The Usefulness of Implicit Measures for the Screening, Assessment and Treatment of Problematic Alcohol Use in Individuals with Mild to Borderline Intellectual Disability

Abstract

Although the neuropsychological underpinnings of problematic alcohol use have been studied extensively, this research has not yet been generalised to individuals with mild to borderline intellectual disability (MBID). In this paper, we present the main findings of a research project aimed at studying the deficiencies in information processing associated with problematic alcohol use in problematic drinkers with and without MBID. The objectives were to develop and test indirect measures of cognitive biases and executive dysfunctioning of problematic drinkers with MBID and studying the extent and nature of the influence of IQ and executive control on these deficiencies. In addition to extending the fundamental knowledge about problematic alcohol use, the research findings provide practical implications that can be translated into the screening, assessment and treatment of problematic drinkers-both with and without MBID. Based on our results, we discourage the use of indirect, reaction time-based measures for cognitive biases for clinical purposes. The word association task, on the other hand, provides better opportunities, for example as a way to identify high-risk situations for alcohol use. With regard to cognitive and executive functioning, we advise practitioners to conduct a thorough assessment in an early phase of the treatment but withhold from incorporating neurocognitive treatment protocols in the treatment of problematic alcohol use.

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

“…As I have argued in my previous paper (Van Duijvenbode et al 2017), and will argue again, pending the lines for future research I have summarized it is still too premature to implement implicit measures in clinical practice.…”

“…This underlines the importance of evidence-based practice in the assessment and treatment of SUD-both in individuals with and without MBID (also see American Psychological Association 2002; European Monitoring Centre for Drugs and Drug Addiction 2011; United Nations Office on Drugs and Crime and World Health Organization 2016). As I have summarized in our paper (Van Duijvenbode et al 2017), the evidence base of implicit measures in the assessment and treatment of SUD in individuals with MBID is very limited to non-existent. After all, we did not find evidence of attentional or approach biases (which are Btrained away^in CBM) and executive dysfunctioning in problematic drinkers with MBID.…”

“…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.…”

The Potential Usefulness of Cognitive Bias Modification (CBM) in the Treatment of Problematic Alcohol Use in Individuals with Mild to Borderline Intellectual Disability

“…With great interest, I read the recent paper by Van Duijvenbode et al (2017) in this journal concerning the usefulness of implicit measures for the screening, assessment and treatment of problematic alcohol use in individuals with mild to borderline intellectual disability (MBID). Although I applaud the subject of the paper, I would argue that some of the conclusions are mistaken and could hinder progress in this important field of research.…”

“…Van Duijvenbode et al (2017) do not recommend implementation of CBM in problem drinkers based on two critical reviews (Christiansen et al 2015;Field et al 2014) and a recent meta-analysis (Cristea et al 2016). However, the first two papers are critical about one specific type of CBM: attentional bias modification, and primarily note that there are as yet very few clinical studies to test the effectiveness of this method in a clinical setting.…”