Das Niederländische Ampelmodell „Traffic light“ zur Beurteilung des Schweregrades eines Suchtproblems in der Praxis

Das Ampelmodell "Traffic Light" ist eine umfassende Strategie zur Risikoermitt-lung, Prävention und Frühintervention von Substanzmissbrauch bei Menschen mit geistiger Behinderung (IQ 50-85). Allgemeine Zielsetzung ist, die Anzahl der Menschen mit geistiger Behinderung mit Suchtproblemen durch eine umfassende Strategie von Risikoermittlung, Prävention und Behandlung für diese Personen-gruppe zu senken. Wir wollen auf europäischer Ebene ein Projekt umsetzen, welches auf dem Am-pelmodell basiert. Wieso gibt es hierfür Bedarf? Erstens ist das Risiko, mit Substanzgebrauch zu beginnen, für Menschen mit geis-tiger Behinderung höher und wir wissen sicher, dass Substanzgebrauch ein reales Problem darstellt. Die Auswirkungen von Substanzgebrauch sind für Menschen mit geistigen Behinderungen oft schwerwiegender als für Menschen mit durch-schnittlichen oder höheren geistigen Fähigkeiten. Die Auswirkungen zeigen sich auf psychologischer, sozialer und/oder physischer Ebene. Auf dieser Grundlage ist jede Klient/in mit geistiger Behinderung Teil der Risi-kogruppe. Zur Messung, in welchem Maße eine Anfälligkeit besteht, haben wir den SumID-Q verwendet. Leider gibt es bislang keine validierten Instrumente zum Screening und zur Risikoermittlung von Substanzgebrauch unter jungen Men-schen mit geistiger Behinderung. Zweitens arbeiten bislang die Organisationen für Menschen mit geistiger Behin-derung und die Suchthilfeeinrichtungen nicht effizient zusammen. Eine bessere Kooperation zwischen beiden Bereichen wird zur besseren gegenseitigen Nutzung der jeweiligen Expertise führen

A Systematic Review of Substance Use (Disorder) in Individuals with Mild to Borderline Intellectual Disability

Although the attention for substance use (SU) and SU disorders (SUD) among individuals with mild to borderline intellectual disability (MBID) has been growing exponentially, this form of dual diagnosis has largely been ignored by addiction medicine. In this article, we systematically review the research between January 2000 and June 2018 on the prevalence, assessment, and treatment of SU(D) among children, adolescents, and adults with MBID. A total of 138 articles were included. It is concluded that individuals with MBID are likely to be at a higher risk for developing SUD compared to those without MBID. Future research should focus on the detection of MBID among patients being treated in addiction medicine, the development and implementation of systematic assessment methods of SU(D) among individuals with MBID, and the development and evaluation of prevention and treatment interventions. System integration, interdisciplinary collaboration, and the development of tailored treatment for individuals with MBID are advised to improve treatment access and outcome for those who have developed SUD

Immersive Virtual Reality Avatars for Embodiment Illusions in People With Mild to Borderline Intellectual Disability: User-Centered Development and Feasibility Study

Background: Immersive Virtual Reality (IVR) has been investigated as tool for treating psychiatric conditions. Especially the practical nature of IVR, by offering a doing instead of talking approach, could support people who do not benefit from existing treatments. Hence, people with mild to borderline intellectual disability (MBID, IQ = 50-85) might profit particularly from IVR therapies, for instance, to circumvent issues in understanding relevant concepts and interrelations. In this context, immersing the user into a virtual body (i.e. avatar) appears promising for enhancing learning (e.g. by changing perspectives) and usability (e.g. natural interactions). However, design requirements, immersion procedures, and the proof of concept of such embodiment illusion (i.e. substituting the real body with a virtual one) have not been explored in this group. Objective: Our work aimed to establish design guidelines for IVR embodiment illusions in people with MBID. We explored three factors to induce the illusion, by testing the (1) avatar’s appearance, (2) locomotion using IVR controllers, and (3) virtual object manipulation. Further, we report on the feasibility to induce the embodiment illusion and provide procedural guidance. Methods: We conducted a user-centered design with 29 end-users in care facilities, to investigate the (1) avatar’s appearance, (2) controller-based locomotion (i.e. teleport, joystick, or hybrid), and (3) object manipulation. Three iterations were conducted using semi-structured interviews to explore design factors to induce embodiment illusions in our group. To further understand the influence of interactions on the illusion, we measured the Sense of Embodiment (SoE) during five interaction tasks. Results: IVR embodiment illusions can be induced in adults with MBID. To induce the illusion, having a high degree of control over the body outweighed avatar customization, despite the participants' desire to replicate the own body image. Likewise, the highest SoE was measured during object manipulation tasks, which required a combination of (virtual) locomotion and object manipulation behavior. Notable, interactions that are implausible (e.g. teleport, occlusions when grabbing) showed a negative influence on the SoE. Contrarily, implementing artificial interaction aids into the IVR avatar’s hands (i.e. for user interfaces) did not diminish the illusion, presuming that the control was unimpaired. Nonetheless, embodiment illusions showed a tedious and complex need for (control) habituation (e.g. motion sickness), possibly hindering uptake in practice. Conclusions: Balancing the embodiment immersion, by focusing on interaction habituation (e.g. controller-based locomotion) and lowering customization effort seems crucial to achieve both a high SoE and usability for people with MBID. Hence, future work should investigate requirements for natural IVR avatar interactions by using multisensory integrations for the virtual body (e.g. animations, physics-based collision, touch), and other interaction techniques (e.g. hand tracking, redirected walking). In addition, procedures and usage for learning should be explored for tailored mental health therapies in people with MBID