SubstanceMisuse:Socialimpact ofsubstancedependencyAn exploration ofsubstance misuse withpeople with LearningDisabilities.
TitleSubstance Misuse: Social impact of substance dependency: Anexploration of substance misuse with people with LearningDisabilities within the United Kingdom. i.
Contents PageTitle i.Table of Contents ii.Abstract iii.Introduction 1Methodology 1,2Main text 2,3,4,5,6Conformity and group 2,3Does having a learning disability increase anindividuals vulnerability to misuse substances? 3.4.5Service provision for people with Learning disabilitieswho have substance use issues.Cost 5,6Conclusions 6Recommendations 7Areas for suggested personal development 7Bibliography 8,9,10,11Apendix 12 a,b ii.
AbstractPeople with learning disabilities have historically been supportedunder the auspices of medical services including long stay specialisthospitals. Government legislation is advocating people with learningdisabilities have greater social inclusion living in the widercommunity. People with learning disabilities can have difficultieswith social rules and interpersonal relationships and can lack theskills and ability to function within socially acceptable norms.Evidence suggests that many people with learning disabilities misusesubstances to support their perceived social inclusion andacceptance. Services available to enable people with learningdisabilities to address their substance misuse are inept in theirservice provision. iii.
IntroductionThe aim of this report is to consider the predisposition that peoplewith learning disabilities may have in relation to substance misuse.The use of the words ‘learning disability is synonymous with theterms ‘Mental Handicap’ and ‘Severe Mental Impairment’ that hasbeen used in Europe. ‘Learning disability’ is used in the UK and assuch this term will be used within this report. Valuing People (2001)There are numerous substances that can be misused and haveholistic psychological, sociological impact on the individual and theimmediate and wider community. These include illicit, prescriptionand more socially acceptable substances such as alcohol and tobaccoand caffeine.MethodologyThe primary intention of this report is to depict the characteristicsof people with Learning disabilities who misuse substances, and thesociological effects of such misuse, The use of pre-existingQualitative, Quantitative and Epidemiological research containedwithin journals; published literature; a historical approach would be 1
more advantageous in meeting these aims considering the timeconstraints imposed on this report and the diverse learning disabilitypopulation.Main TextConformity and groupHistorically people with learning disabilities have been segregatedfrom the wider community. Current government legislation isadvocating changes striving for the empowerment and social inclusionacross all of society for people within the labelled group of having alearning disability. (Valuing people 2001, Same as You, 2001) (Seeappendix 1). The need for social acceptance, interpersonalrelationships is imperative within social construct.People with learning disabilities have increased social barriers andissues with conforming to perceived group social influence andacceptable norms. Asch (1956). Milgram’s (1974) research intoobedience to authority showed that all people are sensitive topressures of social influence. As people with learning disabilities areliving within the community they may be exposed to increased socialand expectation factors that could increase the misuse of 2
substances such as alcohol, tobacco and illicit substances to supporttheir coping ability. The use of substances may be perceived assupporting social acceptance within their peer group. (Moore &Polsgrove, 1991, Gress & Boss, 1996, Clarke & Wilson, 1999, Sturmeyet al., 2003).Within the construct of social care support networks is the powerstruggle and the perceived expectation of a duty to care implyingthat it is the role of support staff and circles of support to ensurethat the person with a learning disability environmental options aresafe. Restricting individuals access to the wider community and bythat construct restricting the opportunity to substances they mayabuse. Valuing people Now (2007).Does having a learning disability increase an individuals vulnerabilityto misuse substances?The need for social acceptance, interpersonal relationships isimperative within social construct. People with learning disabilitieshave increased social barriers and issues with conforming toperceived group social influence and acceptable norms. Asch (1956).Valuing People (2001) a Department of Health white paper estimated 3
that there are around 210,000 people with profound, severe learningdisabilities within the United Kingdom: consisting of 120,000 peoplewithin working ages and 25,000 within retirement. The numbers ofpeople with learning disabilities living within the community isincreasing experientially as specialist hospitals are being closed. Ourhealth our care our say (2006).Vulnerable people such as people with learning disabilities are twiceas likely to use substances to that of their comparative peer group.(Brown et al, 2000) (Hymowitz et al, 1997) People with learningdisabilities who use tobacco are also more likely than people who donot smoke to use illicit substances and drink alcohol. Cosden; Silver(1999) concluded following studies that people in substance misusetreatment programs are more likely to have learning disabilities thanthe proportionate population. Silver (1999) presented findings thatthis percentage could be as high as 60%.Much of the data that exist on learning disabilities and substanceabuse comes from retrospective studies in which respondents arerequested to remember things that happened earlier. Problems mayarise when the individual also has a learning disability and may nothave the cognitive ability to enable the recollection of accurate 4
information to facilitate retrospective data collection. Moore &Polsgrove, (1991).Service provision for people with Learning disabilities who havesubstance use issues.Mainstream services for substance misuse and bespoke services forpeople with learning disabilities pre-port to not have the ability toappropriately support individuals with a learning disability. Lottman,(1993). Many people subsequently do not receive appropriatesupport Lance and Longo (1997). Individuals with learningdisabilities are more likely to have inadequate health care. Ourhealth our care our say (2006).CostCessation interventions consistently are the highest cost outlay forthe NHS in relation to the direct treatment of people needingsupport addressing the physically consequences from theirsubstance misuse. Lancaster et al (2000). Over a 12 year period ahalf of deaths of vulnerable people receiving cessation support wereattributed to substance misuse. Hurt (1996). People with learningdisabilities however evidentially are excluded from the 5
cessation programmes. Lawn et al., (2002)ConclusionsThe need for social acceptance increases the likelihood thatindividuals with learning disabilities under increased social pressuresof living within the wider community experientially expand theirvulnerability to the misuse of substances to facilitate copingstrategies and perceived acceptance.With the lack of bespoke services to enable people with learningdisabilities to identify their substance misuse were do people with areduced level of cognitive ability receive the support they mayrequire to enable them to address their substance misuse.If there is continued development of social inclusion for people withlearning disabilities and the population increases within the widercommunity as services such as specialist hospitals close without thesupport network to enable the development of bespoke services thenit is comparable to consider that the numbers of people withlearning disabilities misusing substances will increase andsubsequently the cost to the NHS is likely to also increase. 6
RecommendationsIdentify people with learning disabilities as early as possible.Support them holistically enabling their ability to develop theirsocial skill and personal development. By doing so, we may reducethe likelihood that they will suffer lower self-esteem, socialdifficulties that may contribute to the possibility of substancemisuse.Bespoke services to support people with learning disabilities tosupport services to develop appropriate skills as identified.Areas for suggested future personal developmentThe process of this report has offered continued personal andprofessional development. The ability to be able to formulate andresearch a report has enabled the opportunity to consider areas ofsocial psychology that I had not previously considered. It willsupport my continued professional development as a Case advocateworking with people with mental health problems and learningdisabilities. This opportunity continues to highlight the need for apersonal centred holistic approach within social care. 7
BibliographyAsch, S. E. (1956), ‘Studies of independence and conformity: aminority of one against a unanimous majority’, PsychologicalMonographs, 70.Brown, S. A., Tapert, S. F., Granholm, E., & Delis, D. C. (2000).Neurocognitive functioning of adolescents: Effects of protractedalcohol use. Alcoholism, Clinical and Experimental Research, 24(2),164-171.Clarke, J. J. & Wilson, D. N. (1999): Alcohol problems and intellectualdisability.Journal of Intellectual Disability Research, Vol. 43, 135-139.Cosden, M. (1999). Substance abuse and learning disabilities:Theories and findings. Paper presented at the CASA-NCLDConference on Substance Abuse and Learning Disabilities, New York,NY 8
Gress, J. R. & Boss, M. S. (1996): Substance abuse differencesamong students receiving special education school services. ChildPsychiatry and Human Development, Vol. 26, 235-246.Hurt, RD. Offord, KP. Croghan, IT. Et al. (1996) Mortality followinginpatient addictions treatment: role of tobacco use in a community-based cohort. JAMA 275(14):1097-1103.Lancaster, T. Stead, L. Silagy, C. Sowden, A. (2000) effectivenessof Interventions to help people stop smoking: findings from theCochrane Library.nBritish Medical Journal. 321 Aug. 355-7Lance P, Longo M D (1997). Mental health aspects of developmentaldisabilities. The Habilitative Mental Healthcare Newsletter, Vol. 16(4), 61-64.Lawn, S.J. Pols, R.G. Barber, J.G. (2002). Smoking and Quitting: aqualitative study with community-living psychiatric clients. SocialScience & Medicine. 54(1):93-104. 9
Lottman, T. (1993): Access to generic substance abuse services forpersons with mental retardation. Journal of Alcohol and DrugEducation, Vol. 39, 41-55.Milgram, S. (1974), Obedience to Authority; An Experimental ViewMoore, D., & Polsgrove, L. (1991). Disabilities, developmentalhandicaps, and substance misuse: A review. International Journal ofthe Addictions, 26(1), 65-90.Department of Health (2007) Our Health our Care our Say .London:Crown.Department of Health (2001) Same as You, London: Crown.Sturmey, P., Reyer, H., Lee, R. & Robek, A. (2003): Substance relateddisorders in persons with mental retardation. NADD: Kingston, NY. 10
Silver, L. B. (1999). Learning disabilities and attention deficithyperactivity disorder: They dont stand alone. Paper presented atthe CASA-NCLD Conference on Substance Abuse andLearning Disabilities, New York, NY.Department of Health (2001) Valuing People. London: Crown.Department of Health (2007) Valuing People Now. London: Crown. 11