Treatment of substance abuse and addiction in adults with ID

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Treatment of substance abuse and addiction in
adults with ID
Co-operation of 5 treatment centers for adults
with ID and serious behavioural problems

Mariet Clerkx, Altrecht-Wier, Den Dolder.
Maria Trentelman, Hoeve Boschoord,
Boschoord Maart 2008
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Content of this presentation

• Prevalence
• Risk factors
• Vision on addiction
• Treatment at Hoeve Boschoord
• Treatment at de Kei (Wier)
• 6. Video interviews with two clients
• 7. Conclusions

Treatment of substance abuse Clerkx
Trentelman 2008
3
PREVALENCE OF SUBSTANCE ABUSEin people with ID

• Estimations
• (IQ below 70) 0,5 2
• Persons living on their own 2-10
• Growing risk
• Higher level of functioning
• Age gt22
• psychiatric disorder (3x higher)
• Living on ones own (8x higher)

Treatment of substance abuse Clerkx
Trentelman 2008
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PREVALENCEde Borg population (2006)

• 42 of clients had problems with substance abuse
  in the year before treatment
• 3 of 4 clients had severe problems as result of
  substance abuse
• 30 had problems with alcohol 30 with cannabis
• Hard drugs 15 cocaine, 6 amphetamine

Treatment of substance abuse Clerkx
Trentelman 2008
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Correlation addiction, delinquency ID

• 66 intoxicated during offence (Hayes Carmody,
  1990)
• 90 some degree of alcohol on day of offence
  (Hayes, 1996)
• 57 during offence or in prehistory (Hoeve
  Boschoord, 2004)
• Will always be very vulnerable and need
  continuing support
• Most common type of offence burglary, theft and
  robbery (McGillivray Moore, 2001)
• More alcohol than softdrugs than harddrugs (Hoeve
  Boschoord, 2004)

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RISK FACTORS

• Cognitive deficiencies memory problems,
  impulsivity
• Lack of skills social, problem solving,
  practical
• Psychiatric/psychological problems
  comorbidity, (self) medication
• Family factors negligence, (sexual) abuse,
  substance abuse by parents, genetic factors
• Degree of independence lack of supervision

Treatment of substance abuse Clerkx
Trentelman 2008
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VISION ON ADDICTION

• Addiction is a (usually) chronic recurrent brain
  disease
• that can lead to permanent changes in the brain
• caused and maintained by an adverse combination
  of biological, psychological and social
  influences

Treatment of substance abuse Clerkx
Trentelman 2008
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Basis of Treatment

• Stabilize clients functioning
• relapse is a logical and accepted part of therapy
• permanent brain damage is possible
• attitude is based on motivational interviewing
  (Miller Rollnick, 1991)

Treatment of substance abuse Clerkx
Trentelman 2008
9
Hoeve Boschoord

• Legally bound (70) voluntary(30) clients IQ
  50-80, men women
• 4 phases in treatment
• 4 treatment programs Veilig Vaardig sexual
  disorders, aggression disorders, autistic
  disorders and addiction

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The AIM of Vaardig Veilig

• Stop using all substances
• No problem behaviour/ no delinquency
• Healthy lifestyle
• A shared plan for the future

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How to provoke motivation

• Make them feel welcome in the therapeutic
  environment
• approach and attitude warm and caring,
  attentive, no pressure, empathetic
• be successful little steps forward (freedom of
  movement)
• getting confidence in oneself and others

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Treatment components

• Learning skills social skills, problem solving,
  finances, relaxation, education
• Learning to talk about substance use and the
  offence chain cognitive group therapy, drama
  therapie
• Manage craving and relapse
• Urine controls for use of drugs/ alcohol
• Medical care
• Lifestyle training job training, managing
  leisure time, housekeeping

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Cognitive group therapyin addiction

• Education knowledge of substances effects
• Analyze your own abuse/ addiction
• Making a relapse prevention plan/ emergency card
• Training skills to prevent and manage relapse
• Practice in drama group and real life
  (reintegration in society)

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emergency card
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CONCLUSIONS

• Both clients and employees get used to talking
  about addiction
• Clients support and confront each other
• Clients need lifelong external control/ support

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De Kei - Utrecht

• Project for the care for homeless with ID and
  borderline intellectual functioning
• Focus is on improving quality of life by
  stimulating a more effective use of regular
  services for (mental health) care and housing

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Criteria for admittance

• Homeless
• (probable) ID
• No hard drugs
• No severe aggression
• Alcohol and soft drugs allowed (within
  limitations)

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House rules

• In de Kei the use of soft drugs and alcohol is
  allowed only after consultation and consent of
  staff. This concerns use in your own room, while
  alone (not together with others, not in the rooms
  for general use). The use of hard drugs is not
  allowed.
• It is not allowed to urge co-occupants to use
  alcohol and drugs. Mutual trade in alcohol and
  drugs is also forbidden.

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Kei 2004 until today

• 25 of the clients submitted in the past three
  years had no (history of) dependence or abuse of
  substances.
• 25 shows poly drug abuse
• Use of alcohol equals use of cannabis
• 100 of our clients is a smoker!

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Treatment aspects in substance abuse in de Kei

• Client sets the target individual agreements
• Aiming for decrease of harmful use
• Motivational interviewing and money management as
  important tools
• Urine controls for hard drugs use
• Cooperation with organisations for treatment of
  substance abuse in individual cases
• group psycho-education is starting

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Experiences until today

• Guarding the atmosphere in de Kei does not cause
  much difficulties (by addressing the actual
  behaviour, not the use itself).
• Alcohol causes much more inconvenience than
  cannabis
• People can fasten each other in substance use
• Substance use stabilizes, decreases or stops.

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WIER HOEVE
BOSCHOORD
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Take home message

• Beware of substance abuse in ID
• Increase knowledge of substance abuse (carers,
  social workers, parents, teachers)
• Do interfere!
• Early detection? Prevention?
• Time to investigate and further develop effective
  treatment

Treatment of substance abuse Clerkx
Trentelman 2008