Building The Missing Model

By Monica E. Oss, Chief Executive Officer, OPEN MINDS
September 17, 2026

Adults with disabilities had three times the rate of alcohol use disorder (AUD) than non-disabled adults. In particular, adults with serious mental illness and acquired brain injury had rates that were over 10 and five times higher than adults without these types of disabilities, respectively, according to recent research – Alcohol Use Disorder Diagnoses Among Commercially Insured US Adults From 2016 To 2023, By Disability And Sex).

Throughout the study period, people with severe mental illness exhibited the highest rates of AUD (from 988.8 per 10,000 persons in 2016 to 1051.4 in 2023). The next highest rates were demonstrated in those with acquired brain injuries (from 479 in 2016 to 595.6 in 2023), in those with other neurological disorders (298.2 in 2016 to 392 in 2023), and in those with other physical disorders (from 142 in 2016 to 207 in 2023). Individuals with intellectual and developmental disabilities (I/DD) followed, from 140.9 in 2016 to 253.5 in 2023. The lowest numbers presented in individuals who are deaf/hard of hearing (from 119.6 in 2016 to 165.2 in 2023), and blind/low vision (from 93.7 in 2016 to 135.9 in 2023).

The authors note that, “It is important for providers to know that adults with serious mental illness, acquired brain injuries, and other neurologic disorders are at particularly elevated risk. Efforts are needed to ensure that providers are aware of this risk, and that they are prepared to screen for AUD and offer evidence-based treatment services. People with disabilities may have unique needs and require person-centered alcohol treatment protocols that are designed specifically to accommodate their conditions.”

We got a detailed look at one of those specialized programs in the RECADEMY webinar, Whole Person Care For Consumers With Co-Occurring I/DD & Substance Use Disorders (SUD): How Monarch Developed A Specialized Treatment Model For A Historically Underserved Population. Todd Posey, Vice President of Clinical Best Practices at Monarch Healthcare, spoke about developing treatment models for consumers with co-occurring I/DD and SUD.

Monarch is a $115 million North Carolina non-profit provider organization serving consumers in 99 of the state’s 100 counties through more than 120 facilities. The organization has approximately 1,600 staff providing outpatient, crisis, residential, and community-based behavioral health and I/DD services.

According to Mr. Posey, the absence of established treatment models reinforced the need for innovation and thinking differently in service of consumers with co-occurring I/DD and SUD. The Monarch curriculum includes highly structured, animated educational videos designed specifically for I/DD consumers. There are 14 modules, each focused on one recovery topic. The program is intentionally flexible rather than time limited, encouraging clinicians to move at the pace of the consumer. And the materials are intentionally structured so they could be used not only by clinicians but also by caregivers, family members, case managers, and other staff supporting consumers.

“We adapted the materials for the cognitive abilities and designed them so that a caregiver or family members could go over the materials that they could then take home with them,” Mr. Posey said. “Each module focuses on one topic with multiple components, keeping it simple and concrete. The importance of that structure creates a summary of the topic, and together, the modules create a turnkey package that allows family members and caregivers to move forward with tools to help the person.”

The path to this specialized program began in 2023 through a state grant. For Monarch, the first step was to create a “work group” of approximately 15 people with lived experience, including individuals with I/DD, caregivers, and family members. Mr. Posey compiled a topical content list in conjunction with a Monarch substance abuse therapist, and the group reviewed recovery concepts related to them to help shape communications over a period of several months.

Group members emphasized the need for concrete rather than abstract concepts, repetition, simple language, and materials consumers could take home. They also cautioned the Monarch team not to make the content juvenile or talk down to adults with I/DD. In the resulting design, the Monarch team addressed the significant barriers in traditional addiction treatment, including materials built around standardized cognitive processing, abstract recovery concepts, and physical access barriers.

“They said, ‘Tell therapists to assume that we’re competent,’” said Mr. Posey. “The more that we can look at them as people and less like a population with a problem, then the better off we are in helping them.”

Mr. Posey noted that Monarch intentionally prioritized practical implementation over theoretical complexity. The curriculum is structured as a turnkey resource that can be facilitated by staff at different levels rather than depending exclusively on licensed clinicians. The organization also made the materials available at no charge so provider organizations, families, and caregivers could adopt them without creating another access barrier.

One challenge Mr. Posey identified was building workforce capability around the model. He noted that many clinicians receive little or no formal education about working with consumers with I/DD during their graduate training and may therefore lack confidence when serving this population. For Monarch, overcoming that barrier required strong executive sponsorship, cross-disciplinary collaboration, ongoing training, and leadership willing to give staff the time and authority needed to develop new expertise.

Monarch Chief Executive Officer Peggy Terhune spearheaded the initiative, dedicated staff resources to its development, and empowered Mr. Posey to lead training inside and outside the organization.

“If the senior leadership is not on board, it’s not likely to work out,” said Mr. Posey. “There has to be that buy-in on the senior management level.” But he emphasized that executive sponsorship alone is not enough. In his view, leaders also need to delegate responsibility and build additional internal champions who can extend the organization’s expertise. “When you delegate, you multiply your ability to develop your own workforce, to help others with developing theirs,” he said. “You’re able to really exponentially increase your influence when you delegate and allow others to use their strengths and skills.”

For executives looking to develop specialized services for populations that traditional treatment systems were not designed to support, Mr. Posey’s advice is to resist beginning with the limitations of the current operating model. “One of the big things is flexibility and a willingness to step outside of your comfort zone,” he said. “As Peggy, our CEO, says, look for ways to say yes. It can be easy to come up with reasons why we can’t do something, and instead, look for ways to say yes, look for ways we can make this happen.”