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Prevention and Intervention of Substance Use and Misuse among Persons with Intellectual Disabilities Marion Kiewik
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... Inpatient or outpatient and pharmacological or psychological interventions can all be suitable for patients regardless on their intellectual and adaptive abilities. Thus, based on a multidisciplinary assessment, each individual with substance use disorder should be offered a tailormade program to meet their individual treatment requirements (Kiewik, 2018). However, treating individuals with ID will require some adaptation (Van Duijvenbode et al., 2015). ...
... Generally, individuals with ID will need more support to be able to apply new information and skills in daily life. Welcoming a confidant within the intake and assessment procedure, and within each or alternating therapy sessions, can provide an important bridge to daily life (VanDerNagel, Kemna, Barendregt, & Wits, submitted;Kiewik, 2018). However, working within the therapist-patientconfidant triade requires specific therapist skills, especially when patient and confidant have different opinions as to the magnitude and scope of the problems, or with regard to the preferred solutions. ...
Interventions for substance use-related problems are limited for individuals with intellectual disability (ID). This is problematic, as the lack of interventions can lead to substance use initiation, progression of substance use into substance use disorder, poorer outcomes of treatment, and stigmatization of individuals with dual diagnosis. Additionally, staff who work with individuals with ID and addiction treatment lack resources to effectively help substance use in individuals with ID. Nevertheless, there has been an increase in studies assessing the feasibility and outcomes of interventions for substance use and abuse in individuals with ID. This chapter reviews psychological and pharmacological interventions for individuals with dual diagnosis of substance abuse and ID.
... Inpatient or outpatient and pharmacological or psychological interventions can all be suitable for patients regardless on their intellectual and adaptive abilities. Thus, based on a multidisciplinary assessment, each individual with substance use disorder should be offered a tailormade program to meet their individual treatment requirements (Kiewik, 2018). However, treating individuals with ID will require some adaptation (Van Duijvenbode et al., 2015). ...
... Generally, individuals with ID will need more support to be able to apply new information and skills in daily life. Welcoming a confidant within the intake and assessment procedure, and within each or alternating therapy sessions, can provide an important bridge to daily life (VanDerNagel, Kemna, Barendregt, & Wits, submitted;Kiewik, 2018). However, working within the therapist-patientconfidant triade requires specific therapist skills, especially when patient and confidant have different opinions as to the magnitude and scope of the problems, or with regard to the preferred solutions. ...
... It is often unclear whether people with ID should seek mainstream AU/AUD services or community ID services for AU/AUD (Slayter and Steenrod 2009) and there is a lack of evidence to suggest which services are more suitable (Huxley et al. 2005). Many community ID service employees do not feel adequately trained nor have the expertise to treat AUD (Kiewik 2018;Lamanna et al. 2020;Williams et al. 2018) and seek advice from mainstream AU/AUD service programs on an ad hoc basis ). In one study from the Netherlands, seventy-nine percent of community ID service employees cited a need for more knowledge and felt illequipped to treat AUD in people with ID (Van Der Nagel et al. 2011). ...
The closure of government-run institutions for people with intellectual disabilities (ID) has led to the advancement of equal rights, status, and community integration. As a result of increased community integration, people with ID now have more access and choice to consume substances such as alcohol. This becomes a significant concern insofar as alcohol use (AU) is on the rise in this population, and people with ID face many barriers to accessing AU/Alcohol Use Disorder (AUD) services. In this chapter, we explore concepts such as “Nothing About Us Without Us”, dignity of risk, choice, autonomy, and self-determination, and highlight their alignment with the principles of harm reduction. We argue that adopting a harm reduction approach is ethically justifiable for people with ID related to AU/AUD. It is crucial to have people with ID lead or be involved in harm reduction strategies to ensure the strategies are meaningful and accessible.
Little is known about rates and risk factors of substance use (SU) in individuals with mild to borderline intellectual disabilities (MBID, IQ 50–85). This hinders targeted prevention and treatment. In this study we assessed SU rates and risk factors in individuals with MBID in 419 adults (63% male, average IQ = 66) in 16 Dutch disability services. Lifetime and current SU, SU picture recognition, knowledge, attitudes and modeling were assessed with the Substance use and misuse in Intellectual Disability - Questionnaire (SumID-Q). Lifetime licit SU (alcohol and tobacco) was 97%, lifetime illicit SU (predominantly cannabis) was 50%. Current users of tobacco (62%), alcohol (64%), and cannabis (15%) initiated SU at a younger age than those who desisted SU (ps < .001). Participants with mild ID and those with borderline ID did not differ in SU rates (ps .429–.812), or age at SU initiation (ps .221–.853). Current licit SU and lifetime illicit SU were related to male gender, younger age, and (for smoking and stimulant use) to lack of daytime activities. However, these factors did not contribute to multivariate models when recognition, knowledge, attitudes and modeling were added. The models correctly identified current SU in 84% (smoking) and 74% (drinking), and lifetime SU in 76% (cannabis) and 84% (stimulants) of the participants. As almost all participants reported lifetime use of licit, and about half reported lifetime illicit substance use, systematic screening for substance use, and development of preventative and treatment interventions targeted to this group are needed.
The use and abuse of alcohol and other drugs (AOD) occurs as frequently, and perhaps more frequently among persons with disabilities. Still, rehabilitation professionals tend to minimize its occurrence, as well as the Impact of AOD misuse in the rehabilitation process. The purpose of this article is to highlight the prevalence and incidence of AOD, the effects of AOD misuse, and unique treatment issues among persons with six disabling conditions. The six disabling conditions include: (1) mental retardation, (2) learning disabled, (3) hearing impaired, (4) visually Impaired, (5) mobility Impaired, or (6) mentally ill/substance abusing.
Background and aims:
Cognitive behavioural therapy (CBT) is a promising treatment for mental health problems in people with intellectual disabilities but some may not be suited or ready. This review critically evaluates the quality and utility of measures of CBT readiness in people with intellectual disabilities.
Methods and procedures:
Twelve studies of six measures based on three aspects of CBT readiness were identified through systematic review.
Outcomes and results:
Across measures, measurement quality was largely poor or un-assessed. Only one study evaluated measurement change over the course of CBT. Not all participants with intellectual disabilities could 'pass' readiness measures and performance may be affected by levels of language and cognitive functioning. There was some evidence that CBT readiness is trainable with brief interventions.
Conclusions and implications:
Before using readiness measures in a clinical context, further work is needed to extend initial evidence on recognising cognitive mediation as a CBT readiness ability. Given the lack of consensus as to the definition of CBT readiness and the heterogeneity of CBT interventions, future research could also focus on developing readiness measures using a bottom up approach, developing measures within the context of CBT interventions themselves, before further refining and establishing their psychometric properties.
What this paper adds:
This paper is the first to systematically review measures of skills thought necessary to be ready for cognitive behavioural therapy in intellectual disabilities. The findings suggest that while readiness skills may be trainable with brief interventions, the available measures of these skills have not been fully evaluated for quality. Levels of functioning on these measures have yet to be established relative to those without intellectual disabilities and critically, there is very little evidence as to whether these skills are important in cognitive behavioural therapy process and outcome. We suggest that future research could focus on those constructs where there is preliminary evidence for utility such as recognising cognitive mediation and also on developing the concept of readiness perhaps by developing measures within the context of specific CBT interventions. Until this is done, clinicians should exercise caution in using these measures to assess readiness for cognitive behavioural therapy in people with intellectual disabilities.
Background and aims:
Adolescents with Intellectual Disability (ID) are at risk for tobacco and alcohol use, yet little or no prevention programs are available for this group. 'Prepared on time' is an e-learning program based on the attitude - social influence - efficacy model originally developed for fifth and sixth grades of mainstream primary schools. The goals of this study were (1) to examine the lifetime use of tobacco and alcohol among this target group and (2) to gain a first impression of the efficacy of 'Prepared on time' among 12-16-year old students with moderate or mild ID (MMID).
Methods and procedures:
Students form three secondary special-needs schools were assigned to the experimental (e-learning) group (n=37) or the control group (n=36). Pre-intervention and follow-up data (3 weeks after completion) were gathered using semi-structured interviews inquiring about substance use among students with MMID and the behavioral determinants of attitude, subjective norm, modelling, intention, and knowledge.
Results:
The lifetime tobacco use and alcohol consumption rates in our sample were 25% and 59%, respectively. The e-learning program had a positive effect on the influence of modelling of classmates and friends. No significant effects were found on other behavioral determinants and knowledge.
Conclusions and implications:
A substantial proportion of adolescents with MMID in secondary special-needs schools use tobacco or alcohol. This study showed that an e-learning prevention program can be feasible for adolescents with MMID.
