Substance use in individuals with mild to borderline intellectual disability: A comparison between self-report, collateral-report and biomarker analysis.
Simple client-plus-staff questionnaires spot most drug use in adults with mild-borderline ID, so skip pricey lab tests unless you need to track alcohol.
01Research in Context
What this study did
The team asked adults with mild to borderline intellectual disability about their drug and alcohol use. They also asked staff who knew the adults well. Then they checked urine and hair samples for proof.
They wanted to see if the simple questions matched the lab results.
What they found
The answers from both the adults and the staff lined up well with the lab tests for most drugs. This means the questionnaires catch current use without needing expensive tests.
The only mismatch was alcohol; here the lab tests found more use than the reports.
How this fits with other research
van Duijvenbode et al. (2015) warned that we hardly have any screening tools made for people with ID. This study gives one that works.
Emerson et al. (2013) told us to doubt self-report from people with ID. The new data say the doubt is overdone when you also ask a staff member.
Pacoricona Alfaro et al. (2017) saw lower use in high-school students with mild ID. The adult group in Bassett-Gunter et al. (2017) showed higher use, so age and setting matter. No real clash—just different life stages.
Why it matters
You can now screen for substance use in adults with mild-borderline ID without blood or hair tests. Hand the client a short picture-supported questionnaire, ask a caregiver the same items, and you have a solid answer. Save lab work for times when alcohol is the main worry.
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02At a glance
03Original abstract
BACKGROUND AND AIMS: Individuals with mild or borderline intellectual disability (MBID) are at risk of substance use (SU). At present, it is unclear which strategy is the best for assessing SU in individuals with MBID. This study compares three strategies, namely self-report, collateral-report, and biomarker analysis. METHODS AND PROCEDURES: In a sample of 112 participants with MBID from six Dutch facilities providing care to individuals with intellectual disabilities, willingness to participate, SU rates, and agreement between the three strategies were explored. The Substance use and misuse in Intellectual Disability - Questionnaire (SumID-Q; self-report) assesses lifetime use, use in the previous month, and recent use of tobacco, alcohol, cannabis, and stimulants. The Substance use and misuse in Intellectual Disability - Collateral-report questionnaire (SumID-CR; collateral-report) assesses staff members' report of participants' SU over the same reference periods as the SumID-Q. Biomarkers for SU, such as cotinine (metabolite of nicotine), ethanol, tetrahydrocannabinol (THC), and its metabolite THCCOOH, benzoylecgonine (metabolite of cocaine), and amphetamines were assessed in urine, hair, and sweat patches. RESULTS: Willingness to provide biomarker samples was significantly lower compared to willingness to complete the SumID-Q (p<0.001). Most participants reported smoking, drinking alcohol, and using cannabis at least once in their lives, and about a fifth had ever used stimulants. Collateralreported lifetime use was significantly lower. However, self-reported past month and recent SU rates did not differ significantly from the rates from collateral-reports or biomarkers, with the exception of lower alcohol use rates found in biomarker analysis. The agreement between self-report and biomarker analysis was substantial (kappas 0.60-0.89), except for alcohol use (kappa 0.06). Disagreement between SumID-Q and biomarkers concerned mainly over-reporting of the SumID-Q. The agreement between SumID-CR and biomarker analysis was moderate to substantial (kappas 0.48 - 0.88), again with the exception of alcohol (kappa 0.02). CONCLUSIONS AND IMPLICATIONS: In this study, the three strategies that were used to assess SU in individuals with MBID differed significantly in participation rates, but not in SU rates. Several explanations for the better-than-expected performance of self- and collateral-reports are presented. We conclude that for individuals with MBID, self-report combined with collateralreport can be used to assess current SU, and this combination may contribute to collaborative, early intervention efforts to reduce SU and its related harms in this vulnerable group.
Research in developmental disabilities, 2017 · doi:10.1016/j.ridd.2016.04.006