Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
to have some muscular pain and headaches. As a way of trying to cope, you began to drink more wine and now you find that not only doesn’t it help but it may be making matters worse. Do I understand things correctly? Client : That’s it in a nutshell. Therapist : It sounds like there are really two problems: The first has to do with all the worry and anxiety, and the second has to do with your drinking. The problems are intertwined so that each makes the other worse. To answer your questions, there are things that we can do together that can help. Most of the work will be up to you, and it’s important that you are ready to do what’s necessary. Client : At this point, I’m really willing to try whatever will help. I just can’t go on like this anymore. INTELLECTUAL DISABILITY There is an emerging body of information regarding individuals with intellectual disability and substance use disorder. Among individuals with intellectual disability (ID), approximately 5% have a substance use disorder (Bhatt & Gentile, 2021), and this prevalence rate is higher among individuals in a facility for people with ID (Bhatt & Gentile, 2021). There are several factors that have a strong correlation to substance use among individuals with intellectual disabilities. Among these factors are dysfunctional family environments, lack of structured and meaningful daytime activities, loneli- ness, and a desire to fit in (Bhatt & Gentile, 2021). Of course, these factors tend to increase the likelihood of substance use in other groups as well, but they may be more important among individuals with intellectual disability. Families that provide a dysfunctional environment because of substance use, men- tal health problems, or criminal activity can often give rise to substance use and emotional problems in offspring. This dysfunction may be an even greater factor for individuals with intellectual disability because they are more likely to be more dependent for a longer period on the family of origin than individuals who do not have intellectual challenges. A lack of structured and meaningful activities may leave an individual feeling bored and without purpose. It is not difficult to under- stand how individuals with intellectual disability who are not engaged in education or work might find themselves having no structured or meaningful activity, and how this may lead to substance use. Many individuals with mild intellectual dis- ability live alone. Such individuals may have some difficulty developing supportive social networks and find themselves with profound feelings of loneliness. Substance use is a means of easing the pain of loneliness and may provide opportunities to interact with others. Like all people, those with intellectual disability experience the need to be part of a group. However, their disability may cause them to have fewer choices of accept- ing groups. If the groups that are available feature substance use as part of their culture, an individual with intellectual disability, wanting to fit in, will follow the group mores and use substances.
A substance use treatment protocol that has been assessed with individuals with intellectual disability and substance use disorders is motivational interviewing (Frielink et al., 2015). Additionally, McGillicuddy and Blane (1999) developed and evaluated two distinct 10-week interventions that had the following goals: to educate people with intellectual disability regarding the dangers of cigarettes, alcohol, and illicit drugs and to provide participants with a behavioral repertoire they could use when confronted with risky situations involving alcohol or drug use. One intervention focused on the development of assertiveness skills in refusing requests to use substances, and the other focused on identifying good role models and model- ing behavior based on them. Both interventions were offered in small groups of about seven individuals by a mixed-gender team of master’s-level instructors. In the assertiveness interven- tion, the protocol was developed to bolster the individuals’ assertiveness skills; participants were trained in various ways to refuse pressure or requests that were undesirable, unhealthy, or risky, with special emphasis placed on situations encouraging substance use. In the modeling intervention, treatment was designed to strengthen an individual’s ability to infer appropri- ate behavior in new social situations; specifically, participants were trained in various ways to distinguish good role models from bad role models. These two interventions were tested against a waiting list condition. The two interventions resulted in increased participant knowledge about cigarettes, alcohol, and illicit drugs, and each program resulted in skill enhance- ment in targeted areas. However, neither intervention was superior to waiting list condition on measures of substance use. The adaptation of motivational interviewing for individuals who have both intellectual disability and SUDs is promising. This allows for evidence-based treatment for other popula- tions to be used among this population as well. Therefore, individuals trained in motivational interviewing may require only minor additional training and consultation or supervision for cases of individuals with intellectual disability. What is clear about treatment of this population is that the language of treatment must be tailored to the intellectual capacities of the individual being treated. The tendency of people with intellectual disability to be fairly concrete and specific in their thinking requires clinicians to use language that is very concrete and very specific. For example, in motivational interviewing, one technique is to ask the client to provide the therapist with examples of consequences of substance use. It may be helpful to provide clients with intellectual disability with some examples of what others have said in the past to help guide them. It may also be helpful to use the language of the clients regarding substance use and consequences. PHYSICAL DISABILITY Substance use can be related to physical disabilities in a num- ber of ways. It may be a contributing cause of a disability, as when an individual under the influence of substances is in an accident that causes serious and permanent injury or when cocaine use causes a stroke (Siniscalchi et al., 2015). It may
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