Treating Substance Abuse among the Intellectually Disabled

"What History Does Not Tell Us"

There is a lack of research on the prevalence of substance abuse and addiction amongst those with Developmental Disabilities (DD) / Intellectual Disabilities (ID).

• Past studies had determined that prevalence is significantly lower than the general population. This was attributed to the fact that a very high percentage of folks with ID reside with caregivers and families who may closely monitor behavior.
• More recent studies have shown that prevalence is only lower when Mental Illness (MI) is not present.
• For those who live with ID and MI, prevalence has been found to be in the range of or even higher than the general population (7.6% Substance Abuse and Mental Health Services Administration, 2008).
  

Those living with ID and MI who abuse substances are less likely to seek help and less likely to find resources that meet their needs. Of further concern is the fact that this population is often prescribed medications for seizure disorders and other health conditions, which may interact significantly with alcohol or other drugs.

Challenges Specific to ID

Substance abuse and addiction treatment has grown over recent decades to incorporate dual diagnosis treatment. If we consider a person living with ID/DD, MI, and substance abuse or addiction, we could say that they are triply or trio diagnosed. Folks who live with all three conditions struggle with abstract concepts like powerlessness and treatment needs to focus on empowerment and improving capabilities.

Barriers to treatment and self help for this population are many:

• Lack of reading skills, socializing skills, and cognitive processing challenges must be overcome to make the most of opportunities in AA, NA, and in group therapy.
• Additionally, people with ID tend to face greater challenges in accessing transportation, managing their daily affairs and in coordinating treatment.

What's Needed

1. Be Aware

The biggest mistake families and professionals make is that we tend to relate to people with ID more as children than adults. This leads to issues relating to the abuse of substances and sexuality being overlooked. We have an awareness that they are more vulnerable to social problems and yet we often fail to see problems as they develop. It's as simple as asking whether drugs and alcohol are being used (not abused - this is an abstract concept) and in what amounts/frequency.

2. Change Feelings by Changing Behaviors

My experience in treating people with less than a year of sobriety is that guidance, instruction, and directions must be completely clear and direct. Anything else is likely to fail.

• Connect the abstract to the concrete. Ideas and feelings are important but changes to one's life are accomplished through specific changes in behavior.

What I'm describing is referred to as "old school" recovery counseling and it is of great potential value to people who live with ID.

3. Be a Facilitator

While there is excellent literature on addictions recovery, (AA, NA, others) folks with ID often have limited ability to read and process written information. This obvious deficit can easily be addressed by friends and family.

• You can take basic concepts from self help groups and develop specific strategies for them. This is far more useful than simply trusting they'll make use of handouts on coping strategies and feelings.

4. Relapse Prevention Efforts

Identifying triggers and making connections can be very problematic for folks with ID.

• It's better to focus on immediate responses and on diminishing impulsivity (a common trait). Teach specific strategies for coping with stress and negative emotions.

Replacing use of alcohol or drugs with other options for temporary escapism can be done through healthy means.

5. Improve Overall Quality of Life 

An enormous contributing factor to the abuse of alcohol and drugs amongst those who live with ID is dissatisfaction with quality of life. A desire to be "normal" and a feeling of being apart from others leaves a void that demands to be filled. We do not struggle to identify this need in mainstream people and yet somehow we easily overlook it in folks who live with ID.

• We must recognize that options for this population are far less than for the rest of society. Helping those with ID to develop meaningful activities is key to promoting and sustaining recovery from addiction.