1. Monday, 21 September 2015 1 Intellectual Disability and Substance Abuse Grahame Gee Staff Nurse Capital and Coast district Health Board

2. Monday, 21 September 2015 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

3. Monday, 21 September 2015 3 Intellectual disability vs IQ Intellectual Disability

4. Monday, 21 September 2015 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

5. Monday, 21 September 2015 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

6. Monday, 21 September 2015 6 Stress and Coping Model Stress Assessment - What am I facing - How do I respond Response Lazarus & Folkman, 1984

7. Monday, 21 September 2015 7 Triad of complex needs Intellectual Disability Substance Abuse Mental Illness

8. Monday, 21 September 2015 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)

9. Monday, 21 September 2015 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

10. Monday, 21 September 2015 10 Consequences of substance abuse of clients with an ID Taggart et al, 2006

11. Monday, 21 September 2015 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.

12. Monday, 21 September 2015 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

13. Monday, 21 September 2015 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.