Commentary on “The bounds of liberty: lessons learnt from treating a man with alcohol use disorder, autism and learning disability”

In commenting on the issues raised by Drake et al. the purpose of this paper is to discuss three areas of practice: assessing capacity in the presence of intransigence and/or rigid patterns of thinking and behaviour; understanding addiction in this context; and identifying “reasonable adjustments” in the way addiction and substance misuse services are provided to this client group.

As well as discussing the issues raised by Drake et al. the commentary refers to a serious case review exploring similar issues.

Both the case discussed by Drake et al. and the serious case review draw attention to the importance of identifying “reasonable adjustments” to current practice.

While the implications of the cases discussed are very significant, further work quantifying the scope of the problems identified would be very useful.

The 1995 Disability Discrimination Act (UK) requires public services to make “reasonable adjustments” in order for people with a range of disabilities to access their services on an equitable basis. This paper identifies what some of those areas of difficulty might be.

This is a relatively new area of work and expertise in both mainstream addiction and specialist intellectual disability and mental health services needs to be developed in order for them to provide more coherent and accessible programmes to individuals.