Social Work, Alcohol and Drugs  
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Disability and Ill Health - Learning disabilities


Prevalence

Very little research has been conducted on the prevalence of alcohol and drug use, and problematic use, among people with learning disabilities.

One of the difficulties is that researchers will use different definitions and terminology to define the same group of people.  The debate about using terminology such as ‘learning disability’ versus ‘learning difficulty’ continues.  The more recent addition of ‘intellectual disability’ adds to the confusion.  What is clear is that service users prefer the term ‘learning difficulty’ and this is the term used more often within social work teaching and practice (see box below for further discussion on terminology).

A word about terminology
The difference in the use of these terms appears to be found in the debate about what constitutes a ‘learning difficulty’ and what constitutes a ‘learning disability’. 

  • A 'learning difficulty' appears to be used more often to describe people who have a range of difficulties processing and learning new information. This can include, for example, dyslexia, dyspraxia, and attention deficit disorders
  • A 'learning disability' appears to be used most often to describe people who have some organic disability that impairs their intellectual capacity or cognitive functioning. According to the DH (2001) learning disability includes : significantly impaired intelligence, impaired social functioning so that a person's ability to cope independently is reduced. Learning disabilities can be developed during pregnancy, for example, in cases of Fetal Alcohol Spectrum Disorder, or through genetic transmission. Learning disabilities are thought to occur in childhood and have a lasting effect on a person's development, although adults who suffer disability through brain injury might be included under this definition. The debate about the basic terminology is further complicated by attempts to describe the severity of the learning difficulty or disability, e.g. mild, moderate, severe
  • The terminology also reflects opinion about the causes of the learning difficulty and disability and whether these causes are genetic, acquired through trauma or other environmental factors such as class and culture, or a combination of all of them.
  • The argument for the differentiation is to ensure that people receive the appropritate support and services and that the research or evidence base for policy and practice development is clearly defined.
         

However, in order to be clear about the prevalence evidence presented here, the term used will be ‘learning disability’ as defined above.
 
The simple answer to the question of prevalence of alcohol and drug use among people with learning difficulties is ‘we don’t know’.  Research evidence is equivocal with most research suggesting that substance use, and problematic use, is not common among this group of people (Cooper et al. 2004).  Conversely, a report from the Royal College of Psychiatrists (1999) states it is “not uncommon”.  

Prevalence research is obviously a gap in the evidence base. There is some evidence that alcohol and cannabis tend to be the drugs of choice for people with learning difficulties (Burgard et al 2000) and certainly the literature available, both research and practice focussed, tends to focus on alcohol more than other substances.

The existing research suggests that people with learning disabilities drink less and abstain more.  However, as Simpson (1998) points out, this may be due to the fact that there are barriers preventing them from choosing to use alcohol and states that insufficient attention has been given to the “cultural and “symbolic importance” of alcohol consumption.

Figures ranging from 0.5% to 2% of the population of people with learning disabilities have been cited in American research (where terms such as ‘mental retardation’ are still used) but the problems of defining learning disabilities and also defining substance use/misuse/abuse means that the limited available research is not particularly helpful.

References

  • Burgard et al (2000)  ‘Prevalence and treatment of substance abuse in the mentally retarded population: an empirical review.’  Journal of Psychoactive Drugs, 32 (3), 293-298
  • Cooper et al. (2004)  ‘People with intellectual disabilities.’  British Medical Journal, 329, 414-415
  • Department of Health (2001)  Valuing People: A New Strategy for Learning Disability for the 21st Century.  London: DH
  • Royal College of Psychiatrists (1997)  Meeting the mental health needs of people with learning disability.  Council Report CR 56.  London: RCP
  • Simpson, M.K. (1998)  ‘Just say ‘No’? Alcohol and People with Learning Difficulties.’  Disability and Society, 13 (4), 541-555

Impact

The impact of substance use on people with learning disabilities will vary from individual to individual in the same way as it will for people with no learning disabilities.  It will also depend on the extent of the person’s disability and what other protective factors they have in their environment, eg. non-using carer, other support systems, home security etc.

The potential negative impact of alcohol or drug use could be far worse for people with learning disabilities if the disability affects their ability to learn about the dangers of substance use, or to develop skills to avoid the potential harm from either the substance or other people supplying or using the substance.  Also, if the person has pre-existing physiological vulnerabilities the negative impact of alcohol or drugs on the body could be exacerbated.  Turner and Moss (1996) discuss how alcohol consumption has been linked to hypertension, CVD and stroke in people with LDs.  In addition, consideration needs to be given to the individuals potentially long term use of prescription drugs both in terms of the combination of alcohol or other substances with existing medication but also whether their existing medication use is causing problems in their own right.  Huxley et al. (2005) state that pre-existing behavioural difficulties might be exacerbated by the substance use adding to the person’s experiences of being marginalised from services. There have also been links in the literature between offending behaviour and substance use among people with learning disabilities.

However, a further concern is that people with LDs may be at greater risk of exploitation from other people who have problems with substance use who are able to take advantage of the person’s physical and sensory impairments.   Turner and Moss (1996) point out how young people in particular have a poor knowledge of alcohol, making them at least as vulnerable to alcohol use and related problems as other young people if not more so.

Huxley et al. (2005) also point out that consideration needs to be given to the broader social impact of substance use.  They state that the impact of substances on a person’s cognition may cover up the individual’s true ability level, leading to problems getting work or housing that is suited to their needs.

While these risks need to be recognised and identified, the argument has to be balanced with the potential positive role substance use, particularly alcohol, may have on a person’s life, as well as on the person’s right to make choices that places them at risk.  Simpson (1998) points out how difficult it is for people with LDs to access alcohol despite its “cultural and symbolic” role in our society.  Manthorpe (1996) has also pointed out the social significance of people with learning disabilities having such choices.  If normalisation and integration into community life are truly goals of deinstitutionalisation and empowerment, such social activities such as drinking in the pub should be accessible to people regardless of their disability.

References

  • Huxley, A., Copello, A, and Day, E. (2005) ‘Substance misuse and the need for integrated services.’  Learning Disability Practice, 8 (6), 14-17
  • Manthorpe, J. (1996) ‘People with learning difficulties: alcohol and ordinary lives.’  In: L. Harrison (ed.) Alcohol Problems in the Community.  London: Routledge
  • Simpson, M.K. (1998)  ‘Just say ‘No’? Alcohol and People with Learning Difficulties.’  Disability and Society, 13 (4), 541-555
  • Turner, S. and Moss, S. (1996)  ‘The health needs of adults with learning disabilities and the Health of the Nation strategy.’  Journal of Intellectual Disability Research, 40 (5), 438-450

 

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