Staff Perspectives of Substance Use and Misuse Among Adults With Intellectual Disabilities Enrolled in Dutch Disability Services

Although the use of psychoactive substances seems to be a growing problem among clients of intellectual disability services (IDS) in the Netherlands, rates of such substance use are unknown, and it is unclear how the services deal with substance-related problems. This study explored the perspectives of staff with respect to the occurrence of substance use and abuse, as well as users' profiles, and service organization policies regarding substance use. A semi-structured questionnaire asked staff to comment on lifetime, current, and problematic substance use among their clients, provide illustrative case reports, and describe policies within their service regarding substance-related problems. Data from 39 IDS were included. Estimations of occurrence of substance use varied greatly across 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. Case reports on 86 substance users were analyzed, and subgroups of users were identified, including younger clients who used both cannabis and alcohol, and older clients with mild ID who used only alcohol. Psychiatric comorbidity and lack of daytime activities were highly prevalent among users. Of the interventions the services reported using to address abuse, psychosocial and restrictive measures were rated as most effective and collaboration with addiction facilities and rewarding abstinence as least effective. Most services reported to have inadequate expertise with substance use. According to respondents, users with both borderline and mild ID used substances, but there were different patterns of use across age groups and level of ID. Respondents noted that substance users face a number of psychosocial problems but that they were poorly equipped to meet the users' needs and to affect functional policies. The authors concluded that the low effectiveness of mainstream addiction treatment or consultation suggests that there is a need for more cross-system collaboration to address this problem.