Taking About Substance Use

I recently gave a presentation for the forensic psychiatry expertise centre in the Netherlands. They asked me if I could give some tips on how to talk to people with mild intellectual disabilities (MID) about drugs, particularly within a forensic context. 

I am not an MID expert and I don’t know everything about the forensic setting, so I called a friend who has worked in probation. She said, ‘The only thing you need to be aware of is that people in a forensic setting are often not honest about drugs. Not because they don’t want to be, but because there is an interest behind it. It can be used against you in a criminal case.’ 

That got me thinking.  

Many of you who work with people with mild intellectual disabilities and substance use will notice that clients are not always honest. There is an interest behind that too. All your life, you hear that you don’t understand things properly and make the wrong choices. Using drugs can feel like failure. There is fear of sanctions. Openness requires trust, but the relationship between care provider and client is by definition unequal. And then there is the fear of change. As soon as you are honest about your use and pressure arise. In other words, stress. 

So perhaps the real question is not: why are they not honest? 

But: how safe have we made it to be honest? 

Many clients expect that everything they say can be used against them. Remove that threat before the conversation begins. For example, by saying: ‘I can’t promise that there will be no consequences. I can promise that I will never surprise you with the things you tell me.’ 

A second pointer is to normalise. Many people keep quiet about their use because being honest often causes more misery than relief. You could say: ‘Many people keep their use to themselves because admitting it honestly usually causes problems. It would actually be strange if it were any different for you.’ 

Another tip: don’t expect honesty. Honesty is not a switch you can flip on, but a process. Especially in a context where honesty was often punished in the past. For example, you could say: ‘I don’t need to hear your whole truth today. As long as we get a little closer to the truth than last time.’ 

You cannot demand honest talk about substance use. It is something you have to earn every day. By being predictable. By giving space. And by showing that honesty does not automatically mean punishment. This applies in a forensic setting, but just as much outside of it. 

What small things do you do in conversations to enable honesty, rather than enforce it? 

Ferry Barendregt, Mainline trainer

Trainer Ferry Barendregt gives trainings across the country on behalf of Mainline about drugs and drug use.