This is for information only. Was an assignment within a foundation degree some years ago.

1. Substance
Misuse:
Social
impact of
substance
dependency
An exploration of
substance misuse with
people with Learning
Disabilities.

2. Title
Substance Misuse: Social impact of substance dependency: An
exploration of substance misuse with people with Learning
Disabilities within the United Kingdom.
i.

3. Contents Page
Title i.
Table of Contents ii.
Abstract iii.
Introduction 1
Methodology 1,2
Main text 2,3,4,5,6
Conformity and group 2,3
Does having a learning disability increase an
individual's vulnerability to misuse substances? 3.4.5
Service provision for people with Learning disabilities
who have substance use issues.
Cost 5,6
Conclusions 6
Recommendations 7
Areas for suggested personal development 7
Bibliography 8,9,10,11
Apendix 12 a,b
ii.

4. Abstract
People with learning disabilities have historically been supported
under the auspices of medical services including long stay specialist
hospitals. Government legislation is advocating people with learning
disabilities have greater social inclusion living in the wider
community. People with learning disabilities can have difficulties
with social rules and interpersonal relationships and can lack the
skills and ability to function within socially acceptable norms.
Evidence suggests that many people with learning disabilities misuse
substances to support their perceived social inclusion and
acceptance. Services available to enable people with learning
disabilities to address their substance misuse are inept in their
service provision.
iii.

5. Introduction
The aim of this report is to consider the predisposition that people
with learning disabilities may have in relation to substance misuse.
The use of the words ‘learning disability is synonymous with the
terms ‘Mental Handicap’ and ‘Severe Mental Impairment’ that has
been used in Europe. ‘Learning disability’ is used in the UK and as
such this term will be used within this report. Valuing People (2001)
There are numerous substances that can be misused and have
holistic psychological, sociological impact on the individual and the
immediate and wider community. These include illicit, prescription
and more socially acceptable substances such as alcohol and tobacco
and caffeine.
Methodology
The primary intention of this report is to depict the characteristics
of people with Learning disabilities who misuse substances, and the
sociological effects of such misuse, The use of pre-existing
Qualitative, Quantitative and Epidemiological research contained
within journals; published literature; a historical approach would be
1

6. more advantageous in meeting these aims considering the time
constraints imposed on this report and the diverse learning disability
population.
Main Text
Conformity and group
Historically people with learning disabilities have been segregated
from the wider community. Current government legislation is
advocating changes striving for the empowerment and social inclusion
across all of society for people within the labelled group of having a
learning disability. (Valuing people 2001, Same as You, 2001) (See
appendix 1). The need for social acceptance, interpersonal
relationships is imperative within social construct.
People with learning disabilities have increased social barriers and
issues with conforming to perceived group social influence and
acceptable norms. Asch (1956). Milgram’s (1974) research into
obedience to authority showed that all people are sensitive to
pressures of social influence. As people with learning disabilities are
living within the community they may be exposed to increased social
and expectation factors that could increase the misuse of
2

7. substances such as alcohol, tobacco and illicit substances to support
their coping ability. The use of substances may be perceived as
supporting social acceptance within their peer group. (Moore &
Polsgrove, 1991, Gress & Boss, 1996, Clarke & Wilson, 1999, Sturmey
et al., 2003).
Within the construct of social care support networks is the power
struggle and the perceived expectation of a duty to care implying
that it is the role of support staff and circles of support to ensure
that the person with a learning disability environmental options are
safe. Restricting individuals access to the wider community and by
that construct restricting the opportunity to substances they may
abuse. Valuing people Now (2007).
Does having a learning disability increase an individual's vulnerability
to misuse substances?
The need for social acceptance, interpersonal relationships is
imperative within social construct. People with learning disabilities
have increased social barriers and issues with conforming to
perceived group social influence and acceptable norms. Asch (1956).
Valuing People (2001) a Department of Health white paper estimated
3

8. that there are around 210,000 people with profound, severe learning
disabilities within the United Kingdom: consisting of 120,000 people
within working ages and 25,000 within retirement. The numbers of
people with learning disabilities living within the community is
increasing experientially as specialist hospitals are being closed. Our
health our care our say (2006).
Vulnerable people such as people with learning disabilities are twice
as likely to use substances to that of their comparative peer group.
(Brown et al, 2000) (Hymowitz et al, 1997) People with learning
disabilities who use tobacco are also more likely than people who do
not smoke to use illicit substances and drink alcohol. Cosden; Silver
(1999) concluded following studies that people in substance misuse
treatment programs are more likely to have learning disabilities than
the proportionate population. Silver (1999) presented findings that
this percentage could be as high as 60%.
Much of the data that exist on learning disabilities and substance
abuse comes from retrospective studies in which respondents are
requested to remember things that happened earlier. Problems may
arise when the individual also has a learning disability and may not
have the cognitive ability to enable the recollection of accurate
4

9. information to facilitate retrospective data collection. Moore &
Polsgrove, (1991).
Service provision for people with Learning disabilities who have
substance use issues.
Mainstream services for substance misuse and bespoke services for
people with learning disabilities pre-port to not have the ability to
appropriately support individuals with a learning disability. Lottman,
(1993). Many people subsequently do not receive appropriate
support Lance and Longo (1997). Individuals with learning
disabilities are more likely to have inadequate health care. Our
health our care our say (2006).
Cost
Cessation interventions consistently are the highest cost outlay for
the NHS in relation to the direct treatment of people needing
support addressing the physically consequences from their
substance misuse. Lancaster et al (2000). Over a 12 year period a
half of deaths of vulnerable people receiving cessation support were
attributed to substance misuse. Hurt (1996). People with learning
disabilities however evidentially are excluded from the
5

10. cessation programmes. Lawn et al., (2002)
Conclusions
The need for social acceptance increases the likelihood that
individuals with learning disabilities under increased social pressures
of living within the wider community experientially expand their
vulnerability to the misuse of substances to facilitate coping
strategies and perceived acceptance.
With the lack of bespoke services to enable people with learning
disabilities to identify their substance misuse were do people with a
reduced level of cognitive ability receive the support they may
require to enable them to address their substance misuse.
If there is continued development of social inclusion for people with
learning disabilities and the population increases within the wider
community as services such as specialist hospitals close without the
support network to enable the development of bespoke services then
it is comparable to consider that the numbers of people with
learning disabilities misusing substances will increase and
subsequently the cost to the NHS is likely to also increase.
6

11. Recommendations
Identify people with learning disabilities as early as possible.
Support them holistically enabling their ability to develop their
social skill and personal development. By doing so, we may reduce
the likelihood that they will suffer lower self-esteem, social
difficulties that may contribute to the possibility of substance
misuse.
Bespoke services to support people with learning disabilities to
support services to develop appropriate skills as identified.
Areas for suggested future personal development
The process of this report has offered continued personal and
professional development. The ability to be able to formulate and
research a report has enabled the opportunity to consider areas of
social psychology that I had not previously considered. It will
support my continued professional development as a Case advocate
working with people with mental health problems and learning
disabilities. This opportunity continues to highlight the need for a
personal centred holistic approach within social care.
7

12. Bibliography
Asch, S. E. (1956), ‘Studies of independence and conformity: a
minority of one against a unanimous majority’, Psychological
Monographs, 70.
Brown, S. A., Tapert, S. F., Granholm, E., & Delis, D. C. (2000).
Neurocognitive functioning of adolescents: Effects of protracted
alcohol use. Alcoholism, Clinical and Experimental Research, 24(2),
164-171.
Clarke, J. J. & Wilson, D. N. (1999): Alcohol problems and intellectual
disability.
Journal of Intellectual Disability Research, Vol. 43, 135-139.
Cosden, M. (1999). Substance abuse and learning disabilities:
Theories and findings. Paper presented at the CASA-NCLD
Conference on Substance Abuse and Learning Disabilities, New York,
NY
8

13. Gress, J. R. & Boss, M. S. (1996): Substance abuse differences
among students receiving special education school services. Child
Psychiatry and Human Development, Vol. 26, 235-246.
Hurt, RD. Offord, KP. Croghan, IT. Et al. (1996) Mortality following
inpatient addictions treatment: role of tobacco use in a community-
based cohort. JAMA 275(14):1097-1103.
Lancaster, T. Stead, L. Silagy, C. Sowden, A. (2000) effectiveness
of Interventions to help people stop smoking: findings from the
Cochrane Library.nBritish Medical Journal. 321 Aug. 355-7
Lance P, Longo M D (1997). Mental health aspects of developmental
disabilities. The Habilitative Mental Healthcare Newsletter, Vol. 16
(4), 61-64.
Lawn, S.J. Pols, R.G. Barber, J.G. (2002). Smoking and Quitting: a
qualitative study with community-living psychiatric clients. Social
Science & Medicine. 54(1):93-104.
9

14. Lottman, T. (1993): Access to generic substance abuse services for
persons with mental retardation. Journal of Alcohol and Drug
Education, Vol. 39, 41-55.
Milgram, S. (1974), Obedience to Authority; An Experimental View
Moore, D., & Polsgrove, L. (1991). Disabilities, developmental
handicaps, and substance misuse: A review. International Journal of
the Addictions, 26(1), 65-90.
Department of Health (2007) Our Health our Care our Say .London:
Crown.
Department of Health (2001) Same as You, London: Crown.
Sturmey, P., Reyer, H., Lee, R. & Robek, A. (2003): Substance related
disorders in persons with mental retardation. NADD: Kingston, NY.
10

15. Silver, L. B. (1999). Learning disabilities and attention deficit
hyperactivity disorder: They don't stand alone. Paper presented at
the CASA-NCLD Conference on Substance Abuse and
Learning Disabilities, New York, NY.
Department of Health (2001) Valuing People. London: Crown.
Department of Health (2007) Valuing People Now. London: Crown.
11

16. Appendix
.
12