Substance use and misuse in persons with intellectual disabilities (ID): Results of a survey in ID and addiction services in Flanders
Introduction
In the last two decades, researchers and practitioners have shown an increasing interest in the prevalence, nature, and treatment of persons with an intellectual disability (ID) who misuse substances (Burgard et al., 2000, Chapman and Wu, 2012, Christian and Poling, 1997, Cocco and Harper, 2002, Degenhardt, 2000, Lance and Longo, 1997, Lottman, 1993, McGillicuddy, 2006, Mutsaert et al., 2007). This interest has become more prominent since the deinstitutionalization era, which has resulted in increased autonomy for people with ID in community living. Although it is undeniable that community living has many advantages for persons with ID (Van Gennep, 1997, Van Hove and van Loon, 2010, Young, 2006), community living may also cause negative consequences, such as increased stressful events and a greater exposure to alcohol and illicit drugs (Christian and Poling, 1997, Lottman, 1993). Eventually, this exposure can lead to substance misuse and other related problems (Burgard et al., 2000, Christian and Poling, 1997, Clarke and Wilson, 1999, Edgerton, 1986, Krishnef and DiNitto, 1981, Westermeyer et al., 1988).
Previous studies have indicated that persons with ID who use alcohol and/or illicit drugs seem to be at greater risk for developing substance misuse problems (Burgard et al., 2000, Degenhardt, 2000, Didden et al., 2009, Krishnef and DiNitto, 1981, McGillicuddy, 2006, Moore and Polsgrove, 1991, Slayter and Steenrod, 2009, Westermeyer et al., 1996) and other negative consequences in several domains of functioning that are (in)directly related to substance (mis)use (Didden et al., 2009, Krishnef and DiNitto, 1981, McGillivray and Moore, 2001, Taggart et al., 2006, Westermeyer et al., 1988). For example, Westermeyer et al. (1996) indicated that persons with ID appear to have a remarkably low tolerance for alcohol, which becomes apparent in marked changes in behavior or personality after only two or three alcoholic drinks. These findings suggest a blurred line between substance use and misuse in persons with ID. A better understanding of the nature of substance use and misuse in persons with ID and, more importantly, of its negative impact on this specific population is a necessary step toward supporting these vulnerable persons. Such an understanding is especially important because this group is often deprived from treatment and falls through the cracks between services. Mainstream addiction and ID services often lack the appropriate resources to identify and treat this specific population (Degenhardt, 2000, Lance and Longo, 1997, Lottman, 1993, McGillicuddy, 2006, Ruf, 1999, Slayter and Steenrod, 2009, Sturmey et al., 2003, Taggart et al., 2008, Tyas and Rush, 1991, VanderNagel et al., 2011). Compared with substance misusers without ID, persons with ID are less likely to receive treatment or to remain in treatment once started (Chapman & Wu, 2012).
In this context, Taggart et al. (2006) conducted a survey on substance misuse in persons with ID in both ID and addiction services in Northern Ireland. Questionnaires were forwarded through the managers of ID and addiction services to their team. Team members who had a person on their caseload with ID that was misusing substances were questioned about this person's characteristics, substance misuse, and how it affected his/her well-being to identify the types of services and supports required to meet the heterogeneous needs of this population. The study identified 67 adults with ID who were misusing substances. Alcohol was the main substance of misuse. Three-quarters of the sample misused alcohol for more than 5 years. Being male and young, having a borderline/mild ID, living independently, and having mental health problems were reported to be risk factors. Substance misuse was frequently associated with a range of distressing negative behaviors, which resulted in substantial problems.
However, the study by Taggart and his colleagues only examined a sample of substance misusers, leaving the larger group of substance users unexplored. Consequently, a question that remains unanswered is whether substance misuse places people with ID at risk for adverse effects on wellbeing and negative (mental) health outcomes or whether substance use in general entails similar problems.
Therefore, the current study aims to characterize the nature and consequences of substance use in a sample of substance users and misusers with ID known to ID or addiction services. In addition, the study aims to provide information regarding the service utilization of these specific groups of people with ID.
Section snippets
Setting and participants
This research was conducted in Flanders, the northern part of Belgium. The new support policy for persons with ID set out by the Flemish Ministry of Public Welfare and Public Health, named Perspective 2020, focuses on the citizenship model and person-centered support for persons with multiple problems, advocating intersectoral collaboration between various services in different fields, including special education, mental health, addiction and ID. Therefore, the Flemish situation lends itself
Client characteristics
The informants reported a total of 104 substance (mis)users with ID. The sample consisted of 44 substance users and 60 substance misusers. Their characteristics are listed in Table 1. The majority of the sample was male, had a partner, had no children, and had attended school, primarily in special schools for persons with ID. The age distribution of the identified group ranged between 21 and 75 years old, with a mean age of 39 years (n = 103). No significant differences were found between the
Discussion
This study examined the situation of 104 substance users and misusers with ID who utilized ID or addiction services in Flanders, of whom 44 were substance users and 60 were substance misusers. This anonymous information was gathered through professionals working with these persons. The characteristics of the identified clients and their substance (mis)use, the effects of substance use and misuse on their behavior and life, and their service use will be discussed in relation to the international
Conclusions
This study has demonstrated that substance misusers and substance users with ID experience negative consequences due to their (mis)use. Overall, few differences were found between the two groups. This underscores the importance of closely monitoring substance use in persons with ID. Substance misusers were found to have more mood changes, more suicidal ideation/thoughts, and more negative long-term consequences on health, daily activities and personal relationships due to substance misuse.
Acknowledgements
This research was financed by the Research Fund of University College Ghent. The authors would like to thank all participants of the study for their valued contribution. Furthermore, the authors would like to express their gratitude to Kurt Lievens, Vincent Vandenbussche and Sven Cole of the Regional Board on Mental Health Care of East-Flanders (PopovGGZ) and the master-level students at the Ghent University, Jo Vande Walle and Silke Partous, for their help in collecting the data. The authors
References (45)
- et al.
Recreational substance use patterns and co-morbid psychopathology in adults with intellectual disability
Research in Developmental Disabilities
(2011) - et al.
Substance abuse, coping strategies, adaptive skills and behavior and emotional problems in clients with mild to borderline intellectual disability admitted to a treatment facility: A pilot study
Research in Developmental Disabilities
(2009) - et al.
Dual diagnosis: A review of etiological theories
Addictive Behaviors
(1998) - et al.
Health characteristics and behaviors of adults with mental retardation residing in three living arrangements
Research in Developmental Disabilities
(1995) Definition of intellectual disability
(2013)Triple diagnosis: Substance abuse, mental illness and mental retardation
(2000)- et al.
Towards the integration of treatment systems for substance abusers: Report on the second international symposium on substance abuse treatment and special target groups
Journal of Psychoactive Drugs
(2003) - et al.
Prevalence and treatment of substance abuse in the mentally retarded population: An empirical review
Journal of Psychoactive Drugs
(2000) - et al.
Substance abuse among individuals with intellectual disabilities
Research in Developmental Disabilities
(2012) - et al.
Drug abuse in persons with mental retardation: A review
American Journal of Mental Retardation
(1997)
Alcohol problems and intellectual disability
Journal of Intellectual Disability Research
Substance use in people with mental retardation: A missing link in understanding community outcomes
Rehabilitation Counseling Bulletin
Interventions for people with alcohol use disorders and an intellectual disability: A review of the literature
Journal of Intellectual and Developmental Disabilities
Drinking patterns of mentally retarded persons
Alcohol Health and Research World
Alcohol and drug use by mentally retarded adults
American Journal of Mental Deficiency
Substance misuse and the need for integrated services
Learning Disability Practice
‘You can’t do it… it's theory rather than practice’: Staff use of the practice/principle rhetorical device in talk on empowering people with learning disabilities
Discourse and Society
An introduction to therapeutic communities
Alcohol abuse among mentally retarded individuals
Mental Retardation
Mental health aspects of developmental disabilities
The Habilitative Mental Healthcare Newsletter
Access to generic substance abuse services for persons with mental retardation
Journal of Alcohol and Drug Education
A review of substance use research among those with mental retardation
Mental Retardation and Developmental Disability Research Reviews
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