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Sobriety Leisure with Individuals with Substance Use Disorder and Intellectual DisabilitiesAbigail Fulton and Amy SaleLongwood UniversityTable of ContentsIntroduction…………………………………………………………………………………..Pg 3Body………………………………………………………………………………………….Pg 4Conclusion……………………………………………………………………………………Pg 6References……………………………………………………………………………………Pg 9Appendix A…………………………………………………………………………………..Pg 11Appendix B…………………………………………………………………………………..Pg 23Pledge………………………………………………………………………………………...Pg 26IntroductionIn the United States, substance use disorders occur 33.8% amongst individuals with intellectual disabilities (Bhaumik, Tyrer, McGrother, & Ganghadaran, 2008). For the purposes of this paper substance use disorder (SUD) refers to what was in the DSM 4 substance abuse and substance dependency which is currently in the DSM 5. The characteristic of substance use disorders are problems in personal and interpersonal life, employment, control, health and safety, and physiological sequences. There are three basic categories of substance related conditions they include substance use disorder, substance intoxication, and substance withdrawal. There are over 300 substance related disorders in the DSM 5 (Morrison, 2014). The characteristic of disability is Intellectual Disabilities (ID) are a disorder with onset during the developmental period that included intellectual and adaptive functioning. There are three criteria that the individual must meet to be diagnosed with ID. The first one is deficits in intellectual functioning just as problem solving, learning from experience, and judgement confirmed by both a clinical assessment and a standardized intelligence test. The second one is deficit is in adaptive function such as failure to meet developmental and sociocultural standards and have adaptive deficits that limit functions of daily living. The last one is onset of intellectual and adaptive deficits during the development (American Psychiatric Association, 2013). “Sobriety is a healthy, happy, rewarding, productive life which is alcohol and drug free” (Faulkner, 1991). Leisure is activities free of obligations that people do in their free time. Leisure has to be intrinsically motivated, have preserve freedom, and have a positive effect (Anderson and Hurd, 2011). Sober Leisure is doing activities that are free of obligation and are intrinsically motivated without drugs and alcohol. Therefore, the purpose of this paper is to explore the prevalence among individuals with intellectual disorders and substance use disorders.BodyIn our research, we found that individuals with ID smoke and use alcohol, but at lower rates compared to the nondisabled population. We also found that individuals with ID misuse and overuse alcohol, illicit drugs, and prescribed medications (Taggart, McLaughlin, Quinn, & McFarlane, 2007). The evidence shows that this argument is true because one article we found was done in 2007 that interviewed ten individuals with ID who misused drugs and alcohol. Seven of them were female and three of them were male. Seven of the individuals misused alcohol only. Three women misused alcohol, illicit drugs (cannabis and ecstasy), and prescribed medication (paracetamol, codeine and diazepam). All of the individuals reported that they had long alcohol use, over 5 years (Taggart, McLaughlin, Quinn, & McFarlane, 2007). Another reason this article is true is in another study that was done in 2014. This study explored people in prison about their alcohol and drug use. There were 180 prisoners with ID and 269 prisoners without ID. The substance use of 1 year prior imprisonment were as follows alcohol was 65%, drugs was 59% and alcohol and drugs were 45%. The drugs that were being used are amphetamines, benzodiazepines, cannabis, methadone, and opiates. The amount of alcohol and drug use were similar for both people with ID and without ID (Mc Gillivray, Gaskin, Newton, Richardson 2014). All three of our articles found that the substances the individuals with ID used were polysubstances, cocaine, opiates, cannabis, alcohol, ecstasy, paracetamol, codeine, diazepam, amphetamines, benzodiazepines, and methadone (Dutra et al., 2008; Taggart, McLaughlin, Quinn, & McFarlane, 2007; Mc Gillivray, Gaskin, Newton, Richardson, 2014).Multiple studies have indicated that leisure enhances the quality of life of individuals with ID, helping to make their lives better, relieving tensions, building and maintaining relationships with family and friends, increasing self-esteem, and enhancing physical health and fitness. Leisure also can help individuals with ID understand themselves, help them gain a stronger sense of who they are, and strengthen their sense of belonging (Patterson & Pegg, 2009). For example, there was a study done with adolescents ages 15 to 16 that studied leisure activity patterns. The researchers’ studies activities such as sports, social clubs, and party subculture. The researchers discovered that sports and social clubs had a negative effect on participant wanting to drink. The researchers also discovered that the party subculture had a positive effect on participants wanting to drink. This means that people involved in leisure activities were less willing to drink (Thorlidsson & Bornburg, 2006). Another example that supports our argument is from a study done in 2009. The study interviewed 10 individuals with mild to moderate ID in relation to their participation in a serious leisure activity. Serious leisure is the activities of a small segment of people who become increasingly involved in different types of leisure. Six of the ten were male and four were female. Most of the respondents reported that they had participated in their activity for at least two years, some even engaged in their activity for up to 15 years. Some of the leisure activities in this study were lawn bowls, ten‐pin bowling, track and field athletics, tennis, guitar playing, singing and volunteering. On person even spent her time training for an athletic competition at the elite level three times a week, while also going to the gym three times a week and going to pool sessions two times a week. The results of this study show that participating in serious leisure showed that the individuals with ID were committed and had the ability to persevere. All individuals that participated in this study had all of the improvements to their quality of life listed above, including increasing self-esteem, making new friends, relieving tension, and more (Patterson & Pegg, 2009).Drugs and alcohol can be used as leisure. Uses of drugs and alcohol can receive a desired effect quickly. People think that the only way to do leisure is to pay for the feeling that they want. People who use drugs and alcohol for leisure often have poor leisure skills. They see chemical free leisure as valueless. The addicts don’t see any problem with their usage if it done it leisure time. Many of these addicts are in denial about their problems (Faulkner, 1999).Therapeutic Recreation (TR) can be used as treatment for SUD. This is because it teaches clients about new leisure skills. There was a study done with 39 participants in an outpatient program who were low income or no income often homeless individuals. These participants worked on several types of TR skills including self-determination, leisure education, and coping skills training programs. The researchers picked these skills because they can enhance problem solving skills and help with non-drug and alcohol alternatives. The results of this study was not statistically significant but there were several problems that were addressed. The first one is that the participants answering in a manner that was a behavior that the therapist was desiring. The second problem was that all the participants were internally motivated so that they did not have an effect on motivation. The main problem with this study was there was not enough participants to make it significant (Cogswell & Negley, 2011).ConclusionIn conclusion, individuals with intellectual disabilities do have substance use issues and need sobriety leisure. As seen above, leisure can be very helpful for individuals with ID and leisure is a valid use of treatment. One of the barriers that we found in the studies was that they did not aim to generalize to wider population of learning disabilities (Taggart, McLaughlin, Quinn, & McFarlane, 2007). Another barrier that we found was that there is no current system to capture those with mild intellectual disorders who access mainstream services (Bhaumik, Tyrer, McGrother, & Ganghadaran, 2008). The last barrier that we found was that there are problems of service for people with lower IQ and knowing if a number should affect the services they are eligible for (?).There were also a few limitations that we found when doing our research. One of the limitations that was found was small sample size (Cogswell & Negley 2011; Patterson & Pegg, 2008). Another limitation that was found was small number of studies (Dutra et al., 2008). Two more limitations that we found were that there needs to be more training for staff who work with individuals with ID and that there needs to be more resources to get help and to be diagnosed (McLaughlin, Taggart, Quinn, & Milligan, 2007). Some more limitations that we found are methods not consistent with typical practices, facilitator differences between the treatment and control groups, and the difficulty to recruit participants for the study (Cogswell & Negley, 2011).One of the recommendations for future research that we found was finding a larger sample size (Cogswell & Negley 2011; Patterson & Pegg, 2008). Another recommendation that we found was to utilize more recent advancements in order to fully engage and work with this resilient population (Taggart, McLaughlin, Quinn, & McFarlane, 2007). Some more recommendations for future research that we found were to find a larger sample and use a randomized clinical trial to help increase the likelihood of finding statistically significant results (Cogswell & Negley 2011).All of the recommendations for client practice that we found were from our Expert Opinion (2016). One of the recommendations was to make sure that the client has a leisure outlet instead of using drugs or alcohol. Another recommendation was to change the habits of the client through a positive leisure source. Another recommendation was to talk on their level and to use appropriate language use. The fourth thing our expert opinion told us to do was to avoid substance use in programs. The last thing that our expert opinion told us was to know individuals past history. Not everyone has a current substance use issue, but some have used substances in the past (Expert Opinion, 2016).References:Expert Opinion, personal communication, October 6, 2016.American Psychiatric Association. (2013).?Diagnostic and statistical manual of mental disorders?(5th ed.). Arlington, VA: American Psychiatric Publishing.Bhaumik, S., Tyrer, F. C., McGrother, C., & Ganghadaran, S. K. (2008). Psychiatric service use and psychiatric disorders in adults with intellectual disability.?Journal of Intellectual Disability Research,?52(11), 986–995. doi:10.1111/j.1365-2788.2008.01124.xDutra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., & Otto, M. W. (2008). A Meta-Analytic review of psychosocial interventions for substance use disorders.?American Journal of Psychiatry,?165(2), 179–187. doi:10.1176/appi.ajp.2007.06111851McGillivray, J. A., Gaskin, C. J., Newton, D. C., & Richardson, B. A. (2015). Substance use, offending, and participation in alcohol and drug treatment programmes: A comparison of prisoners with and without intellectual disabilities.?Journal of Applied Research in Intellectual Disabilities,?29(3), 289–294. doi:10.1111/jar.12175Morrison, J. (2014).?DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY, United States: Guilford Publications.Patterson, I., & Pegg, S. (2009). Serious leisure and people with intellectual disabilities: Benefits and opportunities.?Leisure Studies,?28(4), 387–402. doi:10.1080/02614360903071688Taggart, L., McLaughlin, D., Quinn, B., & McFarlane, C. (2007). Listening to people with intellectual disabilities who misuse alcohol and drugs.?Health & Social Care in the Community,?15(4), 360–368. doi:10.1111/j.1365-2524.2007.00691.xThorlindsson, T., & Bernburg, J. G. (2006). PEER GROUPS AND SUBSTANCE USE: EXAMINING THE DIRECT AND INTERACTIVE EFFECT OF LEISURE ACTIVITY.?ADOLESCENCE,?41(162).McLaughlin, D. F., Taggart, L., Quinn, B., & Milligan, V. (2007). The experiences of professionals who care for people with intellectual disability who have substance‐related problems.?Journal of Substance Use,?12(2), 133–143. doi:10.1080/14659890701237041Cogswell, J., & Negley, S. (2011). The Effect of Autonomy-Supportive Therapeutic Recreation Programming on Integrated Motivation for Treatment among Persons Who Abuse Substances.?Therapeutic Recreation Journal,?45(1), 47–61.Hurd, A. R., & Anderson, D. M. (2010, November 23). Definitions of leisure, play, and recreation. Retrieved November 7, 2016, from Human Kinetics, ALiterature Review TableResearch statement (identified on PICO form): For individuals with comorbid intellectual disability and substance use disorder with an increase in sobriety through the use of sober leisure.SourcePurposeDesignOutcomes/FocusResultsConclusions/Issues IdentifiedAuthor & DateDescribe the research question being investigated and/or purpose of the studyDescribe the research design, measurement tools and number of subjects/participantsList all outcomes measuredSummarize the results including statistical significanceSummarize in bullet points conclusions from findings and/or any concerns regarding study methodology that may have impacted resultsArticle #1 (Abby)Bhaumik, S., F. C. Tyrer, F. C., McGrother, C. & Ganghadaran, S. K.November 2008To describe the prevalence of specialist psychiatric service use among adults with ID; To describe the nature and prevalence of psychiatric disorders in adults with ID; and To identify any differences in the nature and prevalence of psychiatric disorders between men and women and between different severity levels of ID.Cross-sectional studyLeicestershire Learning Disability RegisterStructured home interviews using the Disability Assessment Schedule and questions on demographic details, skill level, behaviour and carer stress7 questions were also asked to determine level of ID2711 adults over 6 yearsDiagnosisAgeSexEthnicityResidential status of patientComorbidityPrescribed MedicationDemographic DetailsSkill levelBehaviorCommunicationDependency1244 (45.9%) adults were seen by specialist psychiatric services in Leicestershire, 707 (56.8%) were men and 537 (43.2%) were womenMost adults were living in residential homes (38.4%) and had severe or profound ID (72.1%)Among those seen by services, 479 (38.5%) adults had epilepsy and 814 (65.4%) adults were prescribed psychotropic medicationThe prevalence of psychiatric disorders in the study population was 33.8%Behavior disorders: 19.8%Autism spectrum disorder: 8.8%Depression: 4.3%Bipolar Affect Disorder: 3.0%Psychiatric service attendance was more common as individuals’ severity of ID increasedThe sample includes only people who access specialist ID services and therefore individuals with mild ID and psychiatric disorders are likely to be are under-represented in this populationThere is no current system to capture those with mild ID who access mainstream services.In this study psychiatric diagnoses were based on clinical assessment and were not subject to the use of a structured diagnostic toolFuture research would benefit from identifying the complex process of accessing mainstream services by people with mild ID and service users’ and carers’ experiences of this process. The development of short validated screening tool to help professionals to identify people with mild ID in mainstream services may also be important.Article #2 (Abby)Taggart, L., McLaughlin, D., Quinn, B., and McFarlane, C.2007To examine the insights of 10 people withintellectual disabilities into the reasons why they may misuse alcohol or drugs, and what impact thisbehavior may have on them; and to explore the services that they receive.Focus groups and semistructured one-to-one interviewsQualitative approachSystematic approach10 participants, ages 28-52Substance the individual abusedReasons for misusing substances: psychological trauma and social distance from their communityLife impacts of alcohol misuseSupports/services: intellectual disability services, mainstream addiction services, and primary care servicesUtilization of specialist support networks/groupsService developments8 interviews took place in a private room in a health center or day center2 interviews took place in the person’s home8 requested their social worker or community nurse1 requested his mother sit in with them1 did not request anyone to sit in with them7 individuals were alcohol only3 women reported using alcohol, illicit drugs, and prescribed medicationAll individuals were reported that they had long alcohol useWithin the past 12 months, 2 people stopped because of specific life circumstances, 6 reduced their patterns, and 2 continued to engage in harmful patterns2 reasons: psychological trauma and social distance from their community4 life impacts: physiological effects, the effects on the person’s mind, financial impacts, and their relationship with family and friendsBoth individuals with and without ID use and misuse a range of substances to self-medicate against life’s negative experiences.This study did not aim to generalize to the wider population with learning disabilities.It may indicate the need for an emphasis to be placed on this population having greater access to a wider range of specialist services that can address these negative life experiences.Both ID and addiction staff need to consider utilizing more recent advancements in order to fully engage and work with this resilient population.Article #3 (Abby)Patterson, I. & Pegg, S.2008To investigate whether serious leisure activities provide opportunities for people with intellectual disabilities to practice, or gain training in work skills in a non‐threatening and enjoyable environment.Qualitative methodologySemi‐structured face-to-face interviews10 individuals with an intellectual disorder in the mild or moderate range (6 male, 4 female)Serious leisure conceptThe importance of serious leisureThe positive benefits of serious leisureMaking new friendsJoining a serious leisure associationVolunteering as a serious leisure activityThe majority of respondents reported that they had participated in their activity for at least two years, with several indicating engagements for up to 15 years.two respondents participating in each of the following leisure activities – lawn bowls, ten‐pin bowling, track and field athleticsone respondent participated in each of the following – tennis, guitar playing, singing and volunteering7 participants lived at home with their parents and siblingsThree older people lived independently in community housing7 were employed in part-time jobs2 were volunteering1 spent most of her time training at the elite level of athletic competitionNeeds a larger sample in the futureserious leisure has been shown to increase their social competencies and provided many with similar individual benefits that can be achieved through open employmentArticle #4 (Abby)Katz, G., Lazcano-Ponce, E.2008To define, find the etiological factors, classify, diagnose, and find the treatment and prognosis of intellectual disorders.DefinitionEtiological FactorsClassificationDiagnosisTreatmentPrognosisthe treatment objectives must focus on the normalization of behavior in accordance with the norms and rules determined by societyintervention as early as possible is fundamentalDuring the infancy period (zero to two years): motor therapy & sensory integration therapyWhen children are diagnosed after two years of age and before puberty, the ideal is to use instruments that determine the maturity level for each one of the developmental areas and apply the same therapiesin addition promoting the development of perceptual abilities, with deficits in, and learning abilities (reading, writing, mathematics, etc.), using techniques similar to those used in children with learning disorders (dyslexia, etc.)Some programs should cover the areas necessary for achieving a partially or totally self-sufficient life, among which are: the academic-basic skills, community integration programs, developing skills for managing domestic tasks, personal healthcare and sexualityprevocational program should be included for the development of abilities for the workplaceIntellectual disability should be treated in a comprehensive manner. Nevertheless, currently, the fundamental task and perhaps the only one that applies is the detection of the limitation and abilities as a function of subjects age and expectations for the future, with the only goal being to provide the support necessary for each one of the dimensions or areas in which the person’s life is expressed and exposed.Article #5 (Abby)Dutra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., Otto, M. W.2008Despite significant advancesin psychosocial treatments for substanceuse disorders, the relative success of theseapproaches has not been well documented.In this meta-analysis, the authorsprovide effect sizes for various typesof psychosocial treatments, as well as abstinenceand treatment-retention ratesfor cannabis, cocaine, opiate, andpolysubstance abuse and dependencetreatment trials.Meta-analysisLiterature searches34 well-controlled treatment conditions2,340 patientsType of Substance usedTreatment TypeControl ConditionWeeks of TreatmentSessions per weekUnique populationDrug contentIntent to treat sampleDropoutAbstinenceEffect size14 contingency management2 cognitive behavioral therapy/contingency management combination13 general cognitive behavioral therapy5 relapse prevention13 of the treatments were polysubstance use9 for cocaine use7 for opiate use5 for cannabis useTreatment types were not significantly associated with (confounded with) the targeted drug use disorders according to chi-square analyses (contingency management versus all other treatments).43.6% of the studies included samples where the participants received medication maintenance in conjunction with both the experimental treatment and control conditionsMean length of treatment: 21 weeksAverage number of sessions per week: 1.8 sessionsThe mean intent-to-treat sample size per treatment condition: 38.23, ranging from 5 to 135 participantsOur meta-analysis was limited by the small number of studies for the combination of contingency management and cognitive behavioral therapy as well as for studies of relapse prevention.fewer studies were completed for cannabis and opiate use disordersnone of the relapse prevention studies analyzed included polysubstance users, the group with the lowest effect size estimatesDirections for future research include studies aimed at improving retention rates for all substance use groups, as well as at improving treatment efficacy for polysubstance users.Article 6 (Amy) McLaughlin D.F.; Taggart L.; Quin B.; Milligan V.; 2007 The purpose of this study was to collect experiences and perceptions working with people with ID and to get the staff views to see if the people with ID’s needs better met Case Study The research design is staff interviews for about 30 to 40 minutes with 13 front line professionals. These professionals have at least 1 person they were working with that had a dual diagnosis. There is not any not resources for people with IDThere is a lack of training of staff who work with individuals with comorbid ID and SUD/O High functioning people with ID and not always identified There was no statistical data reported There needs to be more training for staff who work with people with ID. There also needs to be more resources to get help and also to be diagnosed. Article 7 (Amy)Mc Gillivray J.; Gaskin J. ; Newton C.; Richardson B. 2014To compare drug and alcohol use of people with ID to people without ID Cross sectional studyAnalysis was used for people with and without ID for year and month how much they wanted to use after participation in treatment program Lower the amount of drug and alcohol use for people with ID Study was looking at a prison Use in year prior to prison term was Alcohol for people with ID was .65 and alcohol for people without ID was .74 See page 292 table 2 People without ID use drugs and alcohol more than people with ID but people with ID still use drugs and alcohol Article 8ThorlidssonT.; Bornburg J 2006 To see how leisure effects drug and alcohol use This was a study that surveyed students to see if their leisure effected their substance use It was seen that people who did sports or belonged to clubs used less substances Look at Table 1 and Table 2 Table 1 for leisure activates Table 2 for demographics People who do leisure are less likely to do drugs and are less likely to do drugs when people around them are doing drugs. Article 9Badia M.; Orgaz M.; Verdugo M. ; Ullan A.; Martinez M. 2013To see if leisure participation helps with QOL for people with developmental disabilities Assistants administers a scale for QOL and a GENCAT Psychologist compared the scores People with good leisure life styles had high QOL while people with not so good leisure life styles had lower QOL Look at table 2 and 3 on page 537 and table 4 and 5 on 538Leisure has effect on QOL. This is true of people with disabilities as well Article 10 Roozen H.G.; de Waart R.; van der Kroft P 2010The purpose was to see what intervention for families were better CRAFT or Al- Anon Meta-analysis Used data based with 4 control studies and synthesized the data Craft was better than Al Anon with helping families during treatment Table 1 on page 1732 talks about demographics and substances used CRAFT is better for certain groups. Substance use problems are not only the person using but the whole family’s problem Appendix BOutlineIntroduction (Amy)Explain the purpose of the paper: PICO statementFor individuals with an intellectual disorder, who also have substance use disorder, have increased sobriety by participating in sober leisure instead of using drugs and alcohol.DefinitionsSubstance Use DisorderSubstance abuse and dependenceDrugs and alcoholIntellectual DisabilitiesSobrietySober LeisureLeisureBody (Both worked equally on body)Individuals with ID who are using substancesAmount of drug and alcohol use (article 7 and 2)Different substances used (article 5)Leisure as a modality to serve people with ID (article 3 and 8)Leisure can be used as treatment (article 11 and book) How it can improve motivation Leisure education and skill development Adds to bag of tricks Conclusion (Abby)BarriersDid not aim to generalize to the wider population of learning disabilitiesThere is no current system to capture those with mild ID who access mainstream services.Problems of service for people with lower IQ and knowing if a number should affect the services they are eligible for.LimitationsSmall sample sizeSmall number of studiesRecommendations for future researchLarger sample sizeUtilizing more recent advancements in order to fully engage and work with this resilient population.Recommendations for clinical practiceMake sure that they have a leisure outlet instead of using (interview)Change habits through a positive leisure source (interview)Talk on their level- appropriate language use (interview)Avoid substance use in programs (interview)Know individuals past history- not everyone has a current substance use issue, but some have used substances in the past (interview)Pledge: I have neither given nor received help on this work, nor am I aware of any infraction of the Honor Code.Abigail FultonAmy Sale ................
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