This study from the Netherlands looked at the perspectives of staff to substance use and misuse among people with learning disabilities. The authors point out that the use of psychoactive substances is a growing problem among clients of learning disability services in the Netherlands. However, there are few official statistics and rates of use are unknown. There is little information on the way in which services respond to and deal with such substance use -related issues.

The authors gathered information on users’ profiles, service organisation and policy from 39 service providers. They also conducted semi-structured interviews with staff, asking them to comment on lifetime, current, and problematic substance use among their clients. Staff were also asked to provide illustrative case reports and to describe the policies used within their own service regarding substance-related problems.

They found that the estimates of the occurrence of substance use varied greatly across the services. Alcohol was reported to be used most often but at lower rates than reported in the general population.

Cannabis and other drugs were reported to be used relatively often when compared with the rates noted in the general population.

The authors analysed the case reports of 86 substance users and were able to identify two subgroups of users: younger clients who used both cannabis and alcohol and older clients with mild learning disabilities who used only alcohol.

They also found co-morbid psychiatric difficulties to be highly prevalent amongst the users identified as was the lack of daytime activities.
Services reported a number of interventions to address abuse, including psychosocial and restrictive measures which were rated as the most effective. The least effective were found to be collaboration with addiction facilities and rewarding abstinence.

Unsurprisingly, most of the services involved in the study said they felt they had inadequate expertise with substance use and suggested a need for more information and training. The authors conclude that given the current situation as identified in their findings, there is low effectiveness of mainstream addiction treatment or consultation for people with learning disabilities and there is a need for the development of cross-system collaboration to address the issue.

Staff Perspectives of Substance Use and Misuse Among Adults With Intellectual Disabilities Enrolled in Dutch Disability Services, VanDerNagel, J.,  et al., in Journal of Policy and Practice in Intellectual Disabilities, 8: 143–149