A feasibility randomised controlled trial of extended brief intervention for alcohol misuse in adults with mild to moderate intellectual disabilities living in the community; The EBI-LD study

Abstract

BackgroundExtended brief interventions (EBIs) are effective in targeting alcohol misuse in the general population. However, little is known of the effects of EBI in adults with intellectual (also known as learning) disabilities. In this feasibility trial we compared EBI with usual care for alcohol misuse in adults with mild to moderate Intellectual Disability (ID).MethodsThe study took place in three community ID networks of services in England. Participants aged 18–65 years with reported alcohol problems, a score ≥8 on the Alcohol Use Disorder Identification Test (AUDIT), and IQ <70 (+/5%CI) were recruited and were randomly allocated to either EBI (five weekly sessions and one follow-up at 8 weeks) and usual care or usual care alone. Research assistants were blind to arm allocation. Research assessments took place at baseline, 2 and 3 months. The primary outcome was reduction in alcohol consumption measured by the AUDIT. Preliminary health economic analysis was performed to investigate the costs of delivering EBI and the feasibility of a cost-effectiveness analysis in a full trial. The trial is closed.ResultsParticipants were recruited from January 2014 to August 2015. Thirty individuals were randomised (15 in each arm) and provided primary outcome data. In regard to harmful drinking, at baseline, all the participants exceeded the relevant threshold. At 8 weeks, the proportion of participants with harmful drinking had decreased to 60% for both groups, and at 12 weeks it had decreased by 66°7% and 46°7% for the intervention and the control groups, respectively. The unit cost for the delivery of EBI is £430.ConclusionsRecruitment to this trial has been proven challenging as prevalence of alcohol misuse in the targeted population was lower than anticipated. EBI may provide an effective low-intensity treatment for this population. Participants’ and carers’ feedback on their experience was overall positive. Further work needs to be undertaken to ascertain the group of participants that should be participating in a future definitive trial.Trial registrationPsychological Intervention Alcohol Misuse Learning Disability; isrctn.com, identifier:10.1186/ISRCTN58783633. Registered on 17 December 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1953-0) contains supplementary material, which is available to authorized users.

Alcohol use disorders in people with intellectual disability

“…Also many studies have used instruments designed for use with the general population which do not appear to have been validated for use with PWID (Barrett 2006; Asscher 2012; Bhandari 2015; McGillivray 2016). Although Kouimtsidis 2017 used a more accessible assessment instrument, it has not been formally validated for use with PWID (Kouimtsidis 2017). In both intellectual disability and alcohol use disorders, there is a spectrum of how the individual can be affected by each disorder, and thus when a patient presents with both conditions simultaneously, it is even more important to tailor intervention to the individual's need and abilities.…”

“…A number of adaptations to treatment programmes have been suggested in the literature. Sessions might be more frequent (Barrett 2006; Kouimtsidis 2017), longer (Kouimtsidis 2017) and well-structured (Degenhardt 2000) to allow them to be tailored to the difficulties faced by PWID, specifically regarding the comprehension of, assimilation of, and adaptation to new ideas. Providing individual sessions on top of group sessions (Forbat 1999; Barrett 2006), connecting new ideas with things already familiar to the patient and only progressing once skills in earlier stages are acquired (Degenhardt 2000) can also help in this regard.…”

“…PWID often do not live completely independently of other people and unlike the general population, are more likely to have carers who could play an important role in helping them engage with treatment. Indeed, it has been shown that lack of carer support can adversely affect engagement with interventions (Kouimtsidis 2017).…”

“…The first author has conducted an evaluation of nurse-led health screening in her service and has found that the current screening methods are potentially missing people with intellectual disability who consume alcohol above recommended limits and could benefit from support. An easy-read form of the AUDIT has been developed for use with PWID, which, although it has not yet been formally validated for use in this population group, has been shown to be acceptable to this population (Kouimtsidis 2017).…”

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

“…Furthermore, Take it Personal!+ is based on Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT). MI and CBT are effective methods in decreasing SU in individuals without MID-BIF [ 19 , 20 ] and adapted versions of MI and CBT have shown promising results in increasing motivation and reducing SU in individuals with MID-BIF [ 9 , 18 , 21 , 22 ]. In addition, Take it Personal!+ is supported by a mHealth application (TiP!)…”