Personality dimensions and substance use in individuals with mild to borderline intellectual disabilities

The mediating role of substance use motives in the relationship between personality dimensions and alcohol and drug use in adolescents and young adults with mild intellectual disabilities

Adolescents and young adults with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) are a high-risk group for developing substance use disorders. The aim of this study was to gain a better understanding of the mechanisms that underlie substance use in this particular population. We tested the mediating role of substance use motives in the relationship between personality dimensions and substance use-related outcomes. Self-reported data on substance use risk personality dimensions (i.e., sensation seeking, impulsivity, anxiety sensitivity, and negative thinking), substance use motives (i.e., social, enhancement, coping, and conformity motives), and substance use were obtained from 163 individuals with MID-BIF (mean age 18.9 years). Results show that coping motives played a main role in the associations between personality dimensions and substance use in adolescents and young adults with MID-BIF, with significant relationships between impulsivity and negative thinking and severity of alcohol use or drug use via coping motives. Moreover, findings indicated a relatively high risk for several substance use motives and associated substance use (disorder) in individuals high on impulsivity. Results show significant relationships between impulsivity and severity of alcohol use or drug use via social, enhancement, and coping motives. No mediating associations were found for conformity motives, nor did we find any mediation associations in individuals with high levels of anxiety sensitivity. These insights provide the possibility of tailoring interventions to specific motives that underlie substance use in different types of users with MID-BIF based on personality dimensions.

Co-occurring intellectual disability and substance use disorders

Individuals with intellectual disabilities (ID) are an expanding population that confronts multiple disadvantages from social and environmental determinants of health. Deinstitutionalization and community integration have improved the lives of individuals with ID in many ways. However, deinstitutionalization may increase their access to alcohol and drugs and the potential for developing Substance Abuse Disorders (SUD). It is estimated that 7–8 million people in the United States with an intellectual disability (ID) suffer disproportionately from substance use problems [1]. There is a lack of empirical evidence to inform prevention and treatment efforts in this population and more research needs to be done in order to address these issues.

Exploring the role of emotional and behavioral problems in a personality-targeted prevention program for substance use in adolescents and young adults with intellectual disability

BACKGROUND

Adolescents and young adults with a mild intellectual disability or borderline intellectual functioning (MID-BIF) are at risk for problematic substance use and are more likely to have emotional and behavioral problems than peers without MID-BIF. A personality-targeted prevention program called Take it Personal! effectively reduces substance use in adolescents and young adults with MID-BIF.

AIMS

The program's effectiveness was examined on its secondary goal: reducing emotional and behavioral problems. The potentially moderating role of these problems on the program's effectiveness with substance use was also explored.

METHODS AND PROCEDURES

Substance use and emotional and behavioral problems were compared between participants in Take it Personal! (n = 34) and those in the control condition (n = 32) in a quasi-experimental pre-posttest study with a three-month follow-up. Effectiveness and moderation were assessed with multilevel models.

OUTCOMES AND RESULTS

Take it Personal! seems to reduce rule breaking. There were no significant effects on anxiety, withdrawal, and aggression. None of the problem domains moderated the program's effectiveness on substance use frequency.

CONCLUSIONS AND IMPLICATIONS

Take it Personal! may effectively reduce rule breaking. Moreover, adolescent and young adults with different levels of emotional and behavioral problems benefit equally in terms of reduced substance use.

The effectiveness of an indicated prevention programme for substance use in individuals with mild intellectual disabilities and borderline intellectual functioning: results of a quasi-experimental study

AIMS

To assess the effectiveness of Take it personal!, a prevention programme for individuals with mild intellectual disabilities and borderline intellectual functioning (MID-BIF) and substance use (SU). The prevention programme aims to reduce SU (alcohol, cannabis and illicit drugs) among experimental to problematic substance users.

DESIGN

A quasi-experimental design with two arms and a 3-month follow-up.

SETTING

Adolescents were recruited from 14 treatment centres in the Netherlands specialized in offering intra- and extramural care for people with MID-BIF and behavioural problems.

PARTICIPANTS

Data were collected from 66 individuals with MID-BIF assigned either to the intervention condition (n = 34) or to the control condition (n = 32).

INTERVENTIONS

Take it personal! was designed to target four personality traits: sensation-seeking, impulsive behaviour, anxiety sensitivity and negative thinking. For each of these profiles, interventions were developed that were structurally the same but contained different personality-specific materials, games and exercises. The control group received care as usual.

MEASUREMENTS

Primary outcomes at 3-month follow-up were frequency of SU, severity of SU and binge drinking.

RESULTS

Results showed intervention effects for SU frequency (F(1, 50.43)  = 9.27, P = 0.004) and binge drinking (F(1, 48.02)  = 8.63, P = 0.005), but not for severity of SU (F(1, 42.09)  = 2.20, P = 0.145).

CONCLUSIONS

A prevention programme to reduce substance use among experimental to problematic users with mild intellectual disabilities and borderline intellectual functioning helped participants to decrease substance use frequency and binge drinking.

Take it personal! Development and modelling study of an indicated prevention programme for substance use in adolescents and young adults with mild intellectual disabilities and borderline intellectual functioning

BACKGROUND

This paper describes the theory and development of Take it personal! an indicated prevention programme aimed at reducing substance use in individuals with mild intellectual disabilities and borderline intellectual functioning.

METHOD

The process of the development of Take it personal! followed the steps of the Intervention Mapping protocol. Take it personal! is based on the theory that personality traits are an important construct to understand substance use (14-30 years old). A small modelling study was conducted with six adolescents to examine the feasibility, user-friendliness and potential effectiveness of the intervention.

RESULTS

The results showed that the intervention has good feasibility and user-friendliness. Post-intervention evaluation of frequency, binge drinking and problematic use indicated that use was lower than at pre-intervention.

CONCLUSIONS

Take it Personal! can be a promising preventive intervention designed to reduce substance use in individuals in this target group. A larger scale study is needed to draw further conclusions.

Evaluating a personalized treatment for substance use disorder in people with mild intellectual disability or borderline intellectual functioning: A study protocol of a multiple baseline across individuals design

BACKGROUND

The prevalence of substance use disorder (SUD) in people with Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF) is high. However, an effective personalized treatment for people with MID-BIF and SUD is lacking. This paper describes the study protocol of the effectiveness study of Take it Personal!+, a personalized treatment for people with MID-BIF and SUD.

METHODS

The effectiveness of Take it Personal!+ in decreasing substance use will be assessed in a non-concurrent multiple baseline across individuals design comprising ten participants with MID-BIF and SUD. The participants with MID-BIF and SUD will be randomly allocated to one of the five baseline lengths (7-11 days). Substance use, will be assessed during baseline, intervention, and post-treatment phase using a daily diary method.

DISCUSSION

If this study shows that Take it Personal!+ is effective in decreasing substance use, the gap in treatment for people with MID-BIF and SUD will be filled.

TRIAL REGISTRATION

The study is registered in the Netherlands Trial Register (Trial NL4935, registered July 2, 2019).

Substance use disorders in people with intellectual disability

PURPOSE OF REVIEW

To provide an overview of studies on substance use and substance use disorder (SUD) in individuals with mild intellectual disability or borderline intellectual functioning (MID-BIF).

RECENT FINDINGS

Many individuals with MID-BIF use tobacco, alcohol, and drugs. On average, rates of substance use and SUD are similar to or even higher than those in peers with average intelligence. Individuals with MID-BIF are overrepresented in (forensic) addiction care. Several instruments are now available for the assessment of SUD and its risk factors in this target group. Prevention and intervention programs have been shown feasible and with promising outcomes, although the evidence base is still small. Professionals in addiction care and intellectual disability care facilities show deficiencies in skills in addressing SUD in clients with MID-BIF.

SUMMARY

Research in this area is still in its infancy, though an increasing number of studies show promising outcomes regarding case identification, assessment, and treatment of SUD in intellectual disability. Policy and practice should be adapted to the characteristics of individuals with MID-BIF.

Substance use among individuals with mild intellectual disability or borderline intellectual functioning in residential care: Examining the relationship between drinking motives and substance use

Background

This study examined the relationship between substance use motives (i.e., social, conformity, coping and enhancement) and substance use in individuals with mild intellectual disability or borderline intellectual functioning (MID‐BIF).

Method

Data were collected among 163 clients with MID‐BIF using interactive questionnaires with visual cues on a tablet with a web application.

Results

Results show that social motives were positively related to frequency of alcohol use, while conformity, coping and enhancement motives were positively related to severity of alcohol use. Results for drug use show that social motives were positively related to frequency of cannabis and hard drug use and that conformity motives were negatively related to frequency of cannabis use. Coping motives were positively related to severity of drug use.

Conclusions

Insight in substance use motives should be used when adapting interventions, as it could contribute to the prevention and reduction of substance use disorders in individuals with MID‐BIF.

Higher IQ in juvenile myoclonic epilepsy: Dodging cognitive obstacles and "masking" impairments

Executive deficits and impulsiveness are extensively reported in juvenile myoclonic epilepsy (JME). Previous literature suggests that intelligence may mediate these deficits. In this study, we evaluated and compared the performance of adults with JME with high and low intelligence quotient (IQ) and controls on tasks for executive function (EF) and impulsive traits. We investigated the neuropsychological performance of 53 adults with JME and below average IQ (57% women; 26.9 [±7.88] years; mean IQ: 89.8 [±5.1]), 26 adults with JME and average or above average IQ (53.8% women; 28.2 [±9.33] years; mean IQ: 110.7 [±8.3]), 38 controls with below average IQ (55% women; 28.4 [±8.4] years; mean IQ: 90.1 [±5.8]), and 31 controls with average or above average IQ (61.3% women; 32.20 [±11.3] years; mean IQ: 111.6 [±10.5]) with a comprehensive battery of neuropsychological tests that measure executive/attentional function. Impulsive traits were assessed using the Cloninger et al.'s Temperament and Character Inventory (novelty seeking (NS) domain). The group with JME with higher IQ presented worse performance compared with controls with higher IQ on Controlled Oral Word Association (COWA) and Wisconsin Card Sorting Test (WCST) (errors). This group showed worse performance than controls with lower IQ on Stroop Color-Word Test (SCT) 1, Trail Making (TM) A, COWA, and WCST (errors). Patients with lower IQ showed worse performance than controls with higher IQ on Digit Span Forward (DSF), Digit Span Backward (DSB), SCT1, SCT2, SCT3, TM A, COWA, and WCST (errors and failure to maintain set). Patients with lower IQ showed worse performance than controls with lower IQ on DSF, DSB, SCT1, SCT2, SCT3, TM A, TM B, COWA, and WCST (errors and failure to maintain set). Patients from groups with low and high IQ showed higher scores than controls with higher and lower IQ on impulsivity for NS1 and NS2 (except for patients with higher IQ versus controls with lower IQ). Adults with JME and higher IQ show less evidence of EF deficits compared with those with JME and below average IQ, suggesting that a higher degree of intellectual efficiency may act as a compensatory mechanism. However, it does not minimize some aspects of impulsive traits. Patients with JME and higher cognitive reserve may create strategies to dodge their cognitive obstacles. In this context, intelligence may protect and, at the same time, "mask" impairments that could be detected earlier.