Tobacco and alcohol-related interventions for people with mild/moderate intellectual disabilities: a systematic review of the literature.
We still lack proof that any tobacco or alcohol program works for adults with intellectual disability.
01Research in Context
What this study did
The team hunted for every study that tried to cut smoking or drinking in adults with mild or moderate intellectual disability.
They found only nine papers, all small and weak in design.
Most used simple lessons, pictures, or rewards, but none ran a true experiment.
What they found
Only one study showed clear gains—participants learned more facts after a short class.
The other eight showed little or no change.
The review ends with a loud call: run better trials with real measures.
How this fits with other research
Eldridge et al. (2025) looked at real-world services in California and found almost no programs ready to treat substance use in clients with ID. This extends the 2013 gap—twelve years later, the field still waits for solid care.
McMahon et al. (2014) tested a computer-based HIV course for men with ID and saw big skill gains. This shows that short, visual, hands-on lessons can work, matching the 2013 hint to use pictures and role-play.
Taylor et al. (2017) and Lippold et al. (2009) proved that simple bedtime rules can fix sleep problems in the same population. These studies give a template: pick one clear target, teach a small skill, and measure nightly.
Why it matters
If you serve adults with ID, assume no one has tested a smoking or drinking program for them. Borrow the winning pieces from sleep and HIV work: use visuals, practice in short bursts, and track simple counts like cigarettes per day. Then push your agency to join or start a real trial so we all get better answers.
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02At a glance
03Original abstract
BACKGROUND: The behavioural determinants of health among people with mild/moderate intellectual disabilities (ID) are of increasing concern. With the closure of long-stay institutions, more people with ID are living in the community. As they lead more ordinary and less restricted lives, people with ID may be exposed to social and environmental pressures that encourage them to adopt behaviours that impact negatively on their health. Levels of smoking and alcohol consumption in this client group are of particular concern. METHODS: We undertook a mixed method review of the literature, aiming to assess the Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME) of interventions designed to address the use of tobacco and/or alcohol in people with mild/moderate ID. Key electronic databases were searched (e.g., Medline, Cochrane Register of Controlled Trials, PsycINFO) from 1996 to 2011. The search was developed using appropriate subject headings and key words (e.g., intellectual disability, tobacco use, alcohol drinking, health promotion). On completion of the database searches, inclusion/exclusion criteria, based on an adaptation of the PICO framework (Population, Intervention, Comparison, Outcomes), were applied. Methodological quality was assessed using a seven-point rating scale. RESULTS: Database searches identified 501 unique records, of which nine satisfied the inclusion criteria. Four focused on tobacco, three on alcohol and two on both tobacco and alcohol. Located in the U.K., the U.S.A. and Australia, the studies aimed to increase knowledge levels and/or change behaviour (e.g., to encourage smoking cessation). One was a randomised controlled trial, one a quasi-experiment and the others were before and after studies and/or case studies. Methodological quality was poor or moderate. The combined studies had a sample size of 341, with ages ranging from 14 to 54 years. The interventions were delivered by professionals (e.g., in health, social care, education) during sessions that spanned a period of three weeks to one academic year. The studies highlighted a number of important issues linked to the appropriateness of interventions for this client group (e.g., use of pictures, quizzes, role play, incentives); however, in the majority of cases the interventions appeared to lack a theoretical framework (e.g., behaviour change theory). The appropriateness of the outcome measures for use with this client group was not tested. One study discussed feasibility (teachers delivering lessons on alcohol and tobacco) and only one was informative in terms of effectiveness, i.e., increasing knowledge of the health and social dangers of smoking and excessive alcohol consumption. CONCLUSIONS: This review is the first to systematically collate evidence on tobacco and alcohol-related interventions for people with ID. While there is currently little evidence to guide practice, the review delivers clear insights for the development of interventions and presents a strong case for more robust research methods. In particular there is a need to test the effectiveness of interventions in large-scale, well-designed trials and to ensure that outcome measures are developed/tailored appropriately for this client group.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2012.01543.x