Severe Alcohol Use Disorder in a Patient Who Is Deaf, Mute, and Having Limited Literacy: A Case Report and Review of Disability-Linked Substance Use Vulnerabilities

Alcohol use disorder (AUD) in individuals with communication and literacy disabilities is poorly recognized and rarely described in the literature. Standard diagnostic and withdrawal management tools are not adapted for deaf, mute, and illiterate patients, creating gaps in equitable care. A 64-year-old man who was congenitally deaf, mute, and with limited literacy presented for protective-custody alcohol detoxification after decades of consuming 12-30 beers daily. Bereavement and loss of his primary caregiver triggered an escalation of use. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scoring was not feasible due to communication barriers. Management included a lorazepam taper, naltrexone initiation, mirtazapine for mood symptoms, and osteopathic manipulative treatment for somatic complaints. Interpreter-facilitated therapy and family involvement were central to stabilization. This case highlights the need for culturally and linguistically adapted withdrawal tools, early interpreter involvement, and disability-informed addiction treatment. To our knowledge, this is among the first reports describing detoxification of a deaf, mute, and illiterate patient with severe AUD, underscoring the urgency of inclusive clinical protocols.