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NADD U.S. Policy Update (from the NADD Bulletin Volume IX Number 1)Complete listing
Smoking Cessation as a Policy Issue in Dual Diagnosis
Thomas F. Kelly, MD, MPH
According to the CDC, tobacco use and obesity are the two primary
causes of preventable death in the U.S.; over 400,000 deaths per year
are blamed on tobacco use; and about a quarter of the adult
population smokes tobacco. Over the last decade untold numbers of
dollars have gone into smoking cessation programs. Cities, towns, and
states have implemented broad policy initiatives aimed at limiting
the exposure to second-hand smoke. What is the prevalence of tobacco
use in individuals with MR/DD? A 2003 literature review on the use
tobacco products by individuals with MR/DD revealed some interesting
information.1 Firstly; rates amongst those individuals living in
large institutions were found to be lower, 2.2% and 6.8%, then the
rates of smoking amongst those who lived in community-oriented
settings: 'community residences' (10.2%), 'community agencies that
were vendor-operated' (15.8%), and 'state-run community settings'
(9.7%). Interestingly, the smoking prevalence cited in the 'natural
family' setting was 4.7%.
The differences represented here point to a generally higher rate of
smoking in individuals with MR/DD who live in community-based
residencies, with the exception of 'natural family' settings. There
could be several reasons for this difference. Some might say that it
points to a greater ability of individuals with MR/DD to exert their
personal rights in community-based residences. This viewpoint doesn't
consider the rights of those co-habiting individuals who may want to
live in a smoke free environment without exposure to second-hand
smoke. Another way of looking at the increased rate found in
non-natural family, community residential settings is that it occurs
because of a lack of a meaningful policies or interventions to the
issue. Let us not forget that tobacco dependency is classified as a
substance use disorder in DSM-IV and, consequently, is an important
issue in dual diagnosis. Furthermore, the literature review
previously noted, found that the presence of tobacco dependency in
those individuals with MR/DD and co-morbid mental illness was 18%;
with the highest rates amongst those individuals who have
'borderline' MR (37%) or mild MR (30%).1
The behavior of tobacco use generally begins with volitional acts
geared towards some satisfaction of lifestyle or peer acceptance. The
'profit-oriented' tobacco industry establishes or reinforces these
motivations and, then, habituation and addiction eventually is
established. For consent capacity to be assessed, Ruedrich et al.1
described a four-level approach. The first level is exhibiting the
ability to indicate choice. The second aspect of this assessment
process has to do with the ability to understand factual information.
The third consideration is the ability to appreciate consequences.
And lastly, the highest level of consent capacity is the expressed
ability to rationalize risks and benefits of any suggested treatment.
These four levels imply a fairly high threshold. This fact is
complicated by the difficulty in gauging the extent to which consent
capacity was ever really assessed from the beginning of the behavior.
Historically, cigarettes have been used to reward 'proper' behavior
in various residential settings. To what degree individuals with
MR/DD are more vulnerable to the 'profit-oriented' tobacco industry
is not known. And, also, where on the volitional - addiction gradient
any one individual lays is something that is hard to pinpoint.
That said; probably a good number of individuals with MR/DD and
tobacco addiction have not had the benefit of proper consent
assessments. Ruedrich et al.1 made a very strong conclusion that
competent individuals with MR/DD should be expected to display the
highest (fourth) level of the capacity to give consent in order to be
allowed to smoke. To do less is to expose such a person to higher
risks of preventable illnesses such as lung cancer, emphysema,
cardiovascular disease, and others. Using this ethical standard to
apply such an assessment, one must then ask certain questions. What
has been done and what is being done to see to it that such
individuals have at least a chance to withdraw from this behavior
safely and successfully? And from a policy standpoint, what
'tobacco-fund' monies have gone into the development of targeted
prevention programs for this population?
One example that I have recently reviewed is from the ARC of Lincoln,
Nebraska. With funds from the Nebraska Health Care Cash Fund and the
Nebraska Health and Human Services System, they developed a health
promotion curriculum entitled; Smoking Cessation for Persons with
Developmental Disabilities.2 This curriculum has a facilitator guide
and a participant workbook called "I Want to Quit Smoking!"
This curriculum is made up of eighteen educational and motivational
lessens. The facilitator information includes several areas which
discuss issues related to working with and teaching individuals with
MR/DD. There is also a tool which assesses smoking and medical
history, environmental issues, and personal reflections and
expectations. I would encourage professionals to review it and to
think more about this important issue in dual diagnosis.
1 Ruedrich, S et al. (2003). Cigarette Smoking, and the Use of
Tobacco Products, by Persons with Developmental Disabilities. Mental
Health Aspects of Developmental Disabilities, 6 (3): 99-106.
2 O'Hare, M.(2004). Smoking Cessation for Persons with Developmental
Disabilities: Facilitator Guide & Participant Handbook. ARC of
Lincoln/ Lancaster County, NE.
Dr. Kelly is the Director of Health Care and Behavioral Services,
Division of Developmental Disabilities, Community Service Section,
State of Delaware
His e-mail is: tom.kelly@state.de.us.
The "U.S Public Policy Update" is an ongoing column in the
NADD Bulletin. We welcome your comments, as well as, submissions for
this column. To learn more or to contribute to this column, you may
contact Joan Beasley, chairperson of the U.S. Public Policy
Committee, at jbbeasley@rcn.com.
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Upcoming Conferences:
September
Ohio State 10th Annual MI/DD Conference , Mental Health Aspects
–Treatment & Support (September 18 & September 19, 2012)
Columbus, Ohio
October
NADD 29th Conference & Exhibit Show, (October 17 - 19, 2012)
Denver, Colorado
October 2013
NADD 30th Conference & Exhibit Show, Baltimore MD (October 23 -
October 25, 2013)
Complete Calendar |
New Educational Products:
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 Intellectual
Disability and Mental Health: A Training Manual in Dual Diagnosis
Sharon McGilvery, Ph.D. and Darlene Sweetland, Ph.D.
With the release of this book, Drs. McGilvery and Sweetland share
decades of experience working with individuals diagnosed with an
intellectual disability and co-occurring psychiatric disorders. Their
well-practiced approach takes into account the extremely complex
nature of working with dual-diagnosis. The authors provide
in-depth information about the diagnostic process, hands-on treatment
considerations, and their experience training thousands of people to
work passionately with these individuals. An important
contribution is their approach to addressing complicating factors in
identifying appropriate psychiatric diagnoses, as well as the problem
of the underreporting of psychiatric symptoms and disorders. Finally,
those working in a variety of contexts with these individuals will
benefit from the innovative approaches of looking at treatment and
intervention strategies that can be immediately implemented. 264 pages
Details:
ST11-053B
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 A
PRACTICAL GUIDE to Assessing Medical Issues Associated with
Behavior/ Psychiatric Problems in Persons with Intellectual
Disability – Revised in 2011
Ann R. Poindexter, M.D.
This book discusses medical/medication issues which may present as
behavioral/ psychiatric problems in individuals with intellectual
disability. Three self-directed instructional courses and
several illustrative case histories are included. 110 pages\
Details:
DA05-021BR
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Psychotherapy for Individuals with Intellectual Disability
Edited by: Robert J. Fletcher, DSW, ACSW
This book provides the reader with insightful and useful ways to
provide psychotherapy treatment for individuals who have intellectual
disability (ID). It brings together all three modalities
(individual, couple, and group), and a variety of theoretical models
and techniques are discussed. The first section, Individual
Therapy, offers a variety of approaches and techniques including
dialectical behavioral therapy, positive psychology,
mindfulness-based practice, and relaxation training. Also included in
this section are chapters on specialty populations including victims
of abuse, people who have Autism Spectrum Disorder, and people in
mourning. The second section is a chapter on group therapy addressing
trauma issues. The third section is on family and couple therapy. The
fourth section covers chapters on research, ethics, and
training. The individual authors are respected authorities in
the field of providing psychotherapy treatment for persons with ID
and all have contributed to the professional literature.
This book is a major contribution to the effort to make psychotherapy
available to individuals who have ID and should serve to further
stimulate interest in the provision of psychotherapy treatment for
individuals who have ID co-occurring with significant mental health problems.
NADD # CT11-051B Details
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 Comprehensive
Competence-Based Parenting Assessment for Parents with Learning
Dificulties and Their Children
Maurice Feldman, PhD, Marjorie Aunos, PhD
This book presents an innovative, empirically-supported approach to
assessing parenting capacity of parents with learning difficulties
that can lead to more humane, fair and accurate child custody
decisions. The authors are leading researchers and
practitioners in this field haing worked with hundred of these
families. Many professionals working with these families
recognize that the current parenting capacity assessment approaches
are based on outdatd and invalid assumptions and methods. This
book addresses the unique assessment needs of these families and
includes detailed background information, rationales and methods.
NADD # DA10-050B Details
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 Working
with People with Challeging Behaviors: A Guide for Maintaining
Positive Relation
Nathan Ory
The material in this book introduces general practices
and specific solutions to behavior problems that will work with
people who display difficult and challenging behaviors regardless of
who they are. It is especially suitable for working with
individuals who have developmental or intellectual disabilities
coupled with a behavior disorder. The methods also apply to the
person with emotional or psychiatric disturbances, or another serious
mental health problem. Finally, they are helpful in providing
support to elderly individuals who display challenging behavior.
NADD # ST10-049B Details
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Human Needs and Intellectual Disabilities: Applications for Person
Centered Planning, Dual Diagnosis, and Crisis Intervention
Steven Reiss, Ph.D.
Human Needs and Intellectual Disabilities identifies the 12 human
needs most relevant to the lives of people with intellectual
disabilities, autism and related developmental disabilities. It
includes detailed, practical suggestions for caregivers or parents
interested in the happiness, quality of life, and self-determintion
of their loved ones or consumers. The book includes detailed,
practical suggestions for reducing episodes of challenging behavior
and psychiatric symptoms in people with a dual diagnosis
(intellectual disabilities and mental illness). It shows how to
substitute the language of individuality (e.g., "friendly
person") for the language of disability (e.g., "person with
disability"). It also reduces the tendency of planners to
confuse their own value system for that of the consumer. The
book includes scholarly reviews of dual diagnosis literature on
mental illness, prevalence, and assessment.
NADD # DA10-048B Details
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Positive Identity Development
Author: Karyn Harvey, PhD
Positive Identity Development is an exciting new approach to
treatment for individuals with intellectual disabilities. This
book provides a new theoretical perspective on treatment along with a
variety of innovative tools. It rejects reducing adults with
intellectual disabilities to a mere compilation of their behaviors
and promotes the use of a positive, therapeutic approach to each
unique individual. Psychologists, social workers and therapists
should be able to use the tools presented in this book to directly
enhance the effectiveness of the treatment they provide to adults
with intellectual disabilities. This book promotes well-being on
every level and explores a broad range of issues relevant to the life
and mental health of adults with intellectual disabilities
Mbr Price: $34.95
Non-Mbr: $39.95
NADD #CT09-047B Details |
 Down
Syndrome: When to Worry about Mental Health and What to Do About It
Robin Friedlander, M.D. & Peter Johnson, Ph.D.
NADD # FI09-044B Details |
 Working
with People who have Intellectual Disability and Behavioral
Problems: A Self-Study Guide for Interdisciplinary Team Members
Ann R. Poindexter, M.D. & Paul D. Kolstoe, Ph.D.
NADD # ST09-045B Details |
Multi-Media CDs of NADD 25th Annual Conference Presentations
Presentations recorded at NADD 25th Annual Conference are available
as multi-media CDs. These CDs contain the video and Power Point
from conference presentations and are a great tool for training
yourself and your staff. To order, or for additional
information, click here.
Community Networks of Specialized Care: Building Community
Capacity through Training and Education Lisa Holmes, Liz
Froese, MSW, Rosanne Stein, LLB, BSc, Sandi Bricker
NADD Competency-Based Dual Diagnosis Certification Program Robert
Fletcher, DSW, ACSW, FAAIDD; Donna McNelis, PhD; John McGonigle,
PhD; Kathleen Olson, PhD; Jarrett Barnhill, MD
Autism Spectrum Disorders: Separating the Data from the
Myths Ann R. Poindexter, MD
Diagnostic Systems for Use with People with ID Luis
Salvador-Carulla, MD, PhD, Robert J. Fletcher, DSW, ACSW, FAAIDD,
Sally-Ann Cooper, MD
The price for the above multimedia is: Member:
$49.95 Non-member: $59.95
To order, or for additional information, click
here.
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