The Potential Usefulness of Implicit Measures to Assess and Treat Problematic Substance Use in Individuals with Mild to Borderline Intellectual Disability: Setting a Research Agenda

Abstract

It was with great pleasure that I read the response of Wiers (2017) to our paper (Van Duijvenbode et al. 2017) on the usefulness of implicit measures for the screening, assessment, and treatment of problematic alcohol use in individuals with mild to borderline intellectual disability (MBID). In his response, Wiers argued that Bcognitive bias modification (CBM) is a promising method to change problematic drinking in individuals with MBID who are motivated to change^and that Badding CBM to the treatment of alcohol use disorders in MBID is a promising avenue for further research, and readers should not be discouraged from it by the conclusions of Van Duijvenbode et al.^In this response, I argue that although I agree that studying implicit measures in problematic drinkers with MBID is indeed a promising avenue for further research, the current evidence of their usefulness and effectiveness to screen, assess, and treat substance use disorders (SUD) is scarce and these measures should not be implemented for clinical purposes just yet.I agree with Wiers that implicit or indirect measures provide a promising avenue for future research. Implicit measures provide indirect measures of automatic cognitive processes, such as attention allocation and direction, associations and action tendencies (Wilson et al. 2000). Research in this area is interesting as it can be hypothesized that behavior in those with weak executive control-such as individuals with MBID (Willner et al. 2010)-might be more strongly influenced by automatic cognitive processes than in those with strong executive control. As argued by Wiers, Bthis implies that, especially in this group, relatively automatic or implicit cognitive processes play an important role in the development and maintenance of problem drinking.^In addition, because implicit measures do not rely on verbal capacity, are generally easy to conduct, and are thought to reduce social desirability, these measures might be especially useful for individuals with MBID (Van Duijvenbode et al. 2014).As research using these measures in individuals with MBID is limited to our studies, I also agree with Wiers that further research on this topic is needed. I propose four lines of research that are summarized in Table 1. The first line of research should be directed at examining the theoretical assumptions of the dual process models of addiction, which are often used in this field of study. Questions relating to causality, timeframe, persistence, and generalizability across different substances as well as similarities and differences between individuals with and without MBID all fit in this line of research. The second line of research focuses more on individual differences. More specifically, research should be directed at the identification of personal and contextual factors that influence both the strength of the cognitive biases as well as the nature and degree of executive/cognitive dysfunctioning as a result of SUD. The third line of research I would like to propose should be aimed at improving the...