New form of addiction care for people with mild intellectual disability is effective, says researcher

Problematic substance use occurs relatively frequently in people with a mild intellectual disability. But the mainstream addiction care is not always effective for this group.

During her Ph.D., psychologist Lotte Gosens and colleagues working in intellectual disability care and addiction care developed a treatment that does work. “The participants used less alcohol and fewer drugs at the end of the program,” said Gosens. She will graduate from Radboud University on 16 September.

People with a mild intellectual disability often fall outside the mainstream addiction care, she tells us. “For example, if someone is told to report to addiction care at 9 o’clock on Monday morning, that can be difficult. Because how do you get there by bus and how does that work?

“Often, those people just don’t turn up. And even if they do, the treatment is often ineffective, for example, because the language used is too difficult or because it’s tougher for these people to apply in practice the insights learned during the treatment.”

You generally can’t see on the outside whether someone has a mild intellectual disability. People with a mild intellectual disability don’t function as well intellectually and find it difficult to adapt. They are often overwhelmed in daily life, at school or work, for example, or in social contexts.

Adjusted treatment

Gosens, who also works at the health care institution Pluryn, joined colleagues to develop a treatment program adapted to the target group: Take it Personal!+. In it, clients undergo a treatment based on motivational discussions and cognitive behavior therapy, just as in addiction care.

However, in this treatment program, there are two sessions a week instead of one, and the language has been modified. For example, the practitioners don’t talk about “self-control measures” but “the A’s.”

Gosens says, “Those A’s refer to things that clients can do themselves to reduce their substance use, such as staying away from places where they often take drugs or looking for alternatives in situations where they would usually light up a joint.”

Another important difference with mainstream addiction care is the role of the confidential counselor in the new treatment program. Each client chooses someone to be their confidential counselor. That might be someone from their own network (mother, brother or partner, for example) or from the professional network (a supervisor of the residential group, for example).

That person is present once a week and during the treatment sessions and is able to help the client remember things or to explain something to the practitioner. Outside the sessions, the confidential counselor helps the client apply the knowledge and skills from the treatment in their daily life.

Less severe substance use

“The innovative aspect of Take it Personal!+ is the four personality profiles,” Gosens tells us. “Each profile has a customized treatment: impulsiveness, sensation-seeking, anxiety sensitivity and negative thinking. These profiles are an important risk factor for problematic substance use.”

In addition to the treatment, clients use an app for support, which makes it easier for them to apply the insights they have gained in daily life.

“Clients and their supervisors are enthusiastic,” she says. “They told us that during the process. And three months later, we saw that the severity of the substance use was lower for the majority of clients than it had been before the treatment.

“My colleagues and I are now going to look into how we can apply Take it Personal!+ in more locations. The first results of the new treatment are positive and two organizations for intellectual disability care are working with this treatment.”