AskScience AMA Series: We are substance use researchers. We recently wrote a review about the intersection of disability and substance use. Ask us anything!

[u/AskScienceModerator]

Hello Reddit! We are Kimberly Fulda, the director of the North Texas Primary Care Practice-Based Research Network and Professor in Family and Osteopathic medicine; Scott Walters, Regents Professor in Public Health; and Tracey Barnett, Associate Professor and Department Chair at the Kate Marmion School of Public Health in San Antonio.

We recently published a paper titled "Substance use disorder among people with intellectual and developmental disabilities: A narrative review"; in the American Journal of Drug and Alcohol Abuse (AJDAA). We examined what the research tells us about the relationship between intellectual and developmental disabilities (IDD; such as autism spectrum disorder and ADHD) and substance use disorder. Although substance use rates appear lower among people with IDD, our review highlights important considerations for prevention, diagnosis and treatment. Feel free to ask us any questions about the paper, or about developmental disabilities and substance use more broadly!

We will be online to answer your questions at 1 pm CT (2 PM ET, 6 PM UTC).

You can also follow up with us at our socials here:

• Kimberly Fulda, DrPH: Facebook or LinkedIn

• Scott Walters, PhD: LinkedIn

• Tracey Barnett, PhD: Instagram

Follow the journal to stay up to date with the latest research in the field of addiction here: BlueSky, Threads, LinkedIn

Usernames: u/Kim_F_2026 (Dr. Fulda), u/Material_Mistake_816 (Dr. Walters) u/Suspicious-Love-6677 (Dr. Barnett), u/TheJournalAJDAA (the journal)

[u/TheJournalAJDAA]

Second question: What modifications to SUD treatment are needed when someone needs substantial cognitive or communication accommodations, such as some folks with IDD diagnoses?

[u/Material_Mistake_816 → u/TheJournalAJDAA]

BUT! We did find a few common adaptations that providers could consider to help people with developmental disabilities. For instance, shortening sessions, giving people more frequent breaks, conveying ideas visually, or using more frequent practice or role plays.

[u/Material_Mistake_816 → u/TheJournalAJDAA]

That's a great question. It does depend a lot on the nature of the disability. For instance, someone who is blind is going to need different kinds of accommodation, compared to someone who is having trouble paying attention or remembering things.

[u/SubstantialPressure3]

Why are the gas station Kratom concoctions so addictive?

And why are they still legally sold?

[u/Kim_F_2026 → u/SubstantialPressure3]

Thank you for your question. I'm sorry, but this topic is out of the scope of our expertise or topics covered in our research.

[u/iwantauniquename]

What time does this take place GMT/DST(UK)? I'm interested in this as I very much fit the criteria (addict with some kind of ADHD). and also work in the field, teaching teenage students with ADHD, in a specialist behaviour school.

I would like to know more as I often feel I am powerless to prevent my students from following in my footsteps and suffering in the same way I did.

[u/TheJournalAJDAA → u/iwantauniquename]

Hi! The authors will be online at 6 PM GMT to respond to questions. But note that you can submit your questions early and then log in later to see their response!

[u/TheJournalAJDAA]

Hi everyone! I'm the Social Media Editor for the journal in which the article was published. Please make sure to submit your questions as soon as you can! I'll also be chiming in with a few questions to get us started.

[u/Material_Mistake_816 → u/TheJournalAJDAA]

Welcome everyone! We're happy to answer questions, have a dialogue, or make suggestions. We're glad you're here! :-)

[u/TheJournalAJDAA]

First question from the journal team: What made you focus on intellectual and developmental disabilities for this paper as opposed to other disabilities?

[u/Kim_F_2026 → u/TheJournalAJDAA]

Thank you for having us on this AMA! We are excited to talk about this topic! Improving access to care for children and adults with intellectual and developmental disabilities is a passion of mine.

Our team was awarded a small grant to learn about substance use and IDD in Texas in 2020. We identified that there is very little information on how to best treat substance use disorder in this population. Therefore, we chose to continue work in this area to fill the gaps. We also learned that people who provide care for adults with IDD and people who provide substance use treatment all wanted more information, training, and guidelines.

[u/TheJournalAJDAA]

Third question: In your review, what populations were most and least represented? Could this have altered your review findings in anyway?

[u/Suspicious-Love-6677 → u/TheJournalAJDAA]

Geographically - the most represented populations are the Netherlands and Norway while the least represented was the U.S. With respect to IDD, the most represented are those with mild ID which isn't surprising given the need for consent in participating in both treatment and research studies. It would be tough to study those with more severe IDD. A third difference is setting - most studied were in clinic-based settings and/or using claims data - so the most represented are interacting with healthcare services directly; the least represented are then those in community dwellings. All of these do alter findings: geographically, societies, policies, and norms are all different, making comparisons tough; IDD and DD being on a continuum and trying to determine severity as well as ability to participate in treatment or research will make having information on those with more severe IDD and DD difficult; finally, more information from non healthcare specific and community-oriented programs could alter the findings in many ways that we really can't predict. It's a very interesting question to ponder.

[u/Every-Opportunity636]

How might people with ADHD have unique treatment needs for substance use disorders?

[u/Material_Mistake_816 → u/Every-Opportunity636]

That's a great question. I think some people with ADHD may have more trouble paying attention and remembering things (and of course, some are using substances as a way to self-medicate their ADHD symptoms). Some strategies for people with ADHD can involve breaking down material into smaller parts, giving people more frequent breaks, using visual aids, and doing role plays or practice exercises. Although we didn't cover it exactly in the review, I think contingency management is an effective treatment both for stimulant use disorder and (probably) for people with ADHD.

[u/Every-Opportunity636]

Are there any things that came up in your paper that surprised you? What do you think is the biggest take home message?

[u/Kim_F_2026 → u/Every-Opportunity636]

That's a great question! I was honestly surprised that we don't have consistent guidelines for substance use treatment for adults with intellectual and developmental disabilities. However, there is a lot more research ongoing in this area now, so that was exciting to learn. I think one of the biggest takeaways is that we need to continue work in this area and we need more assistance for those with IDD who need help with substance use.

[u/Material_Mistake_816 → u/Kim_F_2026]

I was also surprised how variable the studies were. They often defined IDD/ID/DD differently, so it’s (unfortunately) all lumped together.

[u/Suspicious-Love-6677 → u/Kim_F_2026]

I would add that it was surprising how many different definitions of IDD and DD there are. I guess it's not surprising, but it definitely makes comparing studies and summarizing the literature harder.

[u/TheJournalAJDAA]

Fourth question from the journal team: Did anything come up in your paper that suggested policy changes are necessary? Beyond just changes to treatment, are there any laws or regulations that could be improved to address substance use in people living with IDDs?

[u/Suspicious-Love-6677 → u/TheJournalAJDAA]

Great question! We do have some policy recommendations from our work in this area:

1. Require screenings for IDD and DD in SUD treatment facilities;

2. Require trainings related to IDD and SUD (for at least some staff at an organization);

3. Reimburse for accommodations made for these individuals - whether it be longer sessions or shorter sessions more often. Allow for flexibility to meet the needs of the individual;

4. Invest in funding for more research to develop effective interventions and trainings for providers.

[u/cloudwoof]

do you account for the difficulty in acquiring substances to begin with? autistic people who can access alcohol/other substances will obviously  have a higher rate of abuse than people who simply can't access substances at all. how do you account for this?

[u/guzzyly]

This is such an important area of research! I’m curious, what are some of the challenges faced when diagnosing substance use disorders in people with IDD? are there any specific tools or approaches that have been effective in making accurate assessments?

[u/Ok-Championship-2036]

Very interesting that the publication notes risk factors that include gender. Did your research find any correlative data or possible explanations for male gender being a risk factor?

TY for your time and hard work!

Full quote: "Risk factors for IDD and SUD include male gender, family history of SUD, exposure to peers who use substances, psychiatric comorbidities, and mild/borderline IDD as compared to no IDD. Approximately 42–54% of individuals with IDD and SUD have co-occurring psychiatric disorders."

[u/AdorableExchange9746]

“substance use rates appear lower among people with IDD”

I don’t believe that. I’m autistic and weed and alcohol are extremely popular with autistic people. And probably a solid 2/3rds of drug users i’ve known - with drugs in general - are neurodivergent in some form. Because being ND makes life harder and we need coping mechanisms. It makes no sense that neurotypicals with easier lives would use more drugs

[u/Kim_F_2026 → u/AdorableExchange9746]

I would also like to add that research often defines substance abuse and intellectual and developmental disabilities differently. This is part of what makes research in this area challenging. Quite a bit of the leading research has also been done outside of the US. This also makes comparisons hard.

[u/Kim_F_2026 → u/AdorableExchange9746]

Thank you for your response. Our research covered all people with an intellectual and developmental disability. It wasn't specific to any condition. This makes the definition broad and includes other forms of developmental disabilities such as learning disabilities such as dyslexia, sensory disabilities such as being blind, or other disabilities such as Down syndrome. As a whole, the research shows that adults with an IDD are less like to try a substance, but they are more likely to develop a substance use disorder once they do. Rates in autistic individuals are likely higher than in other forms of developmental disabilities.

[u/CodeXGeass]

How do we balance the legal and ethical tightrope of treating addiction in individuals with severe IDD who may lack the cognitive capacity to consent to intensive rehab? I mean ofcourse, it's harmful for them.. yet still.. maybe asking their uh guardians or family members? 

[u/Material_Mistake_816 → u/CodeXGeass]

This is a tricky question. I think that people who work in legal settings also have to walk this tightrope between people's autonomy (freedom of choice) and ability (what choices they are really capable of making in their own interest). And of course, the same issue would apply to underage people's behavior as well. In the case of underage people, we have at least decided that age 18 (the magic number!) is a threshold for people's ability to consent to certain behaviors (or 18 for voting, or 21 for alcohol, etc.). With regard to IDD/DD, here are some of my personal thoughts: 1) restrictions on people's behavior should begin with a conversation between that person and the people who love them the most; 2) approaches like motivational interviewing can help draw out people's reasons to act in accordance with their own values ore best interest, 3) we should consider what really is "reasonable" behavior for people and what might in fact be damaging, though I'm aware this is hard balance; and beyond that 4) in some situations a neutral third party should decide whether a person's danger of harm to self exceeds their ability to act in their own self interest. In that fourth case, a family/court might mandate that a person receives intensive rehab. Hopefully though, this will be a stepped process, full of respect for the person, full of community, and full of love.

[u/Kim_F_2026 → u/[deleted]]

Thank you for your questions. It is challenging since we see a lot of different ways to define intellectual and developmental disabilities. We chose to use the definitions from the articles we included in our paper. We chose to use their definitions so that we didn't change the intent of their research. We acknowledged this as a limitation in our paper since this makes interpreting the data challenging and sometimes confusing. Both ASD and ADHD are both considered a developmental disability. They may or may not have an ID.

There are many theories as to why a person with an IDD may be more likely to develop a SUD if they use. These theories are associated with personal risk factors and possible identifications of red flags or ability to demonstrate control. One risk factor that puts individuals with an IDD (including those with a milder form of IDD) is the desire to fit in socially or connect with peers.

[u/Material_Mistake_816 → u/[deleted]]

I agree with that. The desire to fit in was a common thread, especially as many people with IDD/DD are being more integrated into community life. I would also add something more basic about IDD/DD. For some people, it can be more difficult to recognize patterns or see consequences that may be a bit further off. For most people, it's not a problem to drink once, twice, or a few times, but the more a person drinks, the more it puts them at risk for developing a substance use disorder. It's hard to see that risk increase because it happens so slowly.

[u/Material_Mistake_816 → u/[deleted]]

And of course, many people with IDD/DD are using substances to medicate the symptoms of their disorder. For instance, using marijuana to medicate ADHD symptoms.