Treatments for alcohol and drug use in youth with a mild intellectual disability: “We’re beyond the start, but still at the beginning”

Beyond the start

In Dutch society, many young people start experimenting with alcohol and drugs at an early age. This is no different for youth with a mild intellectual disability. Just like their non-disabled peers, they typically have the freedom to make their own choices, even when they receive intra- or extramural care. A mild intellectual disability is characterized by limitations in intellectual functioning and adaptive behavior. For some individuals with this diagnosis, it is difficult to make informed decisions and resist peer pressure, which may increase their vulnerability to developing an addiction. Additionally, some people use substances as a way to cope with traumatic experiences. Drug traffickers often exploit this vulnerability by selling nearby care facilities for people with mild intellectual disabilities. Therefore, it is perhaps unsurprising that on average, individuals with such a diagnosis end up being overrepresented in regular addiction care¹. Fortunately, the past decade has seen a notable increase in research on substance use and addiction problems among individuals with a mild intellectual disability. While progress has been made, we are still in the early stages of truly understanding and addressing substance use issues.  

But still at the beginning

Despite this progress, the evidence base for effective interventions for this group remains alarmingly sparse. Care facilities for individuals with intellectual disabilities often lack the specialized skills and approaches necessary to effectively address substance use disorders. On the other hand, regular addiction care is sometimes ill-equipped to meet the unique needs of clients with intellectual disabilities. This gap results in significant challenges, including difficulties in identifying addiction risks and achieving effective treatment outcomes.

In recent years, several prevention and intervention programs have been developed. For example, Seeking Safety was developed for addiction and trauma problems. However, the Dutch database for effective interventions Vilans currently only registers three programs for alcohol and/or drugs use as “well-substantiated”, while none are officially labeled as “effective” according to scientific standards. Nonetheless, some interventions have shown promise. “Open and alert” is one of the three well-substantiated programs, aiming to enable open dialogue about this topic in care organizations. “Beat the kick” is the second program and increased the motivation to change in 5 out of 6 participants². The third well-substantiated program is “Take it Personal!+”, which tailors intervention exercises to the client’s personality traits related to substance use. This program successfully reduced the frequency of substance use in 8 out of 12 participants with a substance use disorder³. Also within a sample of 66 experimental users, Take it Personal! was more effective on average than treatment as usual⁴. While these findings are valuable, they represent only a small step forward relative to the scale of the issue among this target group.

In summary, although research and practice have made progress, we are still at the beginning of understanding what works for people with a mild intellectual disability, especially when compared to the attention given to addiction problems in the general population. There is still a great deal of work to be done. New interventions are certainly needed, but we don’t necessarily have to start from scratch. Aforementioned programs have shown promise and could be further developed to better meet the needs of this vulnerable group. Hopefully continued research and innovation will ensure that these young individuals receive the care and support they deserve.

This blog was written by Daan Hulsmans, Radboud University, for RAD-blog, the blog about smoking, alcohol, drugs and diet.