Pretreatment for substance-abusing people with intellectual disabilities: intervening on autonomous motivation for treatment entry.
A 10-session SDT program turns external pressure into personal choice for adults with mild ID who abuse substances.
01Research in Context
What this study did
Researchers ran a 10-session program called "Beat the kick" for adults with mild intellectual disability who also had substance-use problems.
They used a multiple-baseline design across six people. Each person started the program at a different time.
The sessions were built on Self-Determination Theory. Staff helped clients feel free, capable, and connected so they would choose treatment on their own.
What they found
Five of the six adults moved from feeling pushed into rehab to wanting it for themselves.
They also said their needs for choice, skill, and friendship were better met after the 10 meetings.
How this fits with other research
Hsu et al. (2011) showed that the old "stages-of-change" checklist sorts adults with ID only a little better than a coin toss. The new study swaps that weak tool for SDT need support and gets real movement.
Giesbers et al. (2020) asked staff and families what drives exercise in people with ID. Fun, mastery, and friendly praise topped the list. "Beat the kick" used the same ingredients, proving they also spark motivation for hard tasks like addiction care.
Porter et al. (2008) proved staff can run group CBT for depression in the same population. Freeman et al. (2015) now show staff can also run a short SDT pretreatment, widening the menu of help that works.
Why it matters
You now have a ready-made 10-session script that flips "I have to go" into "I want to go" for clients with mild ID and drug or alcohol problems. Add it before your standard ABA or CBT track; it costs no meds and only two staff hours a week.
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02At a glance
03Original abstract
BACKGROUND: Despite a lack of consensus regarding prevalence rates of substance abuse, people with intellectual disabilities (ID) on average use substances slightly less often than their non-disabled peers. However, their use of substances is more often problematic. Avoidance of treatment is a crucial problem among substance-abusing people with ID. This study tested a motivational intervention to facilitate autonomous motivation (i.e. wanting to change substance abuse because of a sense of free choice and volition) for engaging with a subsequent addiction treatment. METHOD: A multiple-case experimental design (N = 6) was conducted to measure day-to-day motivation to change substance abuse among individuals with mild ID (N = 3) and borderline level of intellectual functioning (N = 3) in the Netherlands. The participants (five men, one woman) lived in the community (except one, he lived in a residential facility) and abused cannabis, alcohol or hashish. During the intervention phase, the 10-session treatment programme 'Beat the kick' was delivered by an experienced psychologist, based on motivational interviewing techniques adapted for people with mild to borderline ID. Participants completed an adaptive self-reported inventory based on self-determination theory (SDT) two to three times a week during baseline, intervention and 1-month follow-up. RESULTS: The results of five of the six participants (one dropped out) showed that the type of motivation changed from more controlled types of motivation (i.e. external motivation and introjected motivation) at baseline to more autonomous types of motivation after completion of the intervention. In addition, the participants reported a significant increase in overall need satisfaction and autonomy satisfaction and a significant decrease of overall need frustration. CONCLUSIONS: The implementation of SDT and motivational interviewing principles in the treatment programme 'Beat the kick' reliably changed the type of motivation. In addition, the experimental effects provide initial proof of the use and applicability of SDT among people with ID.
Journal of intellectual disability research : JIDR, 2015 · doi:10.1111/jir.12221