Treatment issues

Given that there is no clear idea of prevalence of substance use among people with LDs it is perhaps not surprising that specialist service provision to this group of people is generally considered to be poor.  A recent review of services in Northern Ireland recommended the recruitment of seven link workers to facilitate the delivery of mainstream substance use services to people with LD (DHSSPSNI undated).  In England, the Valuing People strategy (DH 2001: 2) did not mention substance use at all but recognised that “substantial health care needs of people with learning disabilities are often unmet”.

Intervention and treatment delivery therefore needs to develop from the ground up. 

Partnership working has to be the key, not only to good assessment, but also to meeting the individual’s needs in terms of service delivery and intervention.  Collaborative working between specialist drug and alcohol agencies and learning disability specialists will ensure that the person receives an informed and appropriate service.  Huxley et al. (2005) recommend integration of services where LD teams maintain overall care but substance specialists are added to existing services allowing for minimum disruption to the client’s care and avoid being passed from pillar to post.  This has been done with some success in Preston, Lancashire (see previous section on ‘Assessment’ for further details).

Treatment approaches that have been used to date include:

• Educational sessions and behavioural work (Lindsay et al 1991)
• Group work (Paxon 1995)

Some interventions require a degree of insight and these are not always appropriate for some people with LDs.  Thus it is even more important that the assessment has been done holistically and done well and can provide the foundation on which to build an appropriate intervention plan.

Andy Shaw from Preston PCT (Andrew.Shaw@PrestonPCT.nhs.uk) has developed flash cards to help educate people with cognitive difficulties and communication difficulties understand the physiological impact of substance use.  However, what also needs to be identified and recognised in any treatment is the benefits and positive aspects the person’s substance use has for them.  Telling someone to cut down or stop doing something they get enjoyment out of is unlikely to work unless something else that fulfils that role can replace it.

Intervention and treatment delivery also needs to consider transport arrangements and potential access problems, increased anxieties while waiting for appointments, increased worries over poor attitudes and knowledge of health professionals in relation to learning disabilities (SCIE undated) and the need for fully informed consent that does not rely on a carer.  An advocate may need to be involved and communication about consent issues will need to be appropriate to the person’s needs.

What is clear from much of the literature is that preventative and educational work needs to be done from an early age with young people with LDs in order to reduce potential harm and to provide people with informed choices.

It is also clear that staff working with substance use agencies and learning disability specialists need training in the ‘other’ issue.  Free training exchanges between agencies are increasingly common and helpful in building local partnerships.

Agencies working with people with learning disabilities need alcohol and drug policies that deal with practical issues, eg. alcohol on premises, purchasing alcohol for service users (Manthorpe et al 1997) as well as consideration given to other drug use.  There needs to be clear guidance given to service users about what is and is not acceptable.

 References

• DHSSPSNI (undated)  ‘Review of mental health and learning disability. Alcohol and substance misuse working committee.  Workforce Planning.’  Draft document.  Accessed on-line at www.dhsspsni.gov.  15th February 2006
• Department of Health (2001)  Valuing People: A New Strategy for Learning Disability for the 21st Century.  London: DH
• Huxley, A., Copello, A, and Day, E. (2005) ‘Substance misuse and the need for integrated services.’  Learning Disability Practice, 8 (6), 14-17
• Lindsay et al (1991)  ‘An alcohol education service for people with learning difficulties.’  Mental Handicap, 19, 96-100
• Manthorpe et al (1997)  ‘Issues of Risk Practice and Welfare in Learning Disability Services.’  Disability & Society, 12 (1), 69-82
• Paxon, J.E. (1995) ‘Relapse prevention for individuals with developmental disabilities, borderline intellectual functioning, or illiteracy.’  Journal of Psychoactive Drugs, 27, 167-172
• SCIE (undated)  Access to primary care services for people with learning disabilities.  SCIE Research Briefing.  Accessed on-line at www.scie.org.uk.  15th February 2006

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