Addictions Group Therapy for Clients with an Acquired Brain
Injury: Strengths and Challenges
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Brain Injury Services / Step Up! ABI Recovery Established 1987
Full range of ABI rehabilitation services: Mild to catastrophic
brain injury Transition from hospital Two gateways to access
services: Brain Injury Services public funding Step Up! ABI
Recovery private funding Accredited with exemplary standing by
Accreditation Canada Who We Are. What We Do.
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Some of our Group Homes 24/7 staffing Significant care clients
Complex care clients
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Transitional Living Service One-bedroom apartments
Semi-independent clients 24/7 access to staff
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Community Outreach Services Home skills Organization
Technology
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Group Services Multi-purpose activities room
BilliardsComputersCooking
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Adolescent Programs Only through Step Up! Fee-for-service Home
& school support Community integration Ages 13 and up
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ACQUIRED BRAIN INJURY (ABI) An ABI is an injury to the brain
that has occurred since birth Traumatic Non-traumatic
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CAUSES OF ABI o Motor vehicle accidents o Assaults o Falls o
Sports Injury o Anoxia Lack of Oxygen o Atrophy of the Brain o
Strokes o Seizures o Tumors o Infections
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FRONTAL LOBE EXECUTIVE FUNCTIONNING Initiation Problem Solving
Judgment Inhibition, self-monitoring Motor Planning Emotions
Awareness of abilities and limitations Organization Attention and
concentration Speaking (expressive language) Insight Reasoning
Abstract thinking Impulse control
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TEMPORAL LOBE Memory Recognizing and Processing Sound Receptive
language Producing Speech
CEREBELLUM Coordination and balance Skilled motor activity
Motor memory
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OCCIPITAL LOBE Receiving and processing visual information
Differentiation-identification of size, shapes, and colours
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BRAIN STEM Automatic systems: Breathing Heart rate Arousal and
consciousness Sleep and wake cycles
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DAMAGE TO THE LEFT OR RIGHT HEMISPHERE(S)
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CHOICES THERAPEUTIC GROUP CHOICES a Community Correctional
Brief Treatment Relapse Prevention & Maintenance Program Dr.
Lynn O. Lightfoot & Barker originally developed the program for
use in correctional services during 1987 as an Offender Substance
Abuse Pre-Release Program (OSAPP)
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OFFENDER SUBSTANCE ABUSE PRE-RELEASE PROGRAM (OSAPP) -GOALS To
increase awareness of the link between substance use and life
problems to motivate change To provide offenders with cognitive and
behaviourial skills to live a drug abuse free lifestyle + =
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ADAPTING CHOICES TO ABI Obstacles to accessing community based
generic services, for individuals with an ABI. Cognitive and
Behavioural concerns with ABI
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REFERRAL PROCESS Internal referral External/community can
access through manager of clinical services Mandated clients,
referred
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PROGRAM EVALUATION To evaluate program outcome the following
tests were used:
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CHOICES Program Knowledge Test o 10 multiple-choice questions o
Based on program curriculum o Test for each section
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Adult-Self Report (ASR) and Adult Behaviour Checklist (ABCL) o
These are parallel forms that were used to make comparisons between
an individuals perceptions (ASR) of their own functioning and other
peoples perceptions (ABCL) of their functioning o Usually use
primary staff or clients significant other for the ABCL form
completion, same for Pre & Post testing
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Beck Depression Inventory-II o 21 item, self-report o Measures
the severity of common symptoms of anxiety o Each of the symptoms
is rated on a scale of 0-3 with a maximum score of 63.
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Beck Anxiety Inventory o 21 item, self-report o Measures the
severity of depressive symptoms o Each of the symptoms is rated on
a scale of 0-3 with a maximum score of 63.
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Inventory of Drug-Taking Situations (IDTS) o 50-item,
self-report o Provides a profile of the situations in which the
client used alcohol or another drug over the past year
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Alcohol Use Questionnaire (ADS) 25 item, self-report Measures
an individuals level of alcohol dependency and the extent to which
the use of alcohol has progressed from a psychological involvement
to impaired control.
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Problems Related to Drinking Questionnaire o 15 item questions
Yes or No questionnaire o Highlights potential problems linked to
drinking
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The Stages of Change Readiness and Treatment Eagerness Scale,
Version 8D & 8A (Socrates): Beck Depression Inventory o 19
item, self-report o Measures level of recognition, ambivalence and
taking steps towards change for Drug Use (Socrates 8D) or Alcohol
Use (Socrates 8A)
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WEEKLY DRUG USE SURVEY
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WEEKLY SESSION FORMAT Self report of weekly substance use
Review of previous Session Introduction of Topic Lecture- Handout
of Material Discussion Prompt individuals to discuss use of new
strategy with their goals Role Play Questions & Answers
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CHOICES THERAPEUTIC GROUP CURRICULUM OVERVIEW 1. Alcohol &
Drug Knowledge; Pre Testing 2. Understanding and Managing Your
Behaviour 3. Problem Solving 4. Relapse Prevention: Understanding
& Preventing Relapse 5. Understanding and Managing Slips; Post
Testing
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CHOICES THERAPEUTIC GROUP CURRICULUM OVERVIEW Alcohol &
Drug Knowledge Pre Testing
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GOAL SETTING
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PERSONAL COST BENEFIT EXERCISE ProsCons What Drugs Do For MeHow
Drugs Harm Me & Others
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CHOICES THERAPEUTIC GROUP CURRICULUM OVERVIEW Understand ing
& Managing Your Behaviour
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ABC MODEL OF BEHAVIOUR ANTECEDENTS Triggers Feelings People
Places Activities Thought s BEHAVIOUR Drug Taking Drinking Eating
Smoking CONSEQUENCES PAYOFFS Feel Better Belonging Relaxation
Stimulation
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Three contributing factors; WEEK 4: CBT MODEL OF BEHAVIOUR
Behaviour Thoughts Feelings Body Arousal/Emotions )
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CHOICES THERAPEUTIC GROUP CURRICULUM OVERVIEW Problem
Solving
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CHOICES THERAPEUTIC GROUP CURRICULUM OVERVIEW Relapse
Prevention
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CHOICES THERAPEUTIC GROUP CURRICULUM OVERVIEW Understand ing
and Managing Slips; Post Testing
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SLIP AND RELAPSE PREVENTION Written individual plans for: 1)
slip management 2) relapse prevention
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STRENGTHS & CHALLENGES OF CHOICES FOR ABI GROUP
STRENGTHSCHALLENGES VS
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WHAT STAGE OF CHANGE ARE YOU IN? Pre-contemplation
Contemplation Action Maintenance Relapse
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CHALLENGES IN COGNITION Executive Functioning Memory
Attention/Concentration Initiation/Motivation
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FRONTAL LOBE EXECUTIVE FUNCTIONNING Initiation Problem Solving
Judgment Inhibition, self-monitoring Motor Planning Emotions
Awareness of abilities and limitations Organization Attention and
concentration Speaking (expressive language) Insight Reasoning
Abstract thinking Impulse control
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TYPES OF MEMORY Working memory - structures and processes used
to temporarily store and manipulate information Short term the
storage of a limited amount of information for a few seconds Long
term- unlimited amount of information is stored indefinitely
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STORAGE OF INFORMATION MEMORY STRATEGIES INCORPORATED IN GROUP:
Auditory cues Attention Visual cues Motor memory Create a
routine
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ATTENTION/CONCENTRATION Attention is the cognitive process of
selectively concentrating on one thing while ignoring other things
Concentration is sustaining that attention
RETRIEVAL OF INFORMATION STRATEGIES: Allow time Develop
compensatory strategies the client can & wants to use
Periodically repeat & rehearse
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STRATEGIES FOR ATTENTION/CONCENTRATION Few distractions Answer
clients question first, limit waiting period Make sure the client
and facilitator are both attentive Have a visual focus prop,
prompt, pictures, diagrams, Take several breaks Switch from lecture
to activity frequently Make decisions while in the environment Make
interventions brief Ask to ensure understanding
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BEHAVIOURAL CHANGES AFTER ABI Anger Impulsivity Aggression
Sexuality Impaired Lack of social awareness judgment
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MENTAL HEALTH CHALLENGES Top two mental health challenges post
ABI: Depression Anxiety
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MODIFICATIONS FOR ABI CLIENTS (PARTIALLY BASED ON DENNIS JAMES
ET AL, BRAIN INJURY AND SUBSTANCE ABUSE: THE CROSS TRAINING
ADVANTAGE) Increase the number of sessions Slow down sessions
Simplify language Information in small bites Repeat information
using short, simple phrases Hand outs (binder)
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MODIFICATIONS FOR ABI CLIENTS (PARTIALLY BASED ON DENNIS JAMES
ET AL, BRAIN INJURY AND SUBSTANCE ABUSE: THE CROSS TRAINING
ADVANTAGE) Anticipate off-topic remarks Keep instruction brief and
clear Get feedback Do you understand? Summarize ideas and points
often Review learned material each session Redirect off topic,
excessive talk, and inappropriate behaviour
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CHOICES GROUP 2014 Pre and Post data collected Program
Knowledge increased from 67 % to 75% Depression - Neither client
reported a change in levels of depression, with scores remaining in
the severe and minimal ranges; Anxiety Increased for one client
from the moderate to severe range of anxiety symptoms. Results also
indicated that both clients had low alcohol and drug dependency
ratings. Reported significant decrease in problems related to
drinking for one of the clients as he indicated quite a few
problems on the pre-test, and some problems on the post-test.
Self-reported scores in the normal range for alcohol and drug use;
however, increased to the borderline clinical range, at the end of
the group. Stage of change data was available for one of the
clients. The results indicated the client perceived that he had a
low level of problems related to alcohol and drug use and that he
was taking to steps towards managing his use. Feedback from the
clients indicated they found the strategies presented in the group
to be somewhat valuable, that it was usually true that the material
was easy for them to understand, that the material was somewhat
helpful, and that they usually enjoyed the group.
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Thank You Brigitte Langlois, BSW, MSW, RSW Social Worker,
Counsellor 225 King William Street, Hamilton, ON L8R 1B1
905-523-8852 www.braininjuryservices.comwww.step-up-abi.ca
