Substance Use Disorder in People with Intellectual Disabilities: Current Challenges in Low- and Middle-Income Countries

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Abstract

Use of illegal and prescription drugs has significantly increased in recent years all over the world in most populations. Greater worldwide awareness in this regard has substantially improved the epidemiological understanding of substance use, its risk factors, and impact on life. People with intellectual disabilities constitute 0.5%–1.5% of the world's population. It can be conjectured that they might be experiencing similar or even a greater burden of substance use in their lives. This article highlights some important aspects of substance use among this population in low- and middle-income countries that need urgent attention.

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Most cited references 30

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The epidemiology of dual diagnosis.

R Kessler (2004)

The English language literature on the epidemiology of dual diagnosis is reviewed. The literature shows mental disorders to be significantly related to alcohol and drug use disorders. The strongest associations involve externalizing mental disorders and alcohol-drug dependence. Mental disorders are associated with alcohol-drug use, problems among users, dependence among problem users, and persistence among people with lifetime dependence. These dual diagnoses are associated with severity and persistence of both mental and alcohol-drug disorders. A wider range of mental disorders is associated with nicotine dependence. Most people with dual diagnosis report their first mental disorder occurred at an earlier age than their first substance disorder. Prospective studies confirm this temporal order, although significant predictive associations are reciprocal. Analyses comparing active and remitted mental disorders suggest that some primary mental disorders are markers and others are causal risk factors for secondary substance disorders. The article closes with a discussion of ways epidemiologic research can be used to help target and evaluate interventions aimed at preventing secondary substance use disorders by treating early-onset primary mental disorders.

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Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study

Rory Sheehan, Angela Hassiotis, Kate Walters … (2015)

Objectives To describe the incidence of recorded mental illness and challenging behaviour in people with intellectual disability in UK primary care and to explore the prescription of psychotropic drugs in this group. Design Cohort study. Setting 571 general practices contributing data to The Health Improvement Network clinical database. Participants 33 016 adults (58% male) with intellectual disability who contributed 211 793 person years’ data. Main outcome measures Existing and new records of mental illness, challenging behaviour, and psychotropic drug prescription. Results 21% (7065) of the cohort had a record of mental illness at study entry, 25% (8300) had a record of challenging behaviour, and 49% (16 242) had a record of prescription of psychotropic drugs. During follow-up, the rate of new cases of mental illness in people without a history at cohort entry was 262 (95% confidence interval 254 to 271) per 10 000 person years and the rate of challenging behaviour was 239 (231 to 247) per 10 000 person years. The rate of new psychotropic drug prescription in those without a previous history of psychotropic drug treatment was 518 (503 to 533) per 10 000 person years. Rates of new recording of severe mental illness declined by 5% (95% confidence interval 3% to 7%) per year (P<0.001), and new prescriptions of antipsychotics declined by 4% (3% to 5%) per year P<0.001) between 1999 and 2013. New prescriptions of mood stabilisers also decreased significantly. The rate of new antipsychotic prescribing was significantly higher in people with challenging behaviour (incidence rate ratio 2.08, 95% confidence interval 1.90 to 2.27; P<0.001), autism (1.79, 1.56 to 2.04; P<0.001), and dementia (1.42, 1.12 to 1.81; P<0.003) and in those of older age, after control for other sociodemographic factors and comorbidity. Conclusions The proportion of people with intellectual disability who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness. Antipsychotics are often prescribed to people without recorded severe mental illness but who have a record of challenging behaviour. The findings suggest that changes are needed in the prescribing of psychotropics for people with intellectual disability. More evidence is needed of the efficacy and safety of psychotropic drugs in this group, particularly when they are used for challenging behaviour.

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Cyberbullying among students with intellectual and developmental disability in special education settings.

Robert Didden, Ron Scholte, Hubert Korzilius … (2009)

To explore the types, prevalence and associated variables of cyberbullying among students with intellectual and developmental disability attending special education settings.

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Author and article information

Journal

Journal ID (nlm-ta): J Neurosci Rural Pract

Journal ID (iso-abbrev): J Neurosci Rural Pract

Journal ID (publisher-id): JNRP

Title: Journal of Neurosciences in Rural Practice

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 0976-3147

ISSN (Electronic): 0976-3155

Publication date (Print): Apr-Jun 2019

Volume: 10

Issue: 2

Pages: 301-305

Affiliations

[1]Department of Health and Human Performance, Berea College, Berea, USA

[1 ]Division of Epidemiology, University of Utah, Salt Lake, Utah, USA

[2 ]Department of Allied Health, College of Health Science, Northern Kentucky University, Highland Heights, KY, USA

[3 ]Behavioral and Environment Health, Jackson State University, Jackson, Mississippi, USA

[4 ]College of Health Sciences, Walden University, Minneapolis, Minnesota, USA

Author notes

Address for correspondence: Dr. Ram Lakhan, Department of Health and Human Performance, CPO 2187, Seabury Centre #229, Berea College, Berea, KY, USA. E-mail: ramlakhan15@ 123456gmail.com

Article

Publisher ID: JNRP-10-301

DOI: 10.4103/jnrp.jnrp_393_18

PMC ID: 6454939

SO-VID: fbeb84e6-ebdb-4607-8faf-136c8a3ddebe

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Substance Use Disorder in People with Intellectual Disabilities: Current Challenges in Low- and Middle-Income Countries

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Good practices in (cog-neuro) science and science communication

Most cited references 30

The epidemiology of dual diagnosis.

Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study

Cyberbullying among students with intellectual and developmental disability in special education settings.

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