due to power constraints, we were unable to account for co-occurring SUD diagnoses, which includes tobacco use disorder. Nonetheless, in order to address the specific concerns about tobacco, we ran model 3 including tobacco use disorder, and findings were only modestly attenuated and broadly consistent with the prior model 3 findings; the hazard ratios (HRs) estimating suicide risk associated with any current SUD were 1.5 [95% confidence interval (CI) = 1.4-1.6] for men and 1.9 (95% CI = 1.2-2.8) for women. Overall, it is important to acknowledge that this study was undertaken to identify markers of risk for suicide (e.g. to inform providers and health systems), not to necessarily make causal inferences about mechanisms of risk.
Declaration of interestsNone. However, little is known about evidence-based interventions for SUD in individuals with ID. There are several reasons for the gap between epidemiological knowledge and treatment modalities. First, this group is frequently denied access to the full range of available services, including prevention, (early) intervention and aftercare. Secondly, when individuals with ID are admitted to substance treatment they are often unable to benefit from mainstream interventions, due to their limited vocabulary, poor development of memory function and difficulties discriminating between relevant and irrelevant information. They experience problems with planning and attention, have impaired abstract reasoning and low self-insight. Furthermore, group-based programmes are difficult for people with ID to participate in because they are often too abstract, proceed too fast or require adequate social skills. Therefore, a great need exists for effective, tailormade treatment strategies designed for these patients.
KeywordsIn order to bridge the gap between our epidemiological knowledge and treatment modalities, we conducted a review of the literature on obstacles for SUD treatment for individuals with ID, and the opinions of authors regarding the adaptation of treatment programmes. We found only six studies, including two randomized studies, that provide data regarding a treatment modality, covering a total of 148 participants world-wide. The overall conclusions of these reviewed studies are that the substance-related knowledge increased, but failed to impact substancerelated attitudes, intention to stop using or the substance use itself. The interventions are often too short and do not take into account the complex nature of SUD in ID. We conclude that almost no new insights were presented between 1980 and 2015.This provides food for thought that the lack of adequate treatment modalities might lead to societal exclusion, and even criminalization, of this group [6]. This leads to an extremely problematic situation, as there is apparently lack of attention from scholars, clinical agencies, donors and governmental-funded bodies to invest in the development and adaptation of evidence-based treatment modalities for this group.The co-occurrence of SUD and ID thus calls for scientific ...