Disability & Drugs

Four broad areas of intellectual disability and drug use need to be considered when considering management issues.

Drug use (mostly alcohol) by the individual causing the individual's intellectual disability
Parent's drug use causing intellectual disability (parental drug use may reinforce child's drug use)
Intellectually disabled person choosing to use drugs
Intellectually disabled person with a co-existing mental illness using drugs

Strongly related to the above are other issues such as the degree of disability, degree of drug use, social circumstances, supports, etc. All of these factors need to be weighed in determining the most appropriate management strategy.

However, generally speaking, those with intellectual disabilities should not be treated particularly differently to others in the context of managing drug use problems.

Contents on this page

Functions of drug use
Decisions
Controlled use or abstinence
Intervention options

Functions of drug use

As with other drug use in other populations, drugs serve a purpose. It is important assessment attempts to identify the functions as well as problems associated with drug use. Any reduction in drug use will need to provide alternatives to those areas served by the drug use.

Decisions

Depending upon the severity of the intellectual disability, severity of problems associated with the disability and the age of the individual, the person with the disability should make the decision about whether he/she continues to use substances and how much is used.

Controlled use or abstinence

The factors cited at the top of this page need to be considered in determining whether controlled use or abstinence is the most suitable goal. For example, the person who is intellectually disabled because of 40 years of heavy, uncontrolled drinking may find it difficult to manage controlled drinking if this person is living in the community with very little support. A younger person experimenting with alcohol and other drugs with a mild disability living with a supportive family would need to be treated differently.

Overall, the literature makes the following points:

1. People who are given a choice tend to better than people who aren't

2. People who have a significant addiction to drugs, have not been able to control their drug use in the past and have an intellectual disability are likely to find achieving controlled use difficult.

Intervention Options

Drug specialist interventions

While drug specialists may provide useful consultancy and possibly assessment services, they are generally not well placed to manage drug-related problems of those with intellectual disability. Staff are not particularly sensitive to the needs of those with intellectual disability, nor are they trained in the sorts of therapies which are likely to be most beneficial. However, they may be useful in providing detoxification services and supporting staff in dealing with minor drug use issues.

General treatments

Most treatments which are applied to other problem or life skills areas (including mental ill health) can be applied to dealing with drug use issues. In particular, behaviour management principles, social skills training and activity therapy can all be modified to deal with drug use. In addition, cognitive therapy has recently been used with those with mild mental disability to recognise high risk situations and to develop alternative solutions. General supportive counselling may also help through listening and understanding.

Social supports are also a key concern. Family and friends can either help or hinder management of drug use issues. For example, It may sometimes be more productive to find a non-drug using mentor than to work directly with the drug user.

Harm reduction

Harm reduction is a strategy which aims to reduce the harm associated with drug use, without necessarily reducing the amount of drugs used.

The task with this population is exactly as it is with the general population: provide strategies which minimise harm without necessarily condoning drug use. The most likely harm of those with intellectual disability associated with drug use is accidents while intoxicated on alcohol or other substances.