Interventions for smoking cessation and alcohol abuse in people with learning disabilities lack theoretical framework and clear outcome measures


We have posted previously about increasing concerns about misuse of tobacco and alcohol amongst people with mild to moderate learning disabilities, with one review in the United States suggesting that people with learning disabilities were less likely to receive or remain in treatment.

The authors of this systematic review were interested in looking at interventions to address the use of these substances among people with learning disabilities.

They were keen, now that people are  leading ‘more ordinary and less restricted lives’ to look at the impacts of social and environmental pressures that might encourage them to smoke excessively or abuse alcohol.

What they did was to use the FAME framework as a way of assessing the Feasibility, Appropriateness, Meaningfulness and Effectiveness of interventions that had been used to address tobacco and/or alcohol use in people with mild to moderate learning disabilities. They searched electronic databases for publications from 1996 to 2011.

They found 501 unique records and following application of inclusion criteria, were able to look at nine studies. Four of the studies looked at tobacco, three looked at alcohol and two looked at both.  The focus of the interventions reported in the studies was to increase knowledge and change behaviour.

The authors found one randomised controlled trial, one quasi-experiment and a number of ‘before and after’ studies /or case studies.  They assessed the methodological quality of he studies to be generally poor or moderate.  Looking at all the studies combined, the sample size was 341, with an age range in the sample of 14 to 54 years.

They found the interventions lacked a theoretical framework and the appropriateness of outcome measures was not tested. There was a good deal of content in relation to methods of working with people with learning disabilities, for example the use of pictures, quizzes, role play etc., but only one study was judged to offer insight and information into effectiveness of the goal – increasing knowledge of the health and social dangers of smoking and excessive alcohol consumption.

The authors conclude that the review found little evidence to guide practice, there was sufficient information to offer some insight into the development of interventions.

They suggest a need for further research, and in particular research 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.”

Tobacco and alcohol-related interventions for people with mild/moderate intellectual disabilities: a systematic review of the literature, Kerr S et al., in Journal of Intellectual Disability Research, 57: 393–408.

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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