Wednesday, 19 April 2023 1

Intellectual Disability and Substance Abuse

Grahame Gee

Staff Nurse

Capital and Coast district Health Board

Wednesday, 19 April 2023 2

Definition of Intellectual Disability

• IQ below 70

• Have difficulty in abstract reasoning

• See the world in concrete terms

• Have difficulty in understanding subtle cues and messages

• Have difficulty in identifying emotions

• May be functionally illiterate

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Intellectual disability vs IQ

50 55 60 65 70 75 80 85 90 95 100

105

110

115

120

125

130

135

140

145

150

IQ Score

IntellectualDisability

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Challenges faced

• May have considerable difficulty in managing a number of tasks required to live independently e.g. managing finances

• May misunderstand and misinterpret what is said• May have difficulty managing emotions• May become socially isolated and vulnerable to

exploitation• However with appropriate support can live full

fulfilling lives in the community

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Substance abuse as a coping strategy

• Life requires individuals to interpret and respond to a number of external stressors

• This requires an assessment of what the stress is and the how best to respond to the stress

• An individual with an intellectual disability may have difficulty undertaking this assessment

• As a result they may respond in a maladaptive manner • Substance abuse may develop as a maladaptive response• May be complicated by coexisiting mental and/or

physical disorders

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Stress and Coping Model

Stress

Assessment- What am I facing- How do I respond

Response

Lazarus & Folkman, 1984

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Triad of complex needs

IntellectualDisability

SubstanceAbuse

MentalIllness

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Research on ID and substance abuse

• Current research is scant (Taggart et al, 2006)

• Prevalence rates lower than for general population but difference is small (Molina and Pelhan, 2001)

• Overrepresented in treatment programmes (Cosden, 2001)

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Common risk factors

• genetic predisposition• prenatal exposure• behavioural disinhibition• novelty seeking behaviour• neurophysiological response to drugs of abuse• early exposure• co-morbidity with other mental disorders impaired

cognitive ability• poor academic performance• low self-esteem• poor social skills• family and peer influences.

Weinberg, 2001

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Consequences of substance abuse of clients with an ID

Taggart et al, 2006

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Group treatment and the client with an ID

• Due to the communication difficulties experienced by clients with an ID, standard group interventions may not be effective (Cambell, Essex & Held, 1994 )

• Client becomes confused and frustrated• Other members of the group may become frustrated with

the client • As a result the client’s feelings of being different are

reinforced• Group approaches may however be beneficial in a group

of peers where the questions are suitably modified to take into account the communication needs of this client group.

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Assessment of substance abuse

• Assessment of substance abuse uses tools developed for mainstream services and adapted for use for clients with an ID (personal communication with Taggart, 2009)

• However some of the questions used in mainstream assessment tools will be difficult for a client with an ID to understand

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References

• Cambell, J. A., Essex, E. L. & Held, G. (1994). Issues in chemical dependency treatment and aftercare for people with learning differences. Health and Social Work, 19(1), 63-70.

• Cosden, M. (2001). Risk and resilience for substance abuse among adolescents and adults with LD. Journal of Learning Disabilities, 34(4), 352-358.

• Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.

• Molina, B. S. & Pelhan, W. E. (2001). Substance use, substance abuse and LD among adolescents with a childhood history of ADHD. Journal of Learning Disabilities, 34(4), 333-351.

• Taggart, L., McLaughlan, D., Quinn, B., & Milligan, V., (2006). An exploration of substance misuse in people with intellectual disabilities. Journal of Intellectual Disability Research 50(8), 588-597.

• Weinberg, N. H. (2001). Risk factors for adolescent substance abuse. Journal of Learning Disabilities, 34(4), 343-351.