Addiction Risks For People With Developmental Disabilities

Major Lifestyle Changes Increase Vulnerability to Alcohol and Drugs

Ten years ago, studies showed that the number of people with developmental disabilities who developed alcohol and drug addictions was almost nil. Now they are considered a group at risk. The reasons are many and complex.

De-Institutionalization & De-centralization In Community Care Settings

Over the past decade, fewer and fewer people with developmental disabilities have been institutionalized. While institutions have quite rightly developed a negative reputation for poorly serving the needs of these individuals, as well as shielding society from the realities of its members, people in institutions, by and large, did not have access to alcohol and drugs (other than prescribed medications).

In the past, many people with developmental disabilities who were not institutionalized went from families to foster homes to large group homes, where they were well-supervised and controlled. Although the self-advocacy movement has created many more opportunities for these people, they are less well supervised, and their lives and lifestyles are far less controlled. With greater freedom and independence, in many cases, people with developmental disabilities can now get alcohol and drugs as easily as anyone else.

While personal choice, self-expression and maximum independence are now encouraged, people with developmental disabilities do not necessarily have the insight, skills or resources to do what is in their best interests, or to foresee or deal effectively with consequences. For example, when a person with a cognitive disability crosses the line with public drunkenness or dealing drugs, the frontline response is often to allow the natural consequences of police involvement and court diversion or jail, to occur, which are highly questionable as teaching methods, and can be very destructive.

In these circumstances, options for specialized accurate assessment and effective treatment are rare.

Vulnerability

People with developmental disabilities are a widely varied group, with some people functioning relatively well socially and intellectually, and others unable to do much for themselves. What they have in common is some kind of impairment to their normal mental development.

This means that they often lack the cognitive skills required to resist the pressure to use alcohol and drugs, and to engage in other addictive behaviors, such as good judgment, impulse control, and the ability to learn from mistakes.

People with developmental disabilities also tend to be protected while growing up. This is a good thing - without other adults looking out for them, they could be hurt in many different ways. However, a consequence of this is that they may be more trusting and dependent than typical adults, with the tendency to think that others know what is right for them better than they do.

People with developmental disabilities are also at far higher risk for sexual abuse than their typical peers. They may be more inclined to tolerate abuse because they wish to be valued (however negatively), they may feel powerless, they may be lonely, and they may have intellectual impairments that prevent them from correctly judging or reporting a situation.

Wanting to Feel Normal and Accepted

People with developmental disabilities grow up feeling inadequate, and often have a hard time making friends and being accepted by peers.

Alcohol and illicit drugs provide a quick route into social relationships and acceptance - particularly from those who wish to exploit them. With limited job opportunities, they may also find a quick route into prostitution, which can lead into alcohol and drug abuse as well.

Vulnerability to the Will of Others: A Negative Consequence of Therapies?

Many therapies teach children with developmental disabilities, such as Autism Spectrum Disorders, to be compliant. Applied Behavior Analysis (ABA), for example, is focused on teaching children to become more compliant by repeatedly rewarding the behavior that the therapist wants from the child.

Although most behaviors encouraged of children are pro-social and functional, there is a risk that excessive use of these therapies may make these individuals overly compliant, so they can easily be manipulated into doing things they would not necessarily do if they were better able to think for themselves. The slowly rising prevalence of abuse of drugs and alcohol may be linked to a conditioned inability to "just say no" in some individuals.

Progression to true addiction, psychological, physiological, genetically linked, is dependent on a number of other factors.

What Can Be Done

It is too early to give any kind of definitive answer on the best way to address these issues, particularly because the very things that cause alcohol and drug problems among people with developmental disabilities are those that have improved their quality of life immeasurably (particularly freedom, and contact with the outside world). However, politicians and social systems need greater awareness of the vulnerability of people with developmental disabilities as a group, and parents and caregivers need to be aware of appropriately targeted alcohol and drug prevention measures.

Sources

Hershkowitz I, Lamb ME, Horowitz D. “Victimization of children with disabilities.” Am J Orthopsychiatry. Oct 2007 77:629-635.

Ludwig, Barbara. Alcohol, Drugs and Disability: Making the Connection. Health and Wellbeing in Persons With Intellectual/Developmental Disabilities, Children Youth and Adults Conference, Sep 25-26 2008 Coast Plaza Hotel & Suites, Vancouver, British Columbia, Canada.

Newbury-Jones, Margaret, & Johnson, Dr Peter. “Breaking the Cycle of Sexual Abuse: Treating Victims and Offenders.” Interprofessional Workshop, University of British Columbia, Vancouver, British Columbia, Canada. Sep 24 2008.

Slifer, K., Avis, K., Frutchey, R. “Behavioral Intervention to Increase Compliance with Electroencephalographic Procedures in Children with Developmental Disabilities” Epilepsy & Behavior, 2008 13:189-195.

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