Staff Perspectives of Substance Use and Misuse Among Adults With Intellectual Disabilities Enrolled in Dutch Disability Services

Abstract

Although the use of psychoactive substances seems to be a growing problem among clients of intellectual disability services (IDS) in the Netherlands, rates of such substance use are unknown, and it is unclear how the services deal with substance‐related problems. This study explored the perspectives of staff with respect to the occurrence of substance use and abuse, as well as users' profiles, and service organization policies regarding substance use. A semi‐structured questionnaire asked staff to comment on lifetime, current, and problematic substance use among their clients, provide illustrative case reports, and describe policies within their service regarding substance‐related problems. Data from 39 IDS were included. Estimations of occurrence of substance use varied greatly across services. Alcohol was reported to be used most often but at lower rates than reported in the general population. Cannabis and other drugs were reported to be used relatively often when compared with the rates noted in the general population. Case reports on 86 substance users were analyzed, and subgroups of users were identified, including younger clients who used both cannabis and alcohol, and older clients with mild ID who used only alcohol. Psychiatric comorbidity and lack of daytime activities were highly prevalent among users. Of the interventions the services reported using to address abuse, psychosocial and restrictive measures were rated as most effective and collaboration with addiction facilities and rewarding abstinence as least effective. Most services reported to have inadequate expertise with substance use. According to respondents, users with both borderline and mild ID used substances, but there were different patterns of use across age groups and level of ID. Respondents noted that substance users face a number of psychosocial problems but that they were poorly equipped to meet the users' needs and to affect functional policies. The authors concluded that the low effectiveness of mainstream addiction treatment or consultation suggests that there is a need for more cross‐system collaboration to address this problem.

The Limits of Autonomy: Ideals in Care for People with Learning Disabilities

“…Bransen and colleagues (2009) have shown that Dutch people with mild to borderline learning disability are more likely than young people in the general population to engage in binge drinking and heavy use of cannabis. Staff from 39 services for people with learning disability report that cannabis and other (illegal) drugs are used more often in comparison to the general population, whereas alcohol consumption was less (Van Der Nagel et al 2011). Estimations of harmful use or addiction for people with mild to borderline learning disability range from 15 percent to 42 precent (Kaal et al 2009;Tenneij and Koot 2006).…”

“…Estimations of harmful use or addiction for people with mild to borderline learning disability range from 15 percent to 42 precent (Kaal et al 2009;Tenneij and Koot 2006). People with learning disability are reported to be more vulnerable to the negative consequences of substance abuse, including victimization, dropping out of school or leaving work, psychiatric problems and other health-related problems Van Der Nagel et al 2011).…”

Drug use in adolescents with mild intellectual disability in different living arrangements

“…Many researchers found evidence that the prevalence of alcohol use was lower among adolescents with ID in comparison with adolescents without ID (Gress & Boss, 1996;McGillicuddy & Blane, 1999;McGuire et al, 2007;Pack et al, 1998;Rimmer et al, 1995;Robertson et al, 2000;Rurangirwa et al, 2006;VanDerNagel et al, 2011). However, Emerson and Turnbull (2005) reported a lower level of using alcohol at least once a month in adolescents with ID and no differences on lifetime alcohol use between adolescents with and without ID.…”

“…A Dutch study on substance use among the clients of ID services revealed that 79.1% of adolescents and adults had used alcohol (VanDerNagel, Kiewik, Buitelaar, & DeJong, 2011). In the UK study, Taggart, McLaughlin, Quinn, & Milligan (2006) revealed that alcohol was the most commonly used drug among individuals with ID.…”

Substance Use in Individuals with Mild to Borderline Intellectual Disability: an Exploration of Rates and Risks in the Netherlands

“…Several demographic, contextual and diagnostic factors have been associated with SU(D) in MBID, such as younger than 30 years old, male, no structured daytime activities VanDerNagel et al 2011a), and living independently (Taggart et al 2006;To et al 2014). Furthermore, SU(D) in MBID is associated with psychiatric or behavioral (Chaplin et al 2011;Didden et al 2009) and forensic problems (Crocker et al 2007;Hassiotis et al 2011;Mcgillivray et al 2015).…”