Evaluating a selective prevention program for substance use and comorbid behavioral problems in adolescents with mild to borderline intellectual disabilities: Study protocol of a randomized controlled trial

BMC Psychiatry

Evelien A.P. Poelen²  Marloes Kleinjan¹  Rutger C.M.E. Engels¹  Esmée P. Schijven² 

[1] Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands;Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, 6500 HE, The Netherlands

关键词: Study protocol;    Adolescents;    Intervention;    Intellectual disabilities;    Substance use;   

Others  :  1221348
DOI  :  10.1186/s12888-015-0563-1

 received in 2015-06-05, accepted in 2015-07-14,  发布年份 2015

【 摘 要 】

Background

Substance use and abuse is a growing problem among adolescents with mild to borderline intellectual disabilities (ID). Substance use patterns in general population are similar to patterns among non-disabled peers, but substance use has more negative consequences for adolescents with mild to borderline ID, and they are at an increased risk for developing a substance use disorder. Nevertheless, effective and evidence based prevention programs for this groups are lacking. The study described in this protocol tested the effectiveness of a selective intervention aimed at reducing substance use in adolescents with mild to borderline ID and behavioral problems. In the intervention, participants acquire competences to deal with their high-risk personality traits.

Methods

A randomized controlled trial will be conducted among 14–21-year old adolescents with mild to borderline ID and behavioral problems admitted to treatment facilities in the Netherlands. Inclusion criteria are previous substance use and personality risk for substance use. Participants will be individually randomized to the intervention (n = 70) or control (n = 70) groups. The intervention group will be exposed to six individual sessions and five group sessions carried out by two qualified trainers over six-week period. Primary outcomes will be the percentage reduction in substance use (for alcohol: percentage decrease of binge drinking, weekly use and problematic use, for cannabis: the percentage decrease of lifetime cannabis use and weekly use and for hard drug: the percentage decrease of lifetime use). Secondary outcomes will be motives for substance use, intention to use, and internalizing and externalizing behavioral problems. All outcome measures will be assessed after two, six, and twelve months after the intervention.

Discussion

This study protocol describes the design of an effectiveness study of a selective prevention program for substance use in adolescents with mild to borderline ID and behavioral problems. We expect a significant reduction in alcohol, cannabis and hard drug use among adolescents in the intervention group compared with the control group.

Trial registration

This trial is registered in the Dutch Trial Register (Cochrane Collaboration) as NTR5037 registered at 15 April 2015.

【 授权许可】

   
2015 Schijven et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Barrot N: Paschos: Alcohol-related problems in adolescents and adults with intellectual disabilities. Cur Opin Psychiatry 2006, 19:481-485.
• [2]McGillicuddy N: A review of substance use research among those with mental retardation. Dev Disabil Res Rev 2006, 12:41-47.
• [3]McGillivray JA, Moore MR: Substance use by offenders with mild intellectual disability. J Intellect Dev Disabil 2001, 26:297-310.
• [4]Taggart L, McLaughlin D, Quinn B, Milligan V: An exploration of substance misuse in people with intellectual disabilities. J Intellect Disabil Res 2006, 50:588-597.
• [5]Bransen E, Schipper H, Blekman J: Middelengebruik door jongeren met een licht verstandelijke handicap. Een eerste verkenning van aard en omvang. [Substance use among adolescents with mild intellectual disabilities. A first exploration of nature and range]. Verslaving 2009, 5:37-49.
• [6]Steenhuis IHM, Poel van der E: Alcohol‐ en drugsgebruik bij licht verstandelijk gehandicapte jongeren in de leeftijd van 15–25 jaar. Maandblad Geestelijke Volksgezondheid 2009, 64:66-78.
• [7]To WT, Neirynck S, Vanderplasschen W, Vanheule S, Vandevelde S: Substance use and misuse in persons with intellectual disabilities (ID): results of a survey in ID and addiction services in Flanders. Res Dev Disabil 2014, 35:1-9.
• [8]Van der Nagel JEL, Kiewik M, Postel MG, van Dijk M, Didden R, Buitelaar JK, et al. Capture recapture estimation of the prevalence of mild intellectual disability and substance use disorder. Res Dev Disabil. 2014;35:808–13.
• [9]Burgard J, Donohue B, Azrin N, Teichner G: Prevalence and treatment of substance abuse in the mentally retarded population: An empirical review. J Psychoactive Drugs 2000, 32:293-298.
• [10]Lokman S, Neijmeijer L, Bransen E: Toolkit LVB en verslaving. Trimbos-instituut, Utrecht; 2012
• [11]Lawrence M, Kerr S, Darbyshire C, Middleton A, Fitzsimmons L: Tobacco and Alcohol Use in People Who Have A Learning Disability: GivingVoice to Their Health Promotion Needs. Glasgow Caledonian University, Glasgow; 2009.
• [12]Kerr S, Lawrence M, Darbyshire C, Middleton AR, Fitzsimmons L: Tobacco and alcohol-related interventions for people with mild/moderate intellectual disabilities: a systematic review of the literature. J Intellect Disabil Res 2013, 5:393-408.
• [13]Schijven EP, Van der Nagel JEL, Engels RCME, Lammers J, Poelen EAP: Development of a substance use intervention for adolescents with intellectual disabilities. Health Promot Int In press.
• [14]Conrod PJ, Comea N, Maclean AM: Efficacy of cognitive-behavioral interventions targeting personality risk factors for youth alcohol misuse. J Clin Child Adolesc Psychol 2006, 35:490-504.
• [15]Conrod PJ, Castellanos-Ryan N, Strang J: Brief personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period during adolescence. Arch Gen Psychiatry 2010, 2010(67):85-93.
• [16]Conrod PJ, Castellanos-Ryan N, Mackie CJ: Long-term effects of a personality-targeted intervention to reduce alcohol use in adolescents. J Consult Clin Psychol 2011, 79:296-306.
• [17]Lammers J, Goossens F, Lokman S, Monshouwer K, Lemmers LA, Conrod PJ, et al. Evaluating a selective prevention programme for binge drinking among young adolescents: study protocol of a randomized controlled trial. BMC Public Health. 2011;11:126.
• [18]Stewart SH, Devine H: Relations between personality and drinking motives in young students. Pers Individ Dif 2000, 29:495-511.
• [19]Stewart SH, Loughlin HL, Rhyno E: An examination of the mediating roles of internal drinking motives in explaining personality domain-drinking behaviour relations in young adults. Pers Individ Dif 2001, 30:271-286.
• [20]Conrod PJ, Woicik P: Validation of a four factor model of personality risk for substance abuse and examination of a brief instrument for assessing personality risk. Addict Biol 2002, 7:329-346.
• [21]Conrod PJ, Peterson JB, Pihl RO: Disinhibited personality and sensitivity to alcohol reinforcements: Independent predictors of drinking behaviour. Alcohol Clin Exp Res 1997, 21:1320-1332.
• [22]Shall M, Kemeny A, Maltzman I: Factors associated with alcohol use in university students. J Study Alc 1992, 53:122-136.
• [23]Pulkkinen L, Pitkänen T: A prospective study of the precursors to problem drinking in young adulthood. J Study Alc 1994, 55:578-587.
• [24]Spoont MR: Modulatory role of serotonin in neural information processing: implications for human psychopathology. Psychon Bull 1992, 112:330-50.
• [25]Pihl RO, Peterson JB: Drugs and aggression: Correlations, crime and human manipulative studies and some proposed mechanisms. J Psychiatry Neurosci 1995, 20:141-149.
• [26]Stewart SH, Peterson JB, Pihl RO: Anxiety sensitivity and self-reported alcohol consumption rates in university women. J Anxiety Disord 1995, 9:283-292.
• [27]Stewart SH, Zvolensky MJ, Eifert GH: Negative-reinforcement drinking motives mediate the relation between anxiety sensitivity and increased drinking behaviour. Pers Individ Dif; 2001a
• [28]Comeau N, Stewart SH, Loba P: The relations of trait anxiety, anxietysensitivity, and sensation seeking to adolescents’ motivations for alcohol, cigarette, and marijuana use. Addic Behav 2001, 26:1-24.
• [29]Conrod PJ, Pihl RO, Vassileva J: Differential sensitivity to alcohol reinforcement in groups of men at risk for distinct alcoholism syndromes. Alcohol Clin Exp Res 1998, 22:585-597.
• [30]Cooper ML, Frone MR, Russell M, Mudar P: Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J Pers Soc Psychol 1995, 6:990-1005.
• [31]Malmberg M, Overbeek G, Monshouwer K, Lammers J, Vollebergh WAM, Engels RCME: Substance use risk profiles and associations with early substance use in adolescence. J Behav Med 2010, 33:474-485.
• [32]Kendall PC, Braswell L: Cognitive-Behavioral Therapy for Impulsive Children. Guilford, New York; 1985.
• [33]Reynolds S, Wilson C, Austin J, Hooper L: Effects of psychotherapy for anxiety in children and adolescents: A meta-analytic review. Clin Psychol Rev 2012, 32:251-262.
• [34]Seligman LD, Ollendick TH: Cognitive-behavioral therapy for anxiety disorders in youth. Child Adolesc Psychiatr Clin N Am 2011, 20:217-38.
• [35]Webb CA, Auerbach RP, Derubeis RJ: Processes of change in CBT of adolescent depression: Review and recommendations. J Clin Child Adolesc Psychol 2012, 41:654-665.
• [36]Didden R, Korzilius H, Van Oorsouw W, Sturmey P: Behavioral treatment of challenging behaviors in individuals with mild mental retardation: Meta-analysis of single-subject research. Am J Ment Retard 2006, 111:290-298.
• [37]Riper H, Andersson G, Hunter SB, de Wit J, Berking M, Cuijpers P: Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis. Addic 2014, 109:394-406.
• [38]Vereenooghe L, Langdon PE: Psychological therapies for people with intellectual disabilities: A systematic review and meta-analysis. Res Dev Disabil 2013, 34:4085-4102.
• [39]De Wit M, Moonen X, Douma J: Richtlijn effectieve interventies LVB: Aanbevelingen voor het ontwikkelen, aanpassen en uitvoeren van gedragsveranderende interventies voor jeugdigen met een licht verstandelijke beperking. Utrecht, Landelijk Kenniscentrum LVG; 2011.
• [40]Woicik PA, Stewart SH, Phil RO, Conrod PJ: The substance use risk profile scale: a scale measuring traits linked to reinforcement-specific substance use profiles. Addic behav 2009, 34:1042-1055.
• [41]Cohen JA: Coefficient of agreement for nominal scales. Educ Psychol Meas 1960, 20:37-46.
• [42]Bergsma S: De Substance Use Risk Profile Scale voor zwakbegaafde en licht verstandelijk gehandicapte mensen. Master thesis, Universiteit Twente/ Tactus Verslavingszorg; 2010.
• [43]Van der Nagel J, Kiewik M, van Dijk M, de Jong C, Didden R: Handleiding SumID-Q, Meetinstrument voor het in kaart brengen van middelengebruik bij mensen met een lichte verstandelijke beperking. Tactus, Deventer; 2011.
• [44]De Vries H, Dijkstra M, Kuhlman P: Self-efficacy: the third factor besides attitude and Subjective norm as a predictor of behavioural intentions. Health Educ Res 1988, 3:273-282.
• [45]Kuntsche E, Kuntsche S: Development and Validation of the Drinking Motive Questionnaire Revised Short Form (DMQ–R SF). J Clin Child Adolesc Psychol 2009, 38:899-908.
• [46]Verhulst FC, Van der Ende J, Koot HM: Manual for the Youth Self-Report (YSR) [in Dutch]. Rotterdam: Erasmus University/Department of Child and Adolescent Psychiatry, Sophia Children’s Hospital; 1997
• [47]Douma JCH, Dekker MC, Verhulst FC, Koot HM: Self-Reports on mental health problems of youth with moderate to borderline intellectual disabilities. J Am Acad Child Adolesc Psychiatry 2006, 45:1224-1231.
• [48]Dusenbury L, Brannigan R, Falco M, Hansen WB: A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Educ Res 2003, 18:237-256.
• [49]Ennett ST, Haws S, Ringwalt CL, Vincus AA, Hanley S, Bowling JM, Rohrbach LA: Evidence-based practice in school substance use prevention: Fidelity of implementation under real-world conditions. Health Educ Res 2011, 26:361-371.
• [50]Muthén LK, Muthén BO: Mplus User’s Guide. Sixth Edition edition. Muthén & Muthén, Los Angeles, CA; 2007.
• [51]Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. Jama. 1996;276(8):637–9.
• [52]Moher D, Schulz KF, Altman DG: Group C: The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Clin Oral Investig 2003, 7(1):2-7.