Substance misuse among offenders in a forensic intellectual disability service

Abstract

PurposeThere have been few studies about the prevalence of substance abuse and links to offending behaviour among those with intellectual disabilities. This paper aims to address this issue.Design/methodology/approachThis baseline audit describes: the prevalence of alcohol and substance misuse in patients within a forensic intellectual disability service; and the introduction of a Drug and Alcohol Awareness Course. In total, 74 patients were included in the audit.FindingsRoughly half of the patients audited had co‐morbid harmful use or dependence with the problem being equally prevalent in men and women. Whilst alcohol and cannabis were the commonest drugs of abuse, cocaine, stimulants and opiates were abused by a small but significant number. Of those with harmful use or dependence, 35 per cent had used the drug in the immediate lead up to their index offence. A diagnosis of personality disorder and past history of convictions for violent offences was significantly more likely to be present in the group with harmful use or dependence. There were no differences on major mental illnesses or pervasive developmental disorders.Practical implicationsThe high prevalence of substance abuse makes it an important risk factor that could determine treatment outcomes. Forensic intellectual disability units need replicable substance abuse targeted treatment programmes that can be formally audited and evaluated.Originality/valueFindings are discussed in relation to service planning and treatment outcomes from forensic intellectual disability services.

Does substance use predict contact with the criminal justice system for people with intellectual disabilities?

“…A study of adults referred to a specialist mental health service for people with ID found approximately 15 per cent of patients had a reported history of substance use (Chaplin et al, 2011). Similar findings were published by Sinclair (2004), who reported co-occurring substance misuse ranging from 7 to 20 per cent; and Plant (2011), who reported alcohol as the most common substance being used, followed by cannabis, then cocaine, stimulants and opiates. Although the evidence points to alcohol as the most frequently used substance it is thought to be consumed at significantly lower rates than people without ID (Barrett and Paschos, 2006;Chapman et al, 2012;McGillicuddy, 2006).…”

Individuals with Mild Intellectual Disability or Borderline Intellectual Functioning in a Forensic Addiction Treatment Center: Prevalence and Clinical Characteristics

“…This might also explain why individuals with MBID constitute a growing percentage of offenders within the justice system and are overrepresented in forensic institutions (Hellenbach et al 2016;Herrington 2009). In a study by Plant et al (2011), it was found that half of the clients in a forensic institution could be identified with MBID and substance-related problems. Of these clients, 35% had used substances prior to the offense leading to their admission.…”

In-patient services for people with intellectual disability and mental health or behavioural difficulties

“…This is in addition to other comorbid conditions, such as autism spectrum disorders, attention-deficit hyperactivity disorder (ADHD), personality disorders and substance misuse. Similarly high figures are reported for those treated in secure hospital services for people with intellectual disability: up to 50% have a personality disorder, up to 30% have an autism spectrum disorder, about 30–50% have a major mental illness, about 30–50% have substance misuse/dependence and about 20% have epilepsy (Alexander 2002, 2006; Plant 2011). Some of these conditions present with challenging behaviours and some do not.…”