Monday, 21 September 2015 1 Intellectual Disability and Substance Abuse Grahame Gee Staff Nurse...
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Transcript of Monday, 21 September 2015 1 Intellectual Disability and Substance Abuse Grahame Gee Staff Nurse...
Wednesday, 19 April 2023 1
Intellectual Disability and Substance Abuse
Grahame Gee
Staff Nurse
Capital and Coast district Health Board
Wednesday, 19 April 2023 2
Definition of Intellectual Disability
• IQ below 70
• Have difficulty in abstract reasoning
• See the world in concrete terms
• Have difficulty in understanding subtle cues and messages
• Have difficulty in identifying emotions
• May be functionally illiterate
Wednesday, 19 April 2023 3
Intellectual disability vs IQ
50 55 60 65 70 75 80 85 90 95 100
105
110
115
120
125
130
135
140
145
150
IQ Score
IntellectualDisability
Wednesday, 19 April 2023 4
Challenges faced
• May have considerable difficulty in managing a number of tasks required to live independently e.g. managing finances
• May misunderstand and misinterpret what is said• May have difficulty managing emotions• May become socially isolated and vulnerable to
exploitation• However with appropriate support can live full
fulfilling lives in the community
Wednesday, 19 April 2023 5
Substance abuse as a coping strategy
• Life requires individuals to interpret and respond to a number of external stressors
• This requires an assessment of what the stress is and the how best to respond to the stress
• An individual with an intellectual disability may have difficulty undertaking this assessment
• As a result they may respond in a maladaptive manner • Substance abuse may develop as a maladaptive response• May be complicated by coexisiting mental and/or
physical disorders
Wednesday, 19 April 2023 6
Stress and Coping Model
Stress
Assessment- What am I facing- How do I respond
Response
Lazarus & Folkman, 1984
Wednesday, 19 April 2023 7
Triad of complex needs
IntellectualDisability
SubstanceAbuse
MentalIllness
Wednesday, 19 April 2023 8
Research on ID and substance abuse
• Current research is scant (Taggart et al, 2006)
• Prevalence rates lower than for general population but difference is small (Molina and Pelhan, 2001)
• Overrepresented in treatment programmes (Cosden, 2001)
Wednesday, 19 April 2023 9
Common risk factors
• genetic predisposition• prenatal exposure• behavioural disinhibition• novelty seeking behaviour• neurophysiological response to drugs of abuse• early exposure• co-morbidity with other mental disorders impaired
cognitive ability• poor academic performance• low self-esteem• poor social skills• family and peer influences.
Weinberg, 2001
Wednesday, 19 April 2023 10
Consequences of substance abuse of clients with an ID
Taggart et al, 2006
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
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Wednesday, 19 April 2023 11
Group treatment and the client with an ID
• Due to the communication difficulties experienced by clients with an ID, standard group interventions may not be effective (Cambell, Essex & Held, 1994 )
• Client becomes confused and frustrated• Other members of the group may become frustrated with
the client • As a result the client’s feelings of being different are
reinforced• Group approaches may however be beneficial in a group
of peers where the questions are suitably modified to take into account the communication needs of this client group.
Wednesday, 19 April 2023 12
Assessment of substance abuse
• Assessment of substance abuse uses tools developed for mainstream services and adapted for use for clients with an ID (personal communication with Taggart, 2009)
• However some of the questions used in mainstream assessment tools will be difficult for a client with an ID to understand
Wednesday, 19 April 2023 13
References
• Cambell, J. A., Essex, E. L. & Held, G. (1994). Issues in chemical dependency treatment and aftercare for people with learning differences. Health and Social Work, 19(1), 63-70.
• Cosden, M. (2001). Risk and resilience for substance abuse among adolescents and adults with LD. Journal of Learning Disabilities, 34(4), 352-358.
• Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.
• Molina, B. S. & Pelhan, W. E. (2001). Substance use, substance abuse and LD among adolescents with a childhood history of ADHD. Journal of Learning Disabilities, 34(4), 333-351.
• Taggart, L., McLaughlan, D., Quinn, B., & Milligan, V., (2006). An exploration of substance misuse in people with intellectual disabilities. Journal of Intellectual Disability Research 50(8), 588-597.
• Weinberg, N. H. (2001). Risk factors for adolescent substance abuse. Journal of Learning Disabilities, 34(4), 343-351.