Addictive behaviors among people with intellectual disability: An umbrella review

Addictive behaviors pose significant challenges for people with intellectual disability (ID), yet research remains limited. This umbrella review aims to synthesize evidence from systematic reviews on substance use (SU), gambling, and gaming among people with ID, focusing on prevalence and patterns, risk factors and motivations, and intervention approaches. Understanding these aspects is essential for developing effective prevention and treatment.

Following the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines, two independent reviewers searched the Web of Science, PsycINFO, and the Cochrane Database of Systematic Reviews for systematic reviews and meta-analyses focused on people with ID and SU, gambling, or gaming. Quality was assessed using the JBI Checklist for Systematic Reviews.

No eligible studies were found for gambling and gaming. Nine reviews addressed SU (alcohol, tobacco, cannabis, solvents, stimulant, and depressant drugs), revealing higher prevalence among men, adults, and those with less complex support needs. Motivational, educational, and behavioral interventions were employed. Cognitive behavioral therapy, motivational enhancement therapy, and mindfulness showed potential efficacy in increasing knowledge, motivation, and reducing SU.

The findings underscore the importance of inclusive prevention strategies that address social determinants of health (such as socioeconomic status and living conditions), transdiagnostic protective factors, and evidence-based, person-centered, and rights-based frameworks. While SU interventions for people with ID show promise, further research and more robust designs that incorporate these conceptual perspectives is needed. Moreover, it is essential to investigate polypharmacy and behavioral addictions to address these issues from a phenomenological and contextual perspective.