Demographic and clinical characteristics of people with intellectual disabilities with and without substance abuse disorders in a Medicaid population.
Medicaid claims show 2.6 % of adults with ID have substance-abuse diagnoses, but later studies reveal the true rate is higher once you leave claims and look in clinics or independent-living settings.
01Research in Context
What this study did
Slayter (2010) looked at Medicaid records of people with intellectual disability.
The team counted how many also had a substance-abuse diagnosis.
They noted age, race, and other mental-health conditions.
What they found
Only 1 in 40 people with ID had a substance-abuse flag.
Most of them had mild or moderate ID, not severe.
They were more likely to be older, non-White, and carry depression or serious mental illness.
How this fits with other research
Chaplin et al. (2011) saw 8 % current use in mental-health referrals—triple Maclean’s rate. The gap makes sense: clinics see higher-risk people than Medicaid claims capture.
Koegel et al. (2014) used capture-recapture and found twice as many hidden cases of mild ID plus substance use. They show Maclean’s 2.6 % is a floor, not the ceiling.
Clarke et al. (2017) surveyed adults with ID who live alone. Half used tobacco or alcohol—far above Maclean’s figure. Independence itself is a risk factor that Medicaid data miss.
Why it matters
For BCBAs, low official numbers do not mean low real risk. Ask about alcohol, tobacco, and cannabis at intake, especially if the client is mildly affected, lives alone, or has mood symptoms. Add substance-use goals to behavior plans when needed, and coordinate with addiction services.
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02At a glance
03Original abstract
Little is known about the demographic and clinical characteristics of people with intellectual disabilities and substance abuse problems. Drawing on health care billing claims for people with Medicaid coverage aged 12-99 years, the characteristics of people with intellectual disability and a history of substance abuse (N=9,484) were explored and compared with people with intellectual disability but without substance abuse. Age- and/or gender-adjusted odds ratios were derived from logistic regression analyses to consider differences in demographic and clinical diagnoses. People with intellectual disability and substance abuse constituted 2.6% of all people with intellectual disability, most of whom had a diagnosis of mild or moderate intellectual disability. People with intellectual disability and substance abuse problems were, on average, 2 years older than the comparison group and less likely to be White. The sample was more likely than the comparison group to have serious mental illness or depression and substance abuse-related disorders were not prevalent. These data provide a comparison point for existing studies of mental health diagnoses as well as new information about substance abuse disorders. Implications relate to the identification of substance abuse among people with intellectual disabilities as well as the establishment of demographic and clinical correlates.
Intellectual and developmental disabilities, 2010 · doi:10.1352/1934-9556-48.6.417