Substance abuse, coping strategies, adaptive skills and behavioral and emotional problems in clients with mild to borderline intellectual disability admitted to a treatment facility: a pilot study

Addictive disorders, psychiatric symptoms, and potentially traumatic events in individuals with disabilities

Background/Objectives

Individuals with disabilities (IWD) have a higher risk of potentially traumatic events (PTEs) either in childhood or adulthood, increasing the risk of suicide attempts, mental disorders, and substance use disorder. The aim of this study was to explore the association between substance use, psychiatric symptoms and suicidal behavior with PTEs. A Multisite cross-sectional study was conducted.

Materials and methods

The sample includes 1,098 participants with any type of disability (motor, intellectual, visual, and mixed) located in Mexico City. Traumatic events, violence, discrimination, addictive disorders, and psychiatric disorders were examined. Multivariate logistic regression models were conducted. Data was collected between September–October 2014.

Results

People with motor or visual disability have a higher prevalence in nicotine use disorder (NUD), generalize anxiety disorder (GAD), mayor depression disorder (MDD), want to be dead, and lifetime suicide attempts. Intellectual disability group only presents GAD and MDD. All disability groups have a high prevalence of PTEs. Verbal violence in childhood, sexual abuse, discrimination and serious accidents had a strong impact in the development of NUD, psychiatric symptoms and suicidal behavior.

Conclusion

These findings show the relevance of develop specific tools for detection, referral and treatment, in order to improve the mental health of people with disabilities.

Analysing trends of psychiatric disorders, treatment and service use across time in adults with borderline intellectual impairment: A cross-sectional study of private households

While there is evidence that mental health problems are more prevalent in people with borderline intellectual functioning (BIF) compared to the general population, it is not known to what extent this has varied or changed over time and whether there have been changes in access to services. This paper compares the prevalence rates of psychiatric disorders and monitors trends in treatment and services in this population compared to the general population. We conducted secondary analysis on the Adult Psychiatric Morbidity Surveys carried out in England in 2000, 2007 and 2014. The total sample analysed included 21,796 participants, with 12.8% of individuals identified with BIF (n = 2786). Regression models were used to examine trends in psychiatric disorders, treatment and service use across the three datasets. People with BIF had significantly higher odds of developing mood and anxiety disorders, psychosis, drug dependence and suicidal behaviour than the general population, increasing at each subsequent timepoint. They received significantly more pharmacological treatments than the general population but have had increasingly more access to general practitioners, community care and daycare services over time. This study shows increasing prevalence rates of several mental disorders in people with BIF. Access to day-care, community care and healthcare services has increased over time for this group but not formal psychiatric care. These changes over time underline some of the problems this population faces, emphasizing a need to recognize that this is a population often overlooked in research and clinical practice.

Self-Report Stress Measures to Assess Stress in Adults With Mild Intellectual Disabilities-A Scoping Review

Stress has a major negative impact on the development of psychopathology and contributes to the onset of adverse physical conditions. Timely recognition and monitoring of stress-related problems are therefore important, especially in client populations that are more vulnerable to stress, such as people with mild intellectual disabilities (MID). Recent research on the use of physiological measures to assess stress levels emphasize that, in addition to these measures, self-report instruments are necessary to gain insight into the individual perception and impact of stress on daily life. However, there is no current overview of self-report stress measures that focus on the experience of stress in the present moment or in daily life. To provide an overview of the existing self-report stress measures for clinicians and researchers, a scoping review was conducted. In addition, to advise clinical professionals on the use of self-report measures of stress for people with MID, the results of an expert consultation were used to refine the preliminary findings. A systematic scoping literature search resulted in a total of 13 self-reported stress measures that met the final inclusion criteria, of which three were developed specifically for assessing stress in adults with MID (GAS-ID, LI, and SAS-ID). For each included self-report stress measure, the psychometric quality, assessment procedure, and suitability for adults with MID were reported. These were supplemented by the findings from the expert consultation. Implications for clinical practice on the use of self-report stress measures, particularly for people with MID, are discussed. Recommendations for future research and development are given.

Exploring the role of emotional and behavioral problems in a personality-targeted prevention program for substance use in adolescents and young adults with intellectual disability

BACKGROUND

Adolescents and young adults with a mild intellectual disability or borderline intellectual functioning (MID-BIF) are at risk for problematic substance use and are more likely to have emotional and behavioral problems than peers without MID-BIF. A personality-targeted prevention program called Take it Personal! effectively reduces substance use in adolescents and young adults with MID-BIF.

AIMS

The program's effectiveness was examined on its secondary goal: reducing emotional and behavioral problems. The potentially moderating role of these problems on the program's effectiveness with substance use was also explored.

METHODS AND PROCEDURES

Substance use and emotional and behavioral problems were compared between participants in Take it Personal! (n = 34) and those in the control condition (n = 32) in a quasi-experimental pre-posttest study with a three-month follow-up. Effectiveness and moderation were assessed with multilevel models.

OUTCOMES AND RESULTS

Take it Personal! seems to reduce rule breaking. There were no significant effects on anxiety, withdrawal, and aggression. None of the problem domains moderated the program's effectiveness on substance use frequency.

CONCLUSIONS AND IMPLICATIONS

Take it Personal! may effectively reduce rule breaking. Moreover, adolescent and young adults with different levels of emotional and behavioral problems benefit equally in terms of reduced substance use.

Prevalence and Characteristics of Borderline Intellectual Functioning in a Cohort of Patients With Polysubstance Use Disorder

Objective: To determine the prevalence and associated demographic and clinical features of borderline intellectual functioning (BIF) among individuals with polysubstance use disorder (pSUD). Methods: We applied a cross-sectional analytical design to data from the Norwegian STAYER study (n = 162), a cohort study of patients with a pSUD from the Stavanger University hospital catchment area. We used Wechsler Abbreviated Scale of Intelligence Full Scale IQ (FSIQ) to define BIF (FSIQ = 70-85) and non-BIF (FSIQ = >85) and collected demographic and clinical data using semi-structured interviews and self-reports on the Symptom Checklist 90-Revised (SCL-90-R) and the Satisfaction With Life Scale (SWLS). Results: The prevalence of BIF was 18% in the present study. The presence of BIF was associated with higher SCL-90-R GSI scores than in the non-BIF group. There were no significant differences between the BIF and non-BIF groups regarding age, gender, participation in meaningful daily activity, years of work experience, years of education, satisfaction with life, level of care, treatment attempts, age at substance-use onset, years of substance use, history of injecting drugs, or age of onset of injecting drugs. Conclusion: The present study confirmed a higher prevalence of BIF among patients with pSUD than expected from the distribution of IQ scores in a general population. Elevated SCL-90-R GSI scores suggested that BIF is associated with increased psychological distress in patients receiving treatment for pSUD. Further studies on this association, and its effect on treatment procedure and outcomes are strongly warranted.

Music Therapy Interventions for Stress Reduction in Adults With Mild Intellectual Disabilities: Perspectives From Clinical Practice

Stress is increasingly being recognized as one of the main factors that is negatively affecting our health, and therefore there is a need to regulate daily stress and prevent long-term stress. This need seems particularly important for adults with mild intellectual disabilities (MID) who have been shown to have more difficulties coping with stress than adults without intellectual disabilities. Hence, the development of music therapy interventions for stress reduction, particularly within populations where needs may be greater, is becoming increasingly important. In order to gain more insight into the practice-based knowledge on how music therapists lower stress levels of their patients with MID during music therapy sessions, we conducted focus group interviews with music therapists working with adults with MID (N = 13) from different countries and clinical institutions in Europe. Results provide an overview of the most-used interventions for stress reduction within and outside of music. Data-analysis resulted in the further specification of therapeutic goals, intervention techniques, the use of musical instruments, and related therapeutic change factors. The main findings indicate that music therapists used little to no receptive (e.g., music listening) interventions for stress reduction, but preferred to use active interventions, which were mainly based on musical improvisation. Results show that three therapy goals for stress relief could be distinguished. The goal of “synchronizing” can be seen as a sub goal because it often precedes working on the other two goals of “tension release” or “direct relaxation,” which can also be seen as two ways of reaching stress reduction in adults with MID through music therapy interventions. Furthermore, the tempo and the dynamics of the music are considered as the most important musical components to reduce stress in adults with MID. Practical implications for stress-reducing music therapy interventions for adults with MID are discussed as well as recommendations for future research.

Chronic alcoholism and all-cause mortality among disabled individuals: Findings from the Korea National Health Insurance Service-National Sample Cohort

BACKGROUND

Alcohol use among adults with mild to severe disability is an under-researched topic in the literature. Few studies have attempted to assess the impact of alcohol misuse, abuse, and chronic alcoholism among this target group. Thus, we investigated the association between chronic alcoholism and mortality among disabled individuals in South Korea.

METHODS

We used data from the National Health Insurance Service National Sample Cohort (NHIS-NSC) for the years 2003-2013, which included data on 61,013 disabled individuals. Among these patients, a multivariate Cox proportional hazards model was used to estimate the hazard ratio of mortality associated with chronic alcoholism.

RESULTS

A total of 800 individuals died during the study period. Individuals who had medical claims for chronic alcoholism following their disability diagnosis had greater risk of mortality than individuals without chronic alcoholism (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.06-2.31, p = 0.0244). Individuals with a physical disability (HR: 2.30, 95% CI: 1.06-4.95, p = 0.0342), brain lesion (HR: 1.96, 95% CI: 1.03-3.74, p = 0.0405), and/or kidney failure (HR: 4.98, 95% CI: 1.07-23.25, p = 0.0411) had greatest mortality risk when diagnosed with chronic alcoholism, compared to individuals who were not diagnosed with chronic alcoholism.

CONCLUSIONS

Chronic alcoholism following disability diagnosis was associated with greater mortality risk in a nationally representative population of disabled individuals, especially among individuals with a physical disability, brain lesion, and/or kidney failure. Such findings reveal that certain social and political measures must be implemented to help disabled individuals suffering from alcoholism, especially according to disability diagnosis.

Effectiveness of a mindfulness-oriented substance use prevention program for boys with mild to borderline intellectual disabilities: study protocol for a randomised controlled trial

BACKGROUND

Boys with mild to borderline intellectual disabilities (MBID) are at particular risk to drink in harmful ways once they start to consume alcohol. Interventions based on mindfulness have been proven to be effective in preventing substance use, but mostly for adults with MBID. A mindfulness oriented intervention targeting 11-17 years old boys will be tested in a randomised controlled trial. Study aim is to investigate the benefits of this new intervention compared to an active control condition within a 12 months follow-up.

METHODS

In this randomised controlled proof of concept study, 82 boys with MBID who consumed any alcohol during the last year will be randomised either to the 6 week mindfulness oriented intervention or the control group receiving a control intervention equal in dose and length. The intervention group undergoes mindfulness training combined with interactive drug education, while the control group completes a health training combined with the same education. In the intention-to-treat analysis the primary outcome is the self-reported delay of first post-intervention drunkeness within a 12 months follow-up time span, measured weekly with a short app-based questionnaire. Secondary outcome is the use of alcohol, tobacco and other drugs within 30 days post-intervention. Changes in neurobiological behavioural parameters, such as impulse control, reward anticipation, and decision making, are also investigated. Other secondary outcomes regard trait mindfulness, emotion regulation, psychopathological symptoms, peer networks, perceived stress, and quality of life. In addition, a prospective registry will be established to record specific data on the population of 11-17 year old boys with MBID without any alcohol experience.

DISCUSSION

This study offers the opportunity to gain first evidence of the effectiveness of a mindfulness-oriented program for the prevention of substance use for boys with MBID.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00014042 . Registered on March 19th 2018.

Behavioural, psychiatric and psychosocial factors associated with aggressive behaviour in adults with intellectual disabilities: A systematic review and narrative analysis

Background

Aggressive behaviour is prevalent in people with intellectual disabilities. To understand the aetiology, it is important to recognize factors associated with the behaviour.

Method

A systematic review was conducted and included studies published between January 2002 and April 2017 on the association of behavioural, psychiatric and psychosocial factors with aggressive behaviour in adults with intellectual disabilities.

Results

Thirty‐eight studies were included that presented associations with 11 behavioural, psychiatric and psychosocial factors. Conflicting evidence was found on the association of these factors with aggressive behaviour.

Conclusions

The aetiology of aggressive behaviour is specific for a certain person in a certain context and may be multifactorial. Additional research is required to identify contributing factors, to understand causal relationships and to increase knowledge on possible interaction effects of different factors.

Intelligenzminderung und Schuldfähigkeit

Wer zur Frage der Schuldfähigkeitsbeurteilung bei Intelligenzminderung in forensisch-psychiatrischen Lehrbüchern nachschlägt, findet vielfach und teils sehr anschaulich in schematischer Aufbereitung eine Beurteilungsmaßgabe, dass bei schwerster und schwerer Intelligenzminderung die Einsichtsfähigkeit aufgehoben, bei mittelgradiger Intelligenzminderung teils die Einsichts- und teils die Steuerungsfähigkeit aufgehoben und bei leichter Intelligenzminderung entweder die Einsichtsfähigkeit oder die Steuerungsfähigkeit entweder vermindert oder aufgehoben seien. Eine psychopathologische Fundierung dieser Leitsätze oder eine Darlegung möglicher Begründungswege von Fähigkeitsbeeinträchtigungen entsprechend den §§ 20, 21 StGB wird jedoch in aller Regel nicht geboten. Nachfolgend soll versucht werden, unter Bezugnahme auf aktuelle diagnostische Kriterien und Konzeptionen der Intelligenzminderung, die über die isolierte Bestimmung eines IQ-Werts hinausweisen, weitere Orientierung bei der Schuldfähigkeitsbeurteilung von Straftätern mit Intelligenzminderung zu bieten.

Evaluating a personalized treatment for substance use disorder in people with mild intellectual disability or borderline intellectual functioning: A study protocol of a multiple baseline across individuals design

BACKGROUND

The prevalence of substance use disorder (SUD) in people with Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF) is high. However, an effective personalized treatment for people with MID-BIF and SUD is lacking. This paper describes the study protocol of the effectiveness study of Take it Personal!+, a personalized treatment for people with MID-BIF and SUD.

METHODS

The effectiveness of Take it Personal!+ in decreasing substance use will be assessed in a non-concurrent multiple baseline across individuals design comprising ten participants with MID-BIF and SUD. The participants with MID-BIF and SUD will be randomly allocated to one of the five baseline lengths (7-11 days). Substance use, will be assessed during baseline, intervention, and post-treatment phase using a daily diary method.

DISCUSSION

If this study shows that Take it Personal!+ is effective in decreasing substance use, the gap in treatment for people with MID-BIF and SUD will be filled.

TRIAL REGISTRATION

The study is registered in the Netherlands Trial Register (Trial NL4935, registered July 2, 2019).

Emotional Awareness and Cognitive Performance in Borderline Intellectual Functioning Young Adolescents

According to DSM-5 and ICD-10, borderline intellectual functioning (BIF) should not be classified properly as a disorder. However, BIF people may present relevant problems of adaptive functioning in several areas of daily activities, and they seem to be more vulnerable to mental diseases. Young adolescence may be considered a particular period for emotional information processing. The "own and others' emotions" awareness can play a crucial role in many daily life situations, such as decision making, interpersonal relationships, and decoding of facial expressions. On this background, a BIF young adolescents group underwent a neuropsychological assessment including emotional and cognitive domains, and was compared with a healthy young adolescents control group (HC). In the overall sample, a significant negative correlation between general intellectual abilities and emotional awareness was found. The BIF group showed a significantly greater level of alexithymia and a poorer performance in higher cognitive tasks than HC group. As hypothesized, a border cognitive functioning influences mentalization processes as ability to discriminate and monitor emotions, as well as higher domains of cognition.

Validation of assistive technology on psychoactive substances for visually impaired people

PURPOSE

To validate the assistive technology "Drugs: reflection for prevention" to be used with visually impaired people.

METHOD

Quantitative and quasi-experimental study, contrasting knowledge before and after the use of the assistive technology with 140 visually impaired people in institutes and associations for people with visual impairment. A questionnaire with identification data, a pre-test, a post-test and a questionnaire to assess the assistive technology were applied. Data were described through means and standard deviations, and analyses included the McNemar test, the exact binomial distribution test, and the intraclass correlation coefficient.

RESULTS

Participants were male (65.7%), 84.3% were blind, aged 37.1 years on average and with schooling of 10.1 years on average. There were more correct answers in the post-test (p <.001). The attributes of the assistive technology were considered adequate: objectives, access, clarity, structure and presentation, relevance and efficacy, and interactivity (p <.001).

CONCLUSIONS

The assistive technology "Drugs: reflection for prevention" was considered valid and reliable to inform visually impaired people about psychoactive substance abuse. Implications for rehabilitation Created new tool for prevention substance abuse that can be accessed easily. Improved information about substance psychoactive for users of the assistive technology. Improved quality of life for its users.

A Systematic Review of Substance Use (Disorder) in Individuals with Mild to Borderline Intellectual Disability

Although the attention for substance use (SU) and SU disorders (SUD) among individuals with mild to borderline intellectual disability (MBID) has been growing exponentially, this form of dual diagnosis has largely been ignored by addiction medicine. In this article, we systematically review the research between January 2000 and June 2018 on the prevalence, assessment, and treatment of SU(D) among children, adolescents, and adults with MBID. A total of 138 articles were included. It is concluded that individuals with MBID are likely to be at a higher risk for developing SUD compared to those without MBID. Future research should focus on the detection of MBID among patients being treated in addiction medicine, the development and implementation of systematic assessment methods of SU(D) among individuals with MBID, and the development and evaluation of prevention and treatment interventions. System integration, interdisciplinary collaboration, and the development of tailored treatment for individuals with MBID are advised to improve treatment access and outcome for those who have developed SUD.

Cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability

We examined cognitive deficits in problematic drinkers with and without mild to borderline intellectual disability (MBID). Problematic drinkers were expected to show a significantly lower estimated performance IQ (PIQ), but not a lower estimated verbal IQ (VIQ), compared to light drinkers. Participants ( N = 474) were divided into four groups based on IQ and severity of alcohol use-related problems. IQ was estimated using (a short form of) the Wechsler Adult Intelligence Scale third edition. Severity of alcohol use-related problems was assessed using the Alcohol Use Disorder Identification Test. Overall, there were no significant differences between light and problematic drinkers on estimated VIQ. Within the group without MBID, estimated PIQ was significantly lower. Estimated PIQ was not lower in problematic drinkers with MBID compared to light drinkers with MBID. The results are indicative of cognitive deficits in problematic drinkers without MBID. Screening for cognitive deficits with additional instruments is advised.

Development and evaluation of a manual for extended brief intervention for alcohol misuse for adults with mild to moderate intellectual disabilities living in the community: The EBI-LD study manual

BACKGROUND

Extended brief interventions for alcohol misuse are effective in the general population. The process of manualising the first ever such intervention for people with mild to moderate intellectual disabilities in the UK is the focus of this study.

METHODS

The manual was an adaptation of existing manuals based on Motivational Enhancement and Cognitive Behaviour Therapy and was used in a feasibility randomized controlled trial, the EBI-LD study. The sessions were recorded and scored using an adapted version of the Yale Adherence and Competence Scale (YACS II). Feedback was provided by therapists. The trial is closed. Registered: isrctn.com; ISRCTN58783633.

RESULTS

The quality of the sessions provided was rated as good. Therapists were able to cover all topics within each session. Main challenges included session duration and homework task completion.

CONCLUSIONS

We recommend the duration of the sessions to be extended to 40 min to accommodate carers in the session and to enhance their support in homework task completion.

The effect of slow-paced breathing on stress management in adolescents with intellectual disability

BACKGROUND

Intellectual disabilities often create a state of chronic stress for both the person concerned and their significant others (family, caregivers). The development of stress management methods is therefore important for the reduction of stress in persons with intellectual disability. The aim of this experiment was to investigate the effect of slow-paced breathing on stress symptoms experienced by adolescents with intellectual disabilities during a cognitive task under time pressure.

METHOD

Fourteen adolescents with intellectual disabilities (M_age  = 17.39 years, range 15-19 years) took part in two laboratory sessions - a slow-paced breathing session (experimental condition) and an audiobook session (control condition) - the order of which was counterbalanced across participants. Vagal tone was measured through heart rate variability to index stress management.

RESULTS

No difference in vagal tone was observed at baseline between experimental and control conditions. Compared with the control condition, vagal tone was significantly higher during the experimental condition.

CONCLUSIONS

The slow-paced breathing task enhanced stress management to a greater extent than did listening to an audiobook. Slow-paced breathing seems to be an easy to learn stress management technique that appears as an effective auxiliary method of lowering stress in adolescents with intellectual disabilities.

Assessment and Treatment for Persons with Coexisting Ability and Substance Use Issues: A Review and Analysis of the Literature

Persons with ability issues are at considerably higher risk to develop substance use problems when compared to the general population. Yet, little is known about the current status of substance use treatment for this population. A comprehensive search of the literature revealed a need for (a) population-specific instruments for screening and assessment of the use of alcohol and drugs, including the misuse of prescription medication; (b) tailored treatment methods and individualized treatment plans that meet diverse literacy or cognitive needs;

Mild or borderline intellectual disability as a risk for alcohol consumption in adolescents - A matched-pair study

BACKGROUND

Studies that investigate the association between mild or borderline intellectual disability (MBID) and alcohol use in adolescents have not examined whether MBID is an independent risk factor for drinking.

AIM

It is important to examine whether MBID is a risk factor for alcohol consumption by controlling concomitant factors in a matched-pair design.

METHOD

Overall, 329 students from two schools for children with MBID self-reported their drinking behavior via questionnaires, and 329 students from regular schools were matched to this group by gender, age, family composition, and parental drinking behavior. Matched pairs were compared based on alcohol consumption and motivation to drink.

RESULTS

MBID is a protective factor, as disabled adolescents drink less on average. This effect is mainly due to larger proportions of youth with MBID who are abstinent. When male adolescents with MBID begin to drink, they are at an increased risk for intoxication and subsequent at-risk behaviors. Motivations to drink were explained by an interaction between MBID and consumption patterns.

CONCLUSIONS

For male adolescents with MBID, there appears to be an "all-or-nothing" principle that guides alcohol consumption, which suggests a need for special interventions for this group.

Predictors of self-reported alcohol use and attitudes toward alcohol among 11-year-old British children with and without intellectual disability

BACKGROUND

Reducing harmful levels of alcohol consumption among children is an important public health concern internationally and in many high income countries. Little is known about levels and predictors of alcohol use among children with intellectual disability (ID).

METHOD

Secondary analysis of child self-report data at age 11 years collected in the UK's Millennium Cohort Study.

RESULTS

Children with ID were significantly more likely to: have used alcohol in the last 4 weeks; to have had five or more alcoholic drinks on one occasion; to have had five or more alcoholic drinks or been intoxicated on one occasion; to have more positive attitudes about the psychological and social benefits of drinking; and to have less negative attitudes about the social and physical costs of drinking. Potentially harmful levels of drinking (intoxication or 5+ alcoholic drinks on one occasion) among children with ID were associated with child smoking, having friends who use alcohol, reporting that drinking makes it easier to make friends, and reporting that drinking reduces worrying. Children with ID accounted for 9% of all children with potentially harmful levels of drinking.

CONCLUSION

Public health interventions to reduce potentially harmful drinking among children in general must recognise that children with ID are a potentially high risk group and ensure that interventions are appropriately adjusted to take account of their particular needs and situation. Future research in this area is needed to untangle the causal pathways between attitudes toward alcohol and alcohol use among children with ID and the extent to which levels of alcohol use and predictors of alcohol use may be moderated by severity of ID.

It is time to bring borderline intellectual functioning back into the main fold of classification systems

Borderline intellectual functioning is an important and frequently unrecognised comorbid condition relevant to the diagnosis and treatment of any and all psychiatric disorders. In the DSM-IV-TR, it is defined by IQ in the 71-84 range. In DSM-5, IQ boundaries are no longer part of the classification, leaving the concept without a clear definition. This modification is one of the least highlighted changes in DSM-5. In this article we describe the history of the classification of borderline intellectual functioning. We provide information about it and on the importance of placing it in the right context and in the right place in future DSM editions and other classification systems such as the International Classification of Diseases.

The Role of Executive Control and Readiness to Change in Problematic Drinkers with Mild to Borderline Intellectual Disability

BACKGROUND

Problematic alcohol use is associated with neuropsychological consequences, including cognitive biases. The goal of the study was to explore the moderating role of executive control and readiness to change on the relationship between alcohol use and cognitive biases in light and problematic drinkers with and without mild to borderline intellectual disability (MBID).

METHOD

Participants (N = 112) performed the visual dot probe task to measure the strength of the cognitive biases. Executive control was measured using two computerised tasks for working memory capacity (Corsi block-tapping task) and inhibitory control (Go/No-go task). Readiness to change was measured using the Readiness to Change Questionnaire.

RESULTS

No cognitive biases or executive dysfunctions were found in problematic drinkers. Working memory capacity and inhibitory control were impaired among individuals with MBID, irrespective of severity of alcohol use-related problems. Executive control and readiness to change did not moderate the relationship between alcohol use and cognitive biases.

CONCLUSION

The results fail to support the dual-process models of addiction, but results need to be treated with caution given the problematic psychometric qualities of the visual dot probe task. Implementing a neurocognitive assessment and protocols in the treatment of substance use disorders seems premature.

Pretreatment for substance-abusing people with intellectual disabilities: intervening on autonomous motivation for treatment entry

BACKGROUND

Despite a lack of consensus regarding prevalence rates of substance abuse, people with intellectual disabilities (ID) on average use substances slightly less often than their non-disabled peers. However, their use of substances is more often problematic. Avoidance of treatment is a crucial problem among substance-abusing people with ID. This study tested a motivational intervention to facilitate autonomous motivation (i.e. wanting to change substance abuse because of a sense of free choice and volition) for engaging with a subsequent addiction treatment.

METHOD

A multiple-case experimental design (N = 6) was conducted to measure day-to-day motivation to change substance abuse among individuals with mild ID (N = 3) and borderline level of intellectual functioning (N = 3) in the Netherlands. The participants (five men, one woman) lived in the community (except one, he lived in a residential facility) and abused cannabis, alcohol or hashish. During the intervention phase, the 10-session treatment programme 'Beat the kick' was delivered by an experienced psychologist, based on motivational interviewing techniques adapted for people with mild to borderline ID. Participants completed an adaptive self-reported inventory based on self-determination theory (SDT) two to three times a week during baseline, intervention and 1-month follow-up.

RESULTS

The results of five of the six participants (one dropped out) showed that the type of motivation changed from more controlled types of motivation (i.e. external motivation and introjected motivation) at baseline to more autonomous types of motivation after completion of the intervention. In addition, the participants reported a significant increase in overall need satisfaction and autonomy satisfaction and a significant decrease of overall need frustration.

CONCLUSIONS

The implementation of SDT and motivational interviewing principles in the treatment programme 'Beat the kick' reliably changed the type of motivation. In addition, the experimental effects provide initial proof of the use and applicability of SDT among people with ID.

Extended brief intervention to address alcohol misuse in people with mild to moderate intellectual disabilities living in the community (EBI-ID): study protocol for a randomised controlled trial

Background

There is some evidence that people with intellectual disabilities who live in the community are exposed to the same risks of alcohol use as the rest of the population. Various interventions have been evaluated in the general population to tackle hazardous or harmful drinking and alcohol dependence, but the literature evaluating interventions is very limited regarding intellectual disabilities. The National Institute for Health and Clinical Excellence recommends that brief and extended brief interventions be used to help young persons and adults who have screened as positive for hazardous and harmful drinking. The objective of this trial is to investigate the feasibility of adapting and delivering an extended brief intervention (EBI) to persons with mild/moderate intellectual disability who live in the community and whose level of drinking is harmful or hazardous.

Methods/Design

The study has three stages, which include the adaptation of the Extended Brief Intervention (EBI) for people with intellectual disability, a single blind, randomised controlled trial of an individual Extended Brief Intervention to test the feasibility of the intervention, and a qualitative study that will assess the perceived acceptability and usefulness of the intervention. Fifty participants in total will be recruited from community intellectual disability services and social care or third sector organisations. The main outcome is a reduction in alcohol consumption measured by the Alcohol Use Disorders Identification Test.

Discussion

Alcohol misuse is a relatively under-researched mental health problem in people with intellectual disabilities. Therefore, the study addresses both diagnostic issues and the delivery of a simple first stage intervention, which is available to the population of average intelligence and young persons in particular. The findings from the study will guide the preparation of a large-scale study to test whether this treatment is clinically and cost-effective in this population.

Trial registration

ISRCTN58783633 (19 December 2013).

Substance use disorders in individuals with mild to borderline intellectual disability: current status and future directions

Knowledge regarding substance use (SU) and substance use disorder (SUD) in individuals with mild to borderline intellectual disabilities (ID) has increased over the last decade, but is still limited. Data on prevalence and risk factors are fragmented, and instruments for screening and assessment and effective treatment interventions are scarce. Also, scientific developments in other fields are insufficiently incorporated in the care for individuals with ID and SUD. In this selective and critical review, we provide an overview of the current status of SU(D) in ID and explore insights on the conceptualisation of SUD from other fields such as addiction medicine and general psychiatry. SU(D) turns out to be a chronic, multifaceted brain disease that is intertwined with other physical, psychiatric and social problems. These insights have implications for practices, policies and future research with regard to the prevalence, screening, assessment and treatment of SUD. We will therefore conclude with recommendations for future research and policy and practice, which may provide a step forward in the care for individuals with ID and SUD.

Capture recapture estimation of the prevalence of mild intellectual disability and substance use disorder

Persons with mild to borderline intellectual disability (MID) have been identified as a group at risk for substance use disorder (SUD). However, prevalence estimates of co-occurring SUD and MID rely largely on single source studies performed in selected samples. To obtain more reliable population estimates of SUD and MID, this study combines data from an Intellectual Disability Facility (IDF), and an Addiction Treatment Centre (ATC) in a semi-rural area in the Netherlands. Capture-recapture analysis was used to estimate the hidden population (i.e., the population not identified in the original samples). Further analyses were performed for age and gender stratified data. Staff members reported on 88 patients with SUD and MID in the IDF (4.0% of the IDF sample) and 114 in the ATC (5.2% of the ATC sample), with 12 patients in both groups. Only strata for males over 30 years provided reliable population estimates. Based on 97 patients in these strata, the hidden population was estimated at 215. Hence the estimated total population of males over 30 years old with MID and SUD was 312 (95% CI 143-481), approximately 0.16% (0.05-0.25%) of the total population of this age and gender group. This illustrates that while patients with co-occurring SUD and MID often receive professional help from only one service provider, single source data underestimate its prevalence, and thus underestimate treatment and service needs. Therefore, population prevalence estimations of co-occurring SUD and MID should be based on combined multiple source data.

Intellectual disability among Dutch homeless people: prevalence and related psychosocial problems

Background

There is a higher prevalence of intellectual disability (ID) among homeless people than in the general population. However, little is known about the additional psychosocial problems faced by homeless people with ID. We describe the prevalence of ID in a cohort of homeless people in the Netherlands, and report relationships between ID and psychosocial problems in terms of psychological distress, substance (mis)use and dependence, as well as demographic characteristics in this cohort.

Methods

This cross-sectional study is part of a cohort study among homeless people in the four major cities of the Netherlands. Data were derived from 387 homeless people who were interviewed and screened for ID six months after the baseline measurement. Multivariate logistic regression analyses and χ² tests were performed to analyze relationships between ID, psychosocial problems and demographic characteristics.

Findings

Of all cohort members, 29.5% had a suspected ID. Participants with a suspected ID had a higher mean age, were more likely to be male and to fall in the lowest category of education than participants without a suspected ID. Having a suspected ID was related to general psychological distress (OR  = 1.56, p<0.05), somatization (OR  = 1.84, p<0.01), depression (OR  = 1.58, p<0.05) and substance dependence (OR  = 1.88, p<0.05). No relationships were found between a suspected ID and anxiety, regular substance use, substance misuse and primary substance of use.

Conclusion

The prevalence of ID among Dutch homeless people is higher than in the general population, and is related to more psychosocial problems than among homeless people without ID. Homeless people with a suspected ID appear to be a vulnerable subgroup within the homeless population. This endorses the importance of the extra attention required for this subgroup.

Substance use and misuse in persons with intellectual disabilities (ID): results of a survey in ID and addiction services in Flanders

Little is known about the characteristics of substance users with intellectual disabilities (ID). Nevertheless, this group is assumed to be at greater risk of developing substance misuse problems. This study focuses on substance users and misusers with ID, and investigates whether the two groups differ significantly in terms of the nature and consequences of their substance (mis)use. Information regarding the characteristics of the substance (mis)users, the substances used, the negative consequences of substance (mis)use, and the service use was collected through a questionnaire forwarded to ID and addiction services in Flanders. Caregivers identified 104 substance users and misusers with ID. Overall, few differences were observed between users and misusers. This finding underscores that substance use in persons with ID can have important consequences. Substance misusers, however, were found to have more mood changes, more suicidal ideation/thoughts, and more negative long-term consequences on their health, daily activity, and relationships due to substance misuse. Substance use and misuse were associated with mental health problems and were suggested to be a risk factor for offending behavior. To provide appropriate support for this specific population, an individualized approach is suggested that supports better intersectoral collaboration between services.

Executive control in long-term abstinent alcoholics with mild to borderline intellectual disability: the relationship with IQ and severity of alcohol use-related problems

Deficits in executive control might be related to alcohol abuse in individuals with mild to borderline intellectual disability (MBID). The goal of the present study was to test the relationship between executive control (i.e., working memory capacity, inhibitory control and delay discounting), IQ and chronic alcohol use. Participants (N=40) were divided into four groups based on IQ and severity of alcohol use-related problems (heavy and light drinkers with and without MBID). They were all admitted to a psychiatric treatment facility and long-term abstinent at the time of testing. Contrary to the expectations, executive control was not consistently impaired among individuals with MBID. Results showed that working memory capacity did seem to be impaired, whereas inhibitory control and delay discounting did not. Moreover, there were no differences between heavy and light drinkers on any of the parameters and having a dual diagnosis (heavy drinkers with MBID) did not result in additive negative effects on executive control. It is suggested that alcohol-related cognitive impairment is temporary and decreases over time after cessation of drinking.

Gesundheitsförderung von Menschen mit intellektueller Behinderung

Zahlreiche Publikationen belegen, dass die Gesundheit von Menschen mit intellektueller Behinderung (IB) für Krankheiten und Störungen anfälliger ist als die der Allgemeinbevölkerung. Zudem sind bestimmte Risikoverhaltensweisen (z. B. schlechte Ernährung und wenig Bewegung) häufiger bei dieser Personengruppe zu finden. Trotz der sensibleren Gesundheitssituation steht die gesundheitspsychologische Forschung für Menschen mit IB noch am Anfang. Für diesen Überblicksartikel wurde Fachliteratur über Menschen mit IB nach gesundheitspsychologischen Konzeptionen durchsucht und bestehende Forschungsarbeiten analysiert. Des Weiteren wurden rezente Gesundheitsmodelle sowie Kontinuitäts- und Stadienmodelle für die Allgemeinbevölkerung und ihre einzelnen Bestandteile hinsichtlich ihrer Übertragbarkeit auf diese spezielle Population untersucht. Eine Generalisierung von Gesundheitsmodellen der Allgemeinbevölkerung auf die Gruppe von Menschen mit IB erscheint aus verschiedenen Gründen problematisch. So erweist sich z. B. die Erfassung einzelner Bestandteile durch ihre Abstraktheit als zu komplex für Menschen mit IB. Dieses und ähnliche Forschungshindernisse werden in diesem Artikel besprochen. Diese genaue Analyse hilft jedoch notwendige Kriterien für die Entwicklung eines theoretischen Gesundheitsmodells speziell für Menschen mit IB zu erstellen. Schlussendlich werden relevante Modellbausteine für Menschen mit IB, die auf den präsentierten Forschungsergebnissen aufbauen, vorgestellt und diskutiert. Schließlich werden zukünftige Forschungsfragen erörtert.

Cognitive biases in individuals with mild to borderline intellectual disability and alcohol use-related problems

The primary aim of the present pilot study was to examine cognitive biases in individuals with mild to borderline ID and alcohol use-related problems. Participants (N=57) performed the approach avoidance task, picture rating task and visual dot probe task, which was combined with eye-tracking methodology. They were admitted to a forensic setting and were all abstinent and undergoing treatment at the time of testing. Three groups were formed based on the severity of alcohol use-related problems as measured by the AUDIT. In line with the expectations, no differences were found between participants based on the severity of their alcohol use-related problems. In addition, three groups were formed based on IQ to assess the relationship between IQ and the strength of the cognitive biases. There were also no differences between individuals with mild or borderline ID and individuals with (below) average IQ on any of the variables. It is concluded that computer tasks such as these can be used in individuals with mild to borderline ID. As the results suggest no influence of IQ on the strength of cognitive biases, this study opens up new opportunities for future research on the application of measuring cognitive biases in screening, diagnosing and treating individuals with mild to borderline ID and alcohol use-related problems.

Problematic alcohol use and mild intellectual disability: standardization of pictorial stimuli for an alcohol cue reactivity task

The present study focused on the first step in developing a cue reactivity task for studying cognitive biases in individuals with mild to borderline intellectual disability (ID) and alcohol use-related problems: the standardization of pictorial stimuli. Participants (N=40), both with and without a history of alcohol use-related problems and varying in IQ, were admitted to a forensic setting and were all abstinent. They were asked to rate familiarity, complexity, valence and attractiveness of pictures portraying both alcoholic and non-alcoholic beverages. There was a tendency to rate non-alcoholic beverages as more pleasant and attractive than alcoholic beverages. In participants with mild to borderline ID, this difference reached statistical significance, even when controlling for alcohol use-related problems in the past. The overall result of the study is a large database of 255 pictures portraying both alcoholic and non-alcoholic beverages that will be used to validate an implicit measure of cognitive biases for alcohol in individuals with mild to borderline ID.

Substance abuse among individuals with intellectual disabilities

Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.

Recreational substance use patterns and co-morbid psychopathology in adults with intellectual disability

There is very limited evidence on the patterns of recreational substance use among adults with Intellectual Disabilities (ID) who have co-morbid mental health problems. In this study we collected clinical and socio-demographic information as well as data on substance use patterns for consecutive new referrals (N = 115) to specialist mental health services for adults with ID in South-East London. The data were recorded from active clinical case notes. About 15% of patients had a history of substance use, however only 8% were currently using substances. Alcohol was the most frequently used substance (80%) followed by cannabis (28%) and cocaine (12%). Overall, substance use was significantly more likely among male patients, those with a mild level of ID and those with a forensic history. Substance use was less likely among patients with autism and more likely among those with schizophrenia spectrum disorders. Logistic regression analyses revealed that those with a forensic history were about five times more likely to have current substance use problems. Male gender was the only predictor for legal substance (alcohol) use. Illicit substance use was about three times more likely among patients with schizophrenia spectrum disorders. The present results highlight the role of illicit substance use as a health risk factor for adults with ID as well as the need to increase awareness within specialist mental health services.

Demographic and clinical characteristics of people with intellectual disabilities with and without substance abuse disorders in a Medicaid population

Little is known about the demographic and clinical characteristics of people with intellectual disabilities and substance abuse problems. Drawing on health care billing claims for people with Medicaid coverage aged 12-99 years, the characteristics of people with intellectual disability and a history of substance abuse (N=9,484) were explored and compared with people with intellectual disability but without substance abuse. Age- and/or gender-adjusted odds ratios were derived from logistic regression analyses to consider differences in demographic and clinical diagnoses. People with intellectual disability and substance abuse constituted 2.6% of all people with intellectual disability, most of whom had a diagnosis of mild or moderate intellectual disability. People with intellectual disability and substance abuse problems were, on average, 2 years older than the comparison group and less likely to be White. The sample was more likely than the comparison group to have serious mental illness or depression and substance abuse-related disorders were not prevalent. These data provide a comparison point for existing studies of mental health diagnoses as well as new information about substance abuse disorders. Implications relate to the identification of substance abuse among people with intellectual disabilities as well as the establishment of demographic and clinical correlates.