "public accommodations may utilize reasonable policies or procedures, including but not limited to drug testing, designed to ensure that an individual who formerly engaged in the illegal use of drugs is not now engaging in current illegal use of drugs." 11 It is important not to discriminate against those who appropriately use medications. Sometimes individuals who are appropriately using prescription medications will test positive, even if they have not been using drugs illegally, because the drug test is not sensitive enough to discriminate between different types of drugs.

Can We Refuse to Serve an Individual Whose Disability Poses a Direct Threat to the Health and Safety of Others?

One of the rare instances when a program may deny participation in activities to a person based upon disability is when the individual's disability legitimately presents a direct threat to the health or safety of others that cannot be eliminated or reduced to an acceptable level by reasonable changes to policies, practices, or procedures or by the provision of auxiliary aids and services. The program must establish that the perceived threat is real and not based upon preconceptions or unwarranted fears about the individual's disability. Assessments must consider both the particular activity and the actual abilities and disabilities of the individual.

The Department of Justice gives the following guidance for direct threat assessment: The individual assessment must be based on reasonable judgment that relies on current medical evidence, or on the best available objective evidence, to determine

  • The nature, duration, and severity of the risk
  • The probability that a potential injury will actually occur
  • Whether reasonable modifications of policies, practices, or procedures will mitigate or eliminate the risk

Such an inquiry is essential to protect individuals with disabilities from discrimination based on prejudice, stereotypes, or unfounded fear, while giving appropriate weight to legitimate concerns, such as the need to avoid exposing others to significant health and safety risks. Making this assessment will not usually require the services of a physician. Sources for medical knowledge include public health authorities, such as the U.S. Public Health Service, the Centers for Disease Control, and the National Institutes of Health, including the National Institute of Mental Health. 12

EXAMPLE 1: A program may not refuse to admit an individual because he or she is infected with HIV. HIV is not a direct threat to the health and safety of other program participants because it cannot be transmitted through casual contact.EXAMPLE 2: A program may refuse to admit an individual with a contagious form of tuberculosis if the program finds that it cannot reasonably provide other clients adequate protection from the disease.EXAMPLE 3: A man with a traumatic brain injury who is often loud and aggressive may not be denied admission to a program because of staff or participants' fears that he may exhibit violent behavior. However, if he recently placed others at risk during a violent outburst, the program may place behavioral limits on his admission or participation in specific activities, as long as those limits are the same as those expected of other applicants or participants.

When Can We Ask About Disability?

Inquiries regarding disability made prior to acceptance into an alcohol or drug program are generally unnecessary and should not be made. Once a person has been accepted into the program, necessary inquiries can be made regarding special accommodations that an individual may need. Application forms, consent forms, and other documents where such inquiries are made should be reviewed and revised accordingly.

EXAMPLE 1: A residential perinatal program should not require that a woman fill out an application form that asks about additional medical conditions until she has been admitted to the program.EXAMPLE 2: A residential recovery program for persons who are HIV-positive may inquire as to the history of a person's alcoholism and ask for an HIV-positive test result prior to admission because having both disabilities is a prerequisite for participation.EXAMPLE 3: During an intake interview, program staff cannot ask applicants questions about how they acquired their disabilities or why they use mobility aids such as wheelchairs.

What Questions Can We Ask About Disability?

Necessary inquiries about disability are questions asked in order to provide services, not deny them. This includes questions asked to provide program modifications, auxiliary aids and services, health care, or emergency services to the client; questions asked to assess the client's conformance with legitimate health and safety requirements, and questions asked for some other essential purpose. Unnecessary inquiries about disability include questions asked to screen out the participation of people with disabilities, to satisfy one's curiosity, or to discriminate in the provision of treatment, health care, emergency services, etc. They are in direct violation of the ADA. Alcohol and drug programs should adopt policies and procedures to ensure that written and verbal inquiries about disability are limited to necessary ones.

While alcohol and drug programs cannot require that clients disclose information about disability, they may give clients an opportunity to voluntarily provide information about disability. This is especially true if the intention is to use information about disability in order to accommodate the client.

Is Information About a Client's Disability Confidential?

Yes. Programs should have a written policy and procedure in place to ensure that records pertaining to a client's disability are kept confidential and not used in a discriminatory fashion.

To What Extent Must We Modify Our Policies, Practices or Procedures for Individuals With Disabilities?

The ADA requires that privately operated alcohol and drug programs make reasonable modifications to policies, practices, or procedures when required to ensure equal opportunity and avoid discrimination against people with disabilities. Reasonable modification means any modification that does not fundamentally alter the nature of the services provided. In this way, the burden of accommodation is placed upon the program, not the client. Clients should, however, be consulted as to the modifications they need to successfully participate in the program.

EXAMPLE 1: A residential social model treatment program which has a "drug-free" policy for its residents must modify that policy to allow for the appropriate use of prescribed medications in order to avoid discriminating against a qualified applicant who has to inject himself daily with insulin because he has diabetes. The program would also have to allow a qualified applicant with epilepsy to take appropriately prescribed antiseizure medications according to her doctor's instructions.The barbiturate Phenobarbital has occasionally been prescribed to control seizures. If an applicant took Phenobarbital as prescribed, the program could not refuse to admit her for this reason. Program administrators and staff might appropriately accommodate her by modifying the program's drugfree policy and establishing additional security procedures so that her medication would not be misused or fall into the hands of other participants.EXAMPLE 2: A methadone treatment facility requires that clients pass a urine screening just prior to receipt of medication. Clients must urinate in the presence of program staff to ensure the validity of the test. It would not be reasonable for the program to waive the drug screening requirement for a person with a disability even if that person's disability prevented him from providing urine samples on demand. Alternative methods of screening would need to be provided as a reasonable accommodation.

When Is It Appropriate To Place Persons With Disabilities in Separate Programs Designed Especially for Them?

The primary emphasis of alcohol and drug service providers in serving persons with disabilities must be integration into regular programs. However, the ADA does not prohibit the establishment of target programs to serve communities of persons with disabilities, such as a residential treatment facility for persons who are deaf.

Nevertheless, individuals with disabilities cannot be excluded from regular programs or required to accept special services or benefits simply because special or target programs are available. 13

EXAMPLE: A county has established a special residential facility for persons with traumatic brain injuries and alcohol or drug addictions. The county may offer this separate program in order to meet the unique cognitive and environmental needs of persons with traumatic brain injuries in recovery. The county cannot, however, require that persons with traumatic brain injuries participate in this special program or refuse to admit them to regular programs because of their disability.

Can Persons With Disabilities Refuse Special Services and Choose Instead To Participate in Regular Programs?

Yes. Persons with disabilities are entitled to participate in regular programs whether or not alcohol and drug program personnel believe that they can benefit from regular services. The existence of special programs does not relieve alcohol and drug programs of their obligation to provide reasonable modifications and auxiliary aids and services to individuals choosing to participate in the regular program. 14

EXAMPLE: A residential facility called Transitions is located in a rural setting and residents perform farm labor as part of the treatment program. A wheelchair user named Joe applies to Transitions. Program staff advise him that a rigorous physical routine is a fundamental part of the Transitions program. They suggest an alternate program that offers special services for persons with mobility disabilities.Joe chooses to join the Transitions program despite the availability of a special program suited to his disability. He believes that he can negotiate the terrain of the Transitions facility and do some of the required physical labor with limited program modifications.Transitions may limit the extent of modifications provided to Joe because of the availability of an appropriate separate program, but they cannot refuse to admit Joe. Transitions must still reasonably accommodate Joe, including providing transportation for Joe if transportation is provided for other clients, but they need not make extraordinary modifications, such as the purchase of costly specialized farming equipment. They may also modify Joe's chore schedule, with input from Joe regarding which chores he is able to perform.

Is Our Program Required To Cover the Cost of Personal Equipment and Attendant Services?

While a public accommodation is required to provide auxiliary aids for effective communications (such as telecommunications devices for deaf persons) and reasonable personal assistance to persons with disabilities (such as help with filling out an application form), it is not required to provide equipment or services of a personal nature such as wheelchairs, prescription eyeglasses, hearing aids, or assistance in eating, toileting, and dressing. 15

Can We Charge People With Disabilities for the Extra Costs of Providing Services to Them?

No. ADA compliance measures may result in an additional cost for serving clients with disabilities. Alcohol and drug programs may raise the fee for all clients but they may not place a surcharge on particular individuals with disabilities or groups of individuals with disabilities to cover these expenses.

EXAMPLES: A methadone program is located on the second floor of an older four-story building that does not have an elevator. Because the director has determined that providing physical access to the program for those unable to climb stairs would not be readily achievable, she has chosen to provide home services as a readily achievable alternative to barrier removal. A medical technician will visit clients' homes to perform urine tests and give injections, and counselors will provide services to clients by phone. The program may not charge individuals who receive home care for the additional cost of providing services to them. 16

Can We Prohibit Smoking?

Yes. The Department of Justice has indicated that public accommodations such as alcohol and drug programs "may prohibit smoking, or may impose restrictions on smoking, at their facilities." 17

Must We Allow the Use of Service Animals in Our Facility?

Yes. Alcohol and drug programs must allow a service animal (such as a guide, hearing or companion dog) to accompany a person with a disability for all services except when doing so would fundamentally alter the particular activity or jeopardize the safe operation of the program. (See section titled "Limitations and Alternatives" below.)

It is the responsibility of the animal's owner to feed, walk, and care for the service animal in any other way.

EXAMPLE: An individual who is blind wishes to be accompanied by his guide dog to an alcohol and drug program orientation session. The alcohol and drug program must permit the guide dog to accompany its owner in all areas of the facility open to other clients, and may not insist that the dog be separated from him at any time. Furthermore, the client may not be charged a deposit as a condition for permitting the service animal into the program's facility. 18

The ADA Protects People With Disabilities and Their Allies From Retaliation or Coercion

Alcohol and drug programs may not take any retaliatory action against persons who exercise their rights under the ADA or individuals who assist others in exercising their rights. This prohibits the suspension or termination of employees for advising persons with disabilities of their right to reasonable modifications and auxiliary aids and services in the program. 19

Step Three: Understanding Is Everything--Overcoming Communications Barriers

The ADA requires alcohol and drug programs to ensure that communications with people with disabilities are as effective as communications with others. Communications conducted by alcohol and drug programs include outreach, education, prevention efforts, intake interviews, group meetings, counseling sessions, telephone and mail communications, and provision of medical services. Communication barrier removal is especially important for people who are deaf or have hearing, speech, visual, and learning disabilities.

What Are Auxiliary Aids and Services?

In many cases, ensuring effective communication entails the provision of auxiliary aids and services--a wide range of practices and equipment that allow people with disabilities to communicate and access information. The type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the nature and duration of the communication and the individual person's preference and ability to use a particular aid or service. 20 The Department of Justice gives the following examples of auxiliary aids and services:

Auxiliary aids and services for individuals who are deaf or hard of hearing include qualified interpreters, notetakers, computer-aided transcription services, written materials, telephone handset amplifiers, assistive listening systems, telephones compatible with hearing aids, closed caption decoders, open and closed captioning, telecommunications devices for deaf persons (TDDs), videotext displays, and exchange of written notes.Examples for individuals with vision impairments include qualified readers, taped texts, audio recordings, Brailled materials, large print materials, and assistance in locating items.Examples for individuals with speech impairments include TDDs, computer terminals, speech synthesizers, and communication boards. 21

What Range of Auxiliary Aids and Services Must We Provide?

Public accommodations such as alcohol and drug programs should be prepared to provide the widest variety of auxiliary aids and services possible to people with disabilities. The ADA suggests that individuals with disabilities be given the opportunity to request the auxiliary aids and services of their choice and that primary consideration be given to the choice expressed by the individual.

It is important to consult with the individual to determine the most appropriate auxiliary aid or service, because the individual with a disability is most familiar with his or her disability and is in the best position to determine what type of aid or service will be effective. For example, some individuals who were deaf at birth or who lost their hearing before acquiring language use sign language as their primary form of communication. They may be uncomfortable or not proficient with written English. This makes use of a notepad an ineffective method of communication with them. Some individuals who lose their hearing later in life, however, may not be skilled in sign language and can communicate most effectively through writing.

The Department of Justice states that, while consultation is strongly encouraged, the final decision as to what measures to take to ensure effective communication rests in the hands of the alcohol and drug program, provided that the method chosen results in effective communication. 22

When Must We Provide Auxiliary Aids and Services?

If needed to ensure effective communication, auxiliary aids and services must be provided at all phases of a client's participation in an AOD program. This would include application, intake, counseling, group meetings and all social activities. It would extend to followup contact after the client has left the program, if this service is usually provided.

Limitations and Alternatives (Claiming Fundamental Alteration Or Undue Burden)

The ADA does not require privately operated alcohol and drug programs to provide any auxiliary aids and services that would fundamentally alter the nature of the programs and services they offer or result in an undue financial burden.

What Is a Fundamental Alteration?

A fundamental alteration as defined by the Department of Justice is "a modification that is so significant that it alters the essential nature of the goods, services, facilities, privileges, advantages, or accommodations offered." 23

What Is an Undue Burden?

Undue burden is defined as "significant difficulty or expense." The Department of Justice advises programs to consider the following factors in determining whether an action would result in an undue burden:

  • The nature and cost of the action;
  • The overall financial resources of the site or sites involved; the number of persons employed at the site; the effect on expenses and resources; legitimate safety requirements necessary for safe operation, including crime prevention measures; or any other impact of the action on the operation of the site;
  • The geographic separateness, and the administrative or fiscal relationship of the site or sites in question to any parent corporation or entity;
  • If applicable, the overall financial resources of any parent corporation or entity; the overall size of the parent corporation or entity with respect to the number of its employees; the number, type, and location of its facilities; and
  • If applicable, the type of operation or operations of any parent corporation or entity, including the composition, structure, and functions of the workforce of the parent corporation or entity. 24

Any program that cannot provide an accommodation because of fundamental alteration or undue burden concerns should make every effort to provide an equally effective alternative accommodation. The program should carefully document the entire process and be prepared to substantiate their claim of fundamental alteration or undue burden in a court of law.

EXAMPLE: An individual who is deaf requests that a sign language interpreter be provided at all times while he is participating in a day treatment program. The program operates on a small budget and cannot afford to hire an interpreter for frequent and extended periods of time. The program has tried and failed to find volunteer interpreters. The program determines that it would be an undue financial burden to provide professional interpreting services for all aspects of services but resolves to provide an interpreter for weekly counseling sessions and all group meetings. Furthermore, the program welcomes the client to bring a friend or relative to interpret for him at other times and makes a computer terminal available for typed communications between the deaf client and program staff.

Who Is Qualified To Provide Sign-Language Interpreting Services?

A program must ensure that any interpreter it hires or otherwise provides is qualified. There are a number of sign languages used. (The most common methods of communication are American Sign Language and signed English.) Individuals who use one form of sign language may not communicate effectively through an interpreter who uses a different one. A qualified interpreter is an interpreter who is able to sign to the individual who is deaf what is being said by the hearing person and who can voice to the hearing person what is being signed by the individual who is deaf. This communication must be conveyed effectively, accurately, and impartially through the use of any necessary specialized vocabulary, and in the type of sign language the deaf person uses. 25

How Do We Make Telephone Communications Accessible?

If your program has frequent or extensive telephone communications with clients and members of the general public, a telecommunications device for the deaf (TDD) makes telephone communications accessible to individuals who are deaf, hard-of-hearing, or speech impaired. A TDD allows individuals to communicate over regular telephone lines through text rather than voice. Often, a continuous tone or a series of beeps will be heard when an individual calls from a TDD. This is the signal to place the phone receiver in your TDD machine and begin text communication. You may consider installing a separate telephone line for TDD calls to eliminate confusion when receiving a TDD signal over the regular telephone line. If you do provide a separate TDD phone line, that number should be listed wherever you advertise the number for regular telephone service.

In California, individuals who use a TDD may communicate with agencies without a TDD through a service called the California Relay Service, 1-800-735-2922 (voice) and 1-800-735-2929 (TDD). An operator acts as an intermediary, reading to the agency staff what the TDD caller is typing and typing to the TDD caller what the agency staff is saying. Until your program obtains a TDD, it should use the relay service to call clients who have TDDs. Program staff should be advised that some individuals will use the relay service to call even if you have a TDD. These calls should always be accepted.

What About Outgoing Calls by Clients, Patients, or Visitors?

The Department of Justice advises that "TDDs must be provided when customers, clients, patients, or participants are permitted to make outgoing calls on more than an incidental convenience basis. For example, TDDs must be made available on request ... where in-room phone service is provided." 26 If calls come to the front desk before they are transferred to clients' rooms, the front desk should also be equipped with a TDD so that clients using TDDs in their rooms have the same access to in-house services as other clients.

How Do We Make Print, Audiocassette, Videos, and Other Materials Accessible?

Communication barriers also appear when programs attempt to send outreach materials to people with disabilities. If advertising, prevention, or other materials are not available in a format that is appropriate for a person with a disability, then programs should make that material available in an appropriate alternative format. Alternative formats include but are not limited to the following:

  • Print materials may be made available to blind or visually impaired individuals in audiotape, large print, computer disk, Braille or raised text format.
  • Print materials may be made available to people with limited upper body use in computer disk format.
  • Videotapes may be made available to deaf or hard-of-hearing individuals in captioned format (with subtitles).
  • Audiotapes may be made available to deaf or hard-of-hearing individuals in print format.

How Can We Make Advertisements Accessible?

If your program advertises its services, then such advertisements should be made in a sufficient variety of formats to ensure access to people with disabilities. For example, radio advertisements are not accessible to the deaf and newspaper advertisements are not readily accessible to the blind. Only with a combination of the two would both communities be reached. In addition, programs should make an effort to contact those media resources that are frequently used by the disability community.

Designing and Selecting Outreach, Prevention, and Other Materials

Programs should include the following in all outreach, prevention, and other materials that they produce:

  • A statement of the program's responsibilities under the ADA and its commitment to provide effective communication to people with disabilities.
  • A description of the accommodations and resources that the program has available for people with disabilities.

No new or existing outreach, prevention, or other material produced by the program should contain any discriminatory language or representation of people with disabilities. Programs should also take steps to ensure that no material produced by others, but distributed by the program, contains any discriminatory language or representation of people with disabilities.

It may be an unwieldy task for a program to review each of the materials that it currently distributes. As an alternative, programs may choose to establish a procedure by which persons can file a complaint if they find any material to be discriminatory against people with disabilities. A complaint review procedure should be established. Remedies may include discontinuing use of the material or removing the discriminatory portion of the material.

When selecting or designing new materials, PRTA recommends that programs should make an effort to find or produce materials that contain positive representations of people with disabilities. In addition, an appropriate number of materials should address issues specific to disability. For example, you may include a video that addresses the issue of deafness and alcohol use in your video library. PRTA suggests that an "appropriate number" of materials should address disability-related issues. Since over 15 percent of California's population are people with disabilities we recommend that at least 15 percent of your program's materials address the needs of this population.

How Do We Make Open Meetings And Other Public Events Accessible?

The following are minimum guidelines for holding an accessible meeting or other public event:

  • Make invitations, flyers, and other announcements available in alternative formats upon request. Conduct outreach to persons with known disabilities in an appropriate format.
  • Include clip-and-return form and phone numbers on announcements that allow persons with disabilities to contact your program in advance and request accommodations such as large-print handouts or sign-language interpreter services.
  • Hold public events at a wheelchair-accessible location. At a minimum, these sites should have wheelchair-accessible parking, entrances, paths of travel, seating, toilet facilities, and public phones.
  • If possible, secure a sign language interpreter for the event. Otherwise, provide notice in your advertisements that a sign language interpreter will be available if requested 72 hours in advance.
  • If possible, make written handout materials readily available in the following common alternative formats: large print, computer disk, and audiocassette.
  • Place refreshments and handout materials in an accessible location.

Step Four: It Doesn't Have To Cost Much!--Physical Access Can Be Readily Achieved

Under the ADA, privately operated alcohol and drug programs should remove architectural (or physical) barriers to program areas in existing facilities where it is readily achievable to do so. Readily achievable is defined by the Department of Justice as "easily accomplishable and able to be carried out without much difficulty or expense." New construction and alteration requirements are much more stringent than the readily achievable barrier removal standard for existing facilities. When undertaking a new construction or alteration project, privately operated alcohol and drug programs in California must comply with the Americans With Disabilities Act Accessibility Guidelines (ADAAG) and state accessibility regulations (Title 24.)

Title III allows that barriers be removed slowly, over time, as it becomes readily achievable to do so. According to Title III, programs should have removed all those barriers they readily could by January 26, 1992. Over time, programs are obligated to take stock of barriers that remain and to evaluate what resources they have, so that they can determine which additional barriers can be removed.

Because the California Department of Alcohol and Drug Programs (DADP) and each county has its own obligations under the ADA and the Rehabilitation Act of 1973, the state and counties may hold AOD programs they fund to a higher standard of access than readily achievable. The state and counties are likely to require that all publicly funded alcohol and drug programs with 15 or more employees achieve programmatic access. This means that physical barriers to programs and services must be removed whether or not it is readily achievable to do so. Agencies with several facilities may be allowed to make only one facility accessible per this higher standard if each facility provides essentially the same program (same modality and target population) and the facilities are located within the same general geographic area.

Programs with fewer than 15 employees may be required to refer persons with disabilities to essentially equivalent accessible programs within their service group. If no such equivalent accessible program is available, publicly funded programs with fewer than 15 employees will most likely be required to achieve programmatic access. Your county alcohol and drug program administrator or DADP ADA coordinator can help you determine what is currently required of your program.

In addition, PRTA recommends that programs should have a long-term plan to achieve programmatic access whether or not immediately required by the state.

ADAAG or California Title 24 regulations are often used as the standard to survey a facility. Once the survey is complete, a program can narrow the scope of renovation depending upon the level of access immediately required--readily achievable or programmatic access.

Programs that have not already done so should perform a survey of their facilities to identify physical barriers to programs and services. The survey should be performed by a person who is thoroughly familiar with physical access standards and the operation of alcohol and drug programs. This is important because the surveyor should be able to identify and prioritize physical barriers to program access--not just identify ADAAG or Title 24 violations in general. A surveyor who understands the nature of a program can suggest cost-efficient solutions and alternatives to physical barrier removal. The Department of Justice also advises that this process should include consultation with individuals with disabilities or organizations representing them. They may provide useful guidance identifying the most significant barriers to remove and the most efficient means of removing them. "A serious effort at self-assessment and consultation can diminish the threat of litigation and save resources by identifying the most efficient means of providing required access." 27

Depending upon the program, barriers that prevent access to toilet and shower facilities, bedrooms, meeting areas, dining rooms, counseling offices, medical offices, and other essential program areas would be considered programmatic barriers. Programmatic barriers often also include stairs, narrow doorways, and lack of accessible features such as disabled-accessible parking spaces, toilet stalls, sinks, showers, pay telephones, and drinking fountains.

Certain architectural features such as bathrooms and meeting rooms must be made accessible. In many cases, however, alternative measures to barrier removal can narrow the scope of renovation required while providing equivalent program access for persons with disabilities.

EXAMPLE: A program normally performs intake off-site at an inaccessible facility. An alternative to a costly renovation project would be to conduct intake of applicants with disabilities at an alternate accessible location.

This may sound very complicated on paper, but in most cases barrier removal is a common sense issue. Becoming familiar with the ADA Title III physical access requirements is an important first step toward undertaking a barrier removal project.

The following readily achievable barrier removal guidelines are quoted directly from the Department of Justice ADA Title III Technical Assistance Manual unless otherwise specified in the References section of this publication.

What Is an Architectural Barrier?

Architectural barriers are physical elements of a facility that impede access by people with disabilities. These barriers include more than obvious impediments such as steps and curbs that prevent access by people who use wheelchairs.

In many facilities, telephones, drinking fountains, mirrors, and paper towel dispensers are mounted at a height that makes them inaccessible to people using wheelchairs. Conventional doorknobs and operating controls may impede access by people who have limited manual dexterity. Deep-pile carpeting on floors and unpaved exterior ground surfaces often are a barrier to access by people who use wheelchairs and people who use other mobility aids, such as crutches. Impediments caused by the location of temporary or movable structures, such as furniture, equipment, and display racks, are also considered architectural barriers. 28

What Is a Facility?

The term "facility" includes all or any part of a building, structure, equipment, vehicle, site (including roads, walks, passageways, and parking lots), or other real or personal property. Both permanent and temporary facilities are subject to the barrier removal requirements." 29

What Architectural Standards Apply to Alcohol and Drug Programs in California?

Measures taken to remove barriers should comply with the Department of Justice's ADA Accessibility Guidelines (ADAAG) and California Accessibility Regulations (Title 24). Deviations from ADAAG and Title 24 are acceptable only when full compliance with those requirements is not readily achievable. In such cases, barrier removal measures may be taken that do not fully comply with the standards, so long as the measures do not pose a significant risk to the health or safety of individuals with disabilities or others. 30

How Does the Readily Achievable Standard Relate to the ADA Standards for New Constructions And Alterations?

The ADA establishes different standards for architectural barrier removal from existing facilities than from facilities undergoing a new construction or alteration project. In existing facilities, where retrofitting may be expensive, the requirement to provide access is less stringent than it is in new construction and alterations, where accessibility can be incorporated in the initial stages of design and construction, often without a significant increase in cost.

The readily achievable standard also requires a lesser degree of effort on the part of alcohol and drug programs than the "undue burden" limitation on the auxiliary aids requirements of the ADA. In that sense, it can be characterized as a lower standard. 31 Also see section titled "Limitations and alternatives".

What Barriers Are Readily Achievable to Remove?

There is no definitive answer to this question, because determinations as to which barriers can be removed without much difficulty or expense must be made on a case-by-case basis.

The Department of Justice's regulation contains a list of 20 examples of modifications that may be readily achievable:

  1. Installing ramps;
  2. Making curb cuts in sidewalks and entrances;
  3. Repositioning shelves;
  4. Rearranging tables, chairs, vending machines, display racks, and other furniture;
  5. Repositioning telephones;
  6. Adding raised markings on elevator control buttons;
  7. Installing flashing alarm lights;
  8. Widening doors;
  9. Installing offset hinges to widen doorways;
  10. Eliminating a turnstile or providing an alternative accessible path;
  11. Installing accessible door hardware;
  12. Rearranging toilet partitions to increase maneuvering space;
  13. Insulating lavatory pipes under sinks to prevent burns;
  14. Installing a raised toilet seat;
  15. Installing a full-length bathroom mirror;
  16. Repositioning the paper towel dispenser in a bathroom;
  17. Creating designated accessible parking spaces;
  18. Installing an accessible paper cup dispenser at an existing inaccessible water fountain;
  19. Removing high pile, low density carpeting; or
  20. Installing vehicle hand controls.

The list is intended to be illustrative. Each of these modifications will be readily achievable in many instances, but not in all. Whether or not any of these measures pertain to your program or are readily achievable is to be determined on a case-by-case basis in light of the particular circumstances presented and the factors discussed above. 32

How Do We Determine When Barrier Removal Is Readily Achievable?

Determining if barrier removal is readily achievable is necessarily a case-by-case judgment. Factors to consider include:

  • The nature and cost of the action;
  • The overall financial resources of the site or sites involved; the number of persons employed at the site; the effect on expenses and resources; legitimate safety requirements necessary for safe operation, including crime prevention measures; or any other impact of the action on the operation of the site;
  • The geographic separateness, and the administrative or fiscal relationship of the site or sites in question to any parent corporation or entity;
  • If applicable, the overall financial resources of any parent corporation or entity; the overall size of the parent corporation or entity with respect to the number of its employees; the number type, and location of its facilities; and
  • If applicable, the type of operation or operations of any parent corporation or entity, including the composition, structure, and functions of the workforce of the parent corporation or entity.

If the [alcohol and drug program] is a facility that is owned or operated by a parent entity that conducts operations at many different sites, the ... [alcohol and drug program] must consider the resources of both the local facility and the parent entity to determine if removal of a particular barrier is "readily achievable." The administrative and fiscal relationship between the local facility and the parent entity must also be considered in evaluating what resources are available for any particular act of barrier removal. 33

Does the ADA Permit an Alcohol And Drug Program To Consider the Effect of a Modification on the Operation of Its Business?

Yes. The ADA permits consideration of factors other than the initial cost of the physical removal of a barrier. 34

EXAMPLE: A residential drug treatment program with 24 beds that has only one wheelchair accessible sleeping room is considering making another sleeping room accessible. After an appropriate access survey and consultation it is determined that the only way to make the room in question accessible would be to move the partition between it and an adjacent sleeping room, which has four beds. However, moving the partition to create accessible space would mean that the program would lose two of the four beds in the adjacent room. The effect of the net loss of two beds on the program's operation can be considered in the process of determining whether moving the partition would be readily achievable.

What Are the Priorities for Barrier Removal?

The Department [of Justice's] regulation recommends priorities for removing barriers in existing facilities. Because the resources available for barrier removal may not be adequate to remove all existing barriers at any given time, the regulation suggests a way to determine which barriers should be mitigated or eliminated first. The purpose of these priorities is to "facilitate long-term ... planning and to maximize the degree of effective access that will result from any given level of expenditure. These priorities are not mandatory.... [Programs] are free to exercise discretion in determining the most effective "mix" of barrier removal measures to undertake in their facilities."

The regulation suggests that "... [an alcohol and drug program's] first priority should be to enable individuals with disabilities to physically enter its facility." This priority on "getting through the door" recognizes that providing physical access to a facility from public sidewalks, public transportation, or parking is generally preferable to any alternative arrangements in terms of both business efficiency and the dignity of individuals with disabilities.

The next priority is for measures that provide access to those areas of ... [the facility] where services are made available to the public [clients]....

The third priority should be providing access to restrooms, if restrooms are provided for use by clients....

The fourth priority is to remove any remaining barriers to using the ... [alcohol and drug program's] facility by, for example, [installing visual alarms, adding Brailled floor indicators to elevator panels, or] lowering telephones. 35

If We Find Barriers That Should Be Removed, but It Is Not Readily Achievable To Undertake All of the Modifications Now, What Should We Do?

The Department [of Justice] recommends that ... [alcohol and drug programs] develop an implementation plan designed to achieve compliance with the ADA's barrier removal requirements. Such a plan, if appropriately designed and diligently executed, could serve as evidence of a good-faith effort to comply with the ADA's barrier removal requirements. 36

What Are "Alternatives to Barrier Removal"?

When a program can demonstrate that the removal of barriers is not readily achievable, the program must make its services available through alternative methods, if such methods are readily achievable.

EXAMPLE: A residential program that has its counseling rooms upstairs determines that it is not readily achievable to provide a ramp or elevator to these upstairs rooms. However, the program is still required to provide access to its services, if any readily achievable alternative method of delivery is available. Therefore, this program would be required to make counseling available in a downstairs room when needed.

How Can We Determine if an Alternative to Barrier Removal Is Readily Achievable?

"The factors to consider in determining if an alternative is readily achievable are the same as those that are considered in determining if barrier removal is readily achievable." 37

If We Provide Services Through Alternative Measures, Such As Home Visits, May We Charge the Client for His Special Service?

No. "When services are provided to an individual with a disability through alternative methods because ... [a program's] facility is inaccessible, ... [the program] may not place a surcharge on the individual with a disability for the costs associated with the alternative methods." 38

May We Consider Security Issues When Determining If an Alternative Is Readily Achievable?

Yes. "Security is a factor that may be considered when ... [an alcohol and drug program] is determining if an alternative method of delivering its ... services is readily achievable." 39

Must Barriers Be Removed in Areas Used Only by Employees?

No. "The 'readily achievable' obligation to remove barriers in existing facilities does not extend to areas of a facility that are used exclusively by employees as work areas." 40 However, if one or more employees have disabilities which need to be accommodated through barrier removal, then barrier removal must be carried out unless it poses an "undue hardship" to the employer. This "undue hardship" standard is established by Title I of the ADA.

Are Portable Ramps Permitted?

Yes, but "only when the installation of a permanent ramp is not readily achievable. In order to promote safety, a portable ramp should have railings and a firm, stable, nonslip surface. It should also be properly secured." 41

Do We Have to Install an Elevator?

The readily achievable standard does not require barrier removal that would necessitate extensive restructuring or burdensome expense. 42 However, the programmatic access standard would require that program services be moved to an accessible site when needed. Therefore, small privately operated alcohol and drug programs that have limited budgets generally would not be required to remove a barrier to physical access posed by a flight of steps, if removal would require extensive ramping or an elevator.

Does the ADA Require Barrier Removal in Historic Buildings?

Yes, if it is readily achievable. However, the ADA takes into account the national interest in preserving significant historic structures. Barrier removal would not be considered readily achievable if it would threaten or destroy the historic significance of a building or facility that is eligible for listing in the National Register of Historic Places under the National Historic Preservation Act (16 U.S.C. 470, et seq.), or is designated as historic under State or local law.

EXAMPLE 1: A residential treatment program is located in a century old house that was designed by a famous architect and is listed in the National Registry of Historic Places. An architect familiar with disability access regulations has determined that ramping the front entrance would require extensive structural modifications to the front porch. The porch roof is supported by decorative columns that cannot be moved, and a ramp cannot fit between them. Therefore, ramping the front entrance would not be readily achievable. It would be readily achievable, however, to remove obstacles and broaden a pathway to a side door on the ground level which is wide enough to permit wheelchair access.EXAMPLE 2: A nonresidential alcohol and drug counseling center is located in a private building where city founders signed a charter 150 years ago. The building itself has no architectural features that are historic. However, it is well known that the charter was signed there, and a plaque near the front entrance commemorates this fact. The entrances to this building are each up several steps. It would be readily achievable to install a ramp or a platform lift adjacent to the steps at the front entrance if the program had the resources to do so and if access to the plaque and the plaque's visibility were not obstructed by the ramp or lift.

If We Move, Do We Have an Obligation To Search for Accessible Space?

Privately operated alcohol and drug programs are not required to lease space that is accessible. However, upon leasing, the barrier removal requirements for existing facilities apply. In addition, any alterations to the space must meet the accessibility requirements for alterations. 43

Who Has Responsibility for ADA Compliance in Leased Facilities, the Landlord or the Tenant?

Both the landlord and the tenant are public accommodations and have the full responsibility for complying with all ADA Title III requirements applicable to that place of public accommodation. The Title III regulation permits the landlord and the tenant to allocate responsibility, in the lease, for complying with particular provisions of the regulation. However, any allocation made in a lease or other contract is only effective as between the parties, and both landlord and tenant remain fully liable for compliance with all provisions of the ADA relating to that place of public accommodation. 44

Maintaining the Accessible Features Of Your Facility

"Public accommodations [such as privately operated alcohol and drug programs] must maintain in working order equipment and features of facilities that are required to provide ready access to individuals with disabilities."

Where [alcohol and drug programs] must provide an accessible route, the route must remain accessible and not blocked by obstacles such as furniture, filing cabinets, or potted plants. Similarly, accessible doors must be unlocked when ... [the facility] is open for business.

EXAMPLE 1: Placing a vending machine on the accessible route to an accessible restroom would be violation if it obstructed the route.EXAMPLE 2: Placing ornamental plants in an elevator lobby may be a violation if they block the approach to the elevator call buttons or obstruct access to the elevator cars.EXAMPLE 3: Using an accessible route for storage of supplies would also be a violation, if it made the route ... [too narrow or crowded to be accessible].

BUT: An isolated instance of placement of an object on an accessible route would not be a violation, if the object is promptly removed.

Although it is recognized that mechanical failures in equipment such as elevators or automatic doors will occur from time to time, the obligation to ensure that facilities are readily accessible to and usable by individuals with disabilities would be violated if repairs are not made promptly or if improper or inadequate maintenance causes repeated and persistent failures. Inoperable or "out of service" equipment does not meet the requirements for providing access. 45

Final Remarks

People with disabilities need alcohol and drug abuse prevention and treatment services as much as anyone else in society. In fact, people with disabilities are at higher risk for alcohol and drug abuse problems than the general population. Your ADA implementation efforts will help to ensure that people with disabilities in your community will receive desperately needed alcohol and drug prevention and treatment services. We hope that this summary of the US Department of Justice ADA Title III Technical Assistance Manual, as adapted to meet the needs of alcohol and other drug service providers, has been of assistance to you. If needed, further technical assistance is available from PRTA.

Sample Alcohol and Drug Program Policies and Procedures

General Policies

Statement of nondiscrimination

It is the policy of _________________ (program) to support and comply with the requirements and principles of the Americans With Disabilities Act (ADA) and to ensure that, to the maximum extent practicable, persons with disabilities are afforded equal access to the facilities, programs, and services of ______________ (program).

______________ (program) has assigned overall responsibility for ensuring equal opportunity and nondiscrimination in the provision of services and on-going compliance with the ADA to _______________________ (name) ____________________ (title).

The following notice will be included in all contracts we enter into with other entities to provide services to our program and clients:

Federal law requires that you comply with the Americans With Disabilities Act and _____________ (program) requires you to adhere to our policy of nondiscrimination when providing services to _____________ (program) and our clients.

Prevention and outreach

The prevention and outreach materials produced by ________________ (program) will be available in alternative format (such as large print, cassette tape or computer disk) upon request.

A representative number of the outreach events and prevention/educational presentations conducted by ________________ (program) will be held in wheelchair accessible locations. Upon advance request, sign language interpreters will be available at outreach/educational presentations when feasible.

Recruitment and advertising

All written program advertising materials will be available in alternative formats upon request. All advertisements will contain a statement that ____________ (program) does not discriminate against people with disabilities. Whenever possible, information will be circulated to organizations and agencies that serve people with disabilities.

Benefits and services

_________________ (program) will ensure that persons with disabilities are provided maximum opportunity to participate in and benefit from all our programs, services, and activities. Moreover, it is our goal that such participation will be in an equally effective manner as non-disabled people.

Providing accommodations

__________________ (program) will accommodate the known disabilities of otherwise qualified program applicants and participants. When a prospective client or program participant identifies having a disability that requires accommodation, program staff will discuss possible disability accommodations with that person.

Whenever possible, preference will be given to the disability accommodation that is the individual's first choice. If that accommodation cannot be provided, program staff will suggest one or more alternative accommodations that could be provided to ensure the individual's full participation in the program. If necessary, staff will seek the assistance of disability service providers in order to develop effective accommodations.


Program participants will not be excluded from our program because they take appropriately prescribed medications to maintain their health. Program staff will arrange for the secure storage of appropriately prescribed medication. All medications will be locked in _______________. All prescribed medications will be taken as outlined on the bottle and logged in the medication record book.

Application forms and intake questions

The criteria for admission into this program shall not exclude or restrict the participation of people with disabilities. During intake, staff shall not ask questions about disability, unless this information is part of medical history taking and medical history taking is required of all prospective clients. If a prospective client self-identifies as having a disability, intake staff may ask questions about how to accommodate the person's disability needs.

Risk identification

When staff or other participants are concerned that a client or prospective client with a disability may pose a significant risk to others' health and safety, supervisory staff will conduct an assessment of that potential risk. This assessment will take into account factual information about the person's disability and abilities. It will exclude from consideration stereotypes, hearsay, rumors, and unwarranted fears.

Communication Access

General policy

_________________ (program) will ensure equally effective communication and participation in our services for people with disabilities.

Auxiliary aids and services for people with disabilities (including people who are deaf or hard of hearing, blind or vision impaired, speech impaired, learning disabled, and cognitively disabled) will be provided in all phases of participation in our program. These will be provided unless the Program Director determines that a specifically requested auxiliary aid or service would fundamentally alter the nature of our program or result in an undue financial burden.

The individual with the disability will be provided an opportunity to request the auxiliary aid or service of their choice. If it is not feasible for ___________ (program) to provide the requested aid or service, the Program Director will suggest other effective aids or services which __________ (program) can provide to accommodate the individual's needs.

Telecommunication Device for the Deaf (TDD) (For programs that have TDDs)

______________________ has a TDD and at least one staff person per shift is trained in how to use it. Our TDD phone line, if separate, is included in our local telephone directory and in all our advertising materials. Program participants will, as needed, have access to and use of this TDD.

California Relay Service

At least one staff person per shift is trained in how to use the California Relay Service. This person will train other staff in how to use the California Relay Service if necessary.

Interpreter services

Upon being provided with reasonable prior notice of need _____________ (program) will, to the maximum extent feasible, provide interpreters for program services and/or activities by contacting ________________ in our community.

We have the goal of allocating funds in our budget for providing interpreter services when they are needed.

Written materials

All written program materials distributed to clients will, upon reasonable prior notice of need, be made available in alternative formats (large print, cassette tape, Braille, computer disk, modified English).

Emergency Communications and Evacuation

Our fire safety and emergency warning systems are configured and maintained in compliance with applicable state and local building codes and regulations. This includes provision of visual alarms and/or bed shakers to alert the deaf and hard-of-hearing to fire and other emergency situations.

The emergency evacuation procedure is as follows:

  • When the fire alarm rings, clients leave the building and assemble ______________ (location).
  • Roll-call is taken and the sign-out book is checked to account for each resident/participant.
  • The person on duty will assist any disabled person from the building. Other residents/participants will assist if necessary.

Emergency drills are carried out on a regular basis.

Information on emergency evacuation procedures will, as appropriate, be provided to clients verbally, in written form, or in alternative format as earlier described.

Staff and other residents will receive training from each resident/participant with a disability in the best way to assist him/her in an evacuation.

The person(s) responsible for coordination training for emergency evacuation in our program are _____________________________________.


Whenever transportation is provided as a component of program services, _________________ (program) will provided appropriate accessible transportation to residents/participants with disabilities.

  • _______________________ (a number) of the vehicles we use for transporting clients are accessible to people who use wheelchairs.


  • We have no accessible vehicle but contract with _______________ (name of service) to provide accessible transportation services when needed.

Extracurricular Activities

Whenever extracurricular activities, such as 12-Step meetings and social, educational and recreational events, are provided or offered as a component of program services, _________________ (program) will ensure that these or other equivalent activities are accessible to persons with disabilities.

Completion and Followup

Reasonable modifications will be made to completion and followup procedures for participants with disabilities. Referrals will include accessible 12-Step meetings, group and family counseling, educational and vocational services, recreational programs, and other community resources appropriate for the individual participant.

Grievance Procedures

All participants will be informed of their right to express grievances through an effective grievance procedure. It may be used by anyone who wishes to file a complaint alleging discrimination on the basis of disability in the provision of services, activities, programs or benefits.

The complaint should be made in writing and contain information about the alleged discrimination such as name, address, phone number of complainant and location, date, and description of the problem.

Alternative means of filing complaints, such as personal interviews or tape recording of the complaint, will be made available to persons with disabilities upon request.

The complaint should be submitted to ________________ (name), _______________ (title) as soon as possible, but no later than 60 calendar days after the alleged violation.

Within 7 calendar days after receipt of the complaint, ______________ (name/title) will meet with the complainant to discuss the complaint and possible resolutions.

Within 7 calendar days after the meeting ___________ (name/title) will respond in writing, or other format accessible to the complainant and offer options for resolution.

If the client is not satisfied, he or she may appeal the matter to ___________ (name/title/agency/address/phone) who will adhere to steps "c" and "d" above.

If the client is still not satisfied, he or she may appeal to the County ADA Coordinator, ___________ (name/title/agency/address/phone).




See "Individuals with disabilities - General." The ADA, Title III TAM - 2.1000, 8.


See The Americans With Disabilities Act Handbook, Equal Employment Opportunity Commission and U.S. Department of Justice (Washington, DC: U.S. Government Printing Office, 1991), Preamble, 1.


From "Drug addition as an impairment," The Americans With Disabilities Act Title III Technical Assistance Manual (Washington, DC: Department of Justice, Civil Rights Division, Office on the Americans With Disabilities Act), III-2.3000, 9.


See The Americans With Disabilities Act Title III Fact Sheet (Washington, DC: U.S. Department of Justice, Civil Rights Division, Office on the Americans With Disabilities Act).


From Strategizer 9. Coalitions Address Americans With Disabilities, Resource Center on Substance Abuse Prevention and Disability (Washington, DC: Community Anti-Drug Coalitions of America), 3-1, 4.


See Alcohol and Other Drug Abuse Prevention for Persons With Disabilities (Washington, DC: Resource Center on Substance Abuse Prevention and Disability, 1991), 1.


From "Specialties," The Americans With Disabilities Act Title III Technical Assistance Manual (Washington, DC: U.S. Department of Justice, Civil Rights Division, Office on the Americans With Disabilities Act), III-4.2200, 22-23.


From "Drug addiction as an impairment," The Americans With Disabilities Act Title III Technical Assistance Manual, III-2.3000, 9.From "Drug addition as an impairment," The ADA Title III TAM, III-2.3000, 9.




From "Illegal use of drugs," The Americans With Disabilities Act Title III Technical Assistance Manual, III-3.9000, 18.




From "Direct threat," The Americans With Disabilities Act Title III Technical Assistance Manual, III-3.8000, 17-18.


See "Separate benefit/integrated setting," The Americans With Disabilities Act Title III Technical Assistance Manual, III-3.4000, 14, and III-3.4200, 14.


See "Separate benefit/integrated setting" and "Modifications in the regular program," The Americans With Disabilities Act Title III Technical Assistance Manual, III-3.4000 and III 3.4300, 14-15.


See "Personal services and devices," The Americans With Disabilities Act Title III Technical Assistance Manual, III 4.2600, 24.


See "Surcharges," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.1400, 22.


From "Smoking," The Americans With Disabilities Act Title III Technical Assistance Manual, III-3.10000, 18.


An analogous situation is described in "Service animals," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.2300, 23.


See "Retaliation or coercion," The Americans With Disabilities Act Title III Technical Assistance Manual, III-3.6000, 16.


See "Effective communications," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.3200, 25.


From "Examples of auxiliary aids and services," quoted from The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.3300, 26-27.


See "Effective communications," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.3200, 26.


From "Limitations and alternatives," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.3600, 27


From Ibid, 28.


See "Effective communications," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.3200, 26.


From "Outgoing calls by customers, clients, patients, or participants," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.3420, 27.


Ibid, 34.


From "Removal of barriers--General," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4100, 28-29.




See "Standards to apply," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.4300, 32.


See "Readily achievable barrier removal," The Americans With Disabilities Title III Technical Assistance Manual, III-4.4200, 29.


Ibid, 30-31.


Ibid, 29-30.


Ibid, 32.


See "Priorities for barrier removal," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.4500, 34.


Ibid, 34-35.


From "Alternatives to barrier removal--General," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.5100, 38.






From "Priorities for barrier removal," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.4500, 34.


From "Standards to apply," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.4300, 33.


See "Readily achievable barrier removal," The Americans With Disabilities Act Title III Technical Assistance Manual, III-4.4200, 31.




From "Public accommodations," The Americans With Disabilities Act Title III Technical Assistance Manual, III-1.2000, 3.


From "Maintenance of accessible features," The Americans With Disabilities Act Title III Technical Assistance Manual, III-3.7000, 17.


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