Upload
phillip-logan
View
217
Download
2
Tags:
Embed Size (px)
Citation preview
Substance Abuse Substance Abuse and Traumatic and Traumatic Brain InjuryBrain Injury
Evidence-Based Techniques Evidence-Based Techniques
to Prepare People to Prepare People
for Lasting Changefor Lasting Change
Gary S. Seale, PhD LPA LCDCGary S. Seale, PhD LPA LCDC
Director, Clinical ProgramsDirector, Clinical Programs
Transitional Learning Center (TLC) at GalvestonTransitional Learning Center (TLC) at Galveston
Addictive Behavior - Defined
Addictive behavior patterns are repeated and become predicable in their regularity and excess
Abuse/dependence refers to a pattern of behavior that involves poor self-regulation, continues despite negative feedback (consequences), and often appears “out of control”
Reinforcers for engaging in the behavior are very strong and the behavior is an integral part of the person’s life and way of coping
Addictive Behavior - Defined
Failure to change, despite change is 1) possible, 2) in the best interest of the individual, is a characteristic of addiction
Change is the antithesis of addiction, but how do we help people change?
“ If I had six hours to chop down a tree, I would spend four hours sharpening the axe…”
- Abraham Lincoln
Scope of the problemScope of the problemStatisticsStatistics
Alcohol (ETOH) is Alcohol (ETOH) is THETHE most frequently most frequently used used depressant and the cause of depressant and the cause of considerable considerable morbidity and mortalitymorbidity and mortality
In the United States, as many as 90% of In the United States, as many as 90% of adults adults have had some experience with have had some experience with alcoholalcohol
Of those adults who have used alcohol Of those adults who have used alcohol 60% of 60% of males and 30% of females report males and 30% of females report an adverse an adverse life event related to alcohol life event related to alcohol use.use.
Most people learn from their experiences Most people learn from their experiences and and moderate or stop drinkingmoderate or stop drinking
Scope of the problemScope of the problemStatistics - continuedStatistics - continued
14 million Americans abuse alcohol or are 14 million Americans abuse alcohol or are alcohol dependent (1 in 13)alcohol dependent (1 in 13)
Alcohol abuse and dependence are more Alcohol abuse and dependence are more common in men than in women (5:1 common in men than in women (5:1
ratio)ratio) Men start drinking early; women start Men start drinking early; women start
drinking drinking heavily later in life; abuse heavily later in life; abuse and dependence and dependence progress more rapidly progress more rapidly in women, causing in women, causing more health-related more health-related problemsproblems
Size matters - differences in blood alcohol Size matters - differences in blood alcohol concentrations (BAC)concentrations (BAC)
Scope of the problemScope of the problemStatistics-continuedStatistics-continued
Social-cultural differences exist Social-cultural differences exist (family, religious, (family, religious, etc.)etc.)
Alcohol abuse and dependence rates Alcohol abuse and dependence rates are about are about equal in Caucasian and equal in Caucasian and African-American African-American populationspopulations
Slightly higher abuse and dependence Slightly higher abuse and dependence rates in rates in Latino malesLatino males
Very low in Asian populations (due to Very low in Asian populations (due to adverse adverse physical affects at low doses)physical affects at low doses)
Scope of the problemScope of the problemStatistics-continuedStatistics-continued
The earlier one starts drinking, the greater The earlier one starts drinking, the greater the the risk for developing alcohol abuse/risk for developing alcohol abuse/dependence (those drinking at 15 are 7X dependence (those drinking at 15 are 7X
more likely to develop alcohol use more likely to develop alcohol use problems problems compared to those that begin compared to those that begin at 21)at 21)
Health-related problems associated with Health-related problems associated with drinking include cancer, brain damage, drinking include cancer, brain damage, immune system dysfunction, fetal immune system dysfunction, fetal
alcohol alcohol syndrome, etc.syndrome, etc. 50% of fatal traffic accidents involve 50% of fatal traffic accidents involve
alcoholalcohol Many homicides and suicides involve ETOHMany homicides and suicides involve ETOH
Scope of the ProblemScope of the ProblemSubstance Abuse and TBISubstance Abuse and TBI
Males are about twice as likely to sustain a TBI Males are about twice as likely to sustain a TBI than than femalesfemales
Males are about 3 to 4 times more likely to be Males are about 3 to 4 times more likely to be under the under the influence of alcohol at the time of influence of alcohol at the time of injuryinjury
29% to 58% of persons who sustain a TBI are 29% to 58% of persons who sustain a TBI are under under the influence of drugs/alcohol at the time the influence of drugs/alcohol at the time of injuryof injury
About 50% of TBI survivors return to pre-injury About 50% of TBI survivors return to pre-injury use use patterns within the first year of injurypatterns within the first year of injury
54% of persons who sustain a second TBI are 54% of persons who sustain a second TBI are under under the influence at the time of injurythe influence at the time of injury
Scope of the ProblemScope of the ProblemSubstance Abuse and TBISubstance Abuse and TBI
Males are about 3 to 4 times more likely to Males are about 3 to 4 times more likely to be be under the influence of alcohol at the under the influence of alcohol at the time of time of injuryinjury
29% to 58% of persons who sustain a TBI 29% to 58% of persons who sustain a TBI are are under the influence of drugs/alcohol at under the influence of drugs/alcohol at the the time of injurytime of injury
About 50% of TBI survivors return to pre-About 50% of TBI survivors return to pre-injury injury use patterns within the first year of use patterns within the first year of injuryinjury
54% of persons who sustain a second TBI 54% of persons who sustain a second TBI are are under the influence at the time of injuryunder the influence at the time of injury
Scope of the Problem Scope of the Problem Substance Abuse and TBISubstance Abuse and TBI
TBI is among the leading killers and TBI is among the leading killers and disablers of all young adults under disablers of all young adults under the age of 35the age of 35
Medical and rehabilitation costs Medical and rehabilitation costs associated with TBI exceed 45 billion associated with TBI exceed 45 billion dollars annuallydollars annually
Scope of the problemScope of the problem
In purely economic terms, alcohol In purely economic terms, alcohol related related problems cost the American problems cost the American society an society an estimated $185 billion estimated $185 billion annually annually (ER/Hospital costs, (ER/Hospital costs, rehabilitation costs, law rehabilitation costs, law enforcement/incarceration, lost enforcement/incarceration, lost wages/productivity)wages/productivity)
In human terms, the cost can not be In human terms, the cost can not be calculated!calculated!
Treatment ChallengesTreatment ChallengesSubstance Abuse and TBISubstance Abuse and TBI
More frequent complications in the acute More frequent complications in the acute medical medical phase phase of recovery (i.e., of recovery (i.e., respiratory, vascular, edema respiratory, vascular, edema and ICP, etc.) and ICP, etc.) resulting in longer lengths of stay resulting in longer lengths of stay in acute in acute phasephase
Lower levels of consciousness (lower GCS Lower levels of consciousness (lower GCS scores) and scores) and longer lengths of comalonger lengths of coma
Greater agitation when emerging from comaGreater agitation when emerging from coma Greater levels of non-compliance and increased Greater levels of non-compliance and increased
risk of risk of leaving acute and post-acute care leaving acute and post-acute care AMAAMA
Greater risk of “losing” patient during follow-upGreater risk of “losing” patient during follow-up
Treatment ChallengesTreatment ChallengesSubstance Abuse and TBISubstance Abuse and TBI
29% to 40% of persons with TBI had substance 29% to 40% of persons with TBI had substance abuse abuse problems pre-injury.problems pre-injury.
A large number of persons who were not A large number of persons who were not problem problem drinkers before injury (up to 20%) drinkers before injury (up to 20%) are at risk for are at risk for developing abusive patterns developing abusive patterns after injuryafter injury
Persons who present for post-acute Persons who present for post-acute rehabilitation may rehabilitation may be “dry” but not “sober”be “dry” but not “sober”
Persons with TBI, because of multiple and Persons with TBI, because of multiple and complex complex changes associated with brain injury, changes associated with brain injury, may feel they may feel they have a “reason” to usehave a “reason” to use
Drug seeking, relapse, & leaving treatment are Drug seeking, relapse, & leaving treatment are frequent frequent occurrences that impact outcomes occurrences that impact outcomes
Treatment ChallengesTreatment ChallengesSubstance Abuse and TBISubstance Abuse and TBI
TBI survivors report that very small TBI survivors report that very small amounts of amounts of substances previously used substances previously used can have a big can have a big impact on cognition impact on cognition and behaviorand behavior
TBI survivors and family members report TBI survivors and family members report that that cognitive, physical, and cognitive, physical, and emotional deficits emotional deficits stemming from stemming from injury are exaggerated with injury are exaggerated with substance substance useuse
Prescriptions may be offered without Prescriptions may be offered without considering substance abuse historyconsidering substance abuse history
Traditional Treatment Traditional Treatment ApproachesApproaches
Substance Abuse and TBISubstance Abuse and TBI Minnesota (Hazelton) Model was heavily Minnesota (Hazelton) Model was heavily
influenced by influenced by Jellenik’s disease concept of Jellenik’s disease concept of alcoholismalcoholism
Emphasizes group work to help patients Emphasizes group work to help patients understand understand the nature of their illnessthe nature of their illness
Requires patients to accept a diagnostic Requires patients to accept a diagnostic label and label and recovery is dependent upon recovery is dependent upon complete abstinencecomplete abstinence
Resistance is seen as denial of the problem Resistance is seen as denial of the problem and must be and must be confrontedconfronted
Uses 12-step principles in recoveryUses 12-step principles in recovery
Traditional Treatment Traditional Treatment ApproachesApproaches
Substance Abuse and TBISubstance Abuse and TBI
Persons with TBI may resist traditional Persons with TBI may resist traditional approaches due approaches due to negative initial to negative initial experiences with 12-step experiences with 12-step programsprograms
Requires patient to accept yet another diagnostic Requires patient to accept yet another diagnostic labellabel
Difficulty with concepts central to 12-step Difficulty with concepts central to 12-step programs programs (i.e., “higher power”, “spiritual (i.e., “higher power”, “spiritual awakening”, “first awakening”, “first things first”, “one day at a things first”, “one day at a time”, etc.)time”, etc.)
Heavy handed confrontation results in Heavy handed confrontation results in defensivenessdefensiveness
Conflicts between recommendations of treatment Conflicts between recommendations of treatment team team and advice from “old timers”.and advice from “old timers”.
An Alternative Treatment An Alternative Treatment Approach – Stage ChangeApproach – Stage Change
Transtheoretical Model (TTM) of Transtheoretical Model (TTM) of intentional intentional behavior change behavior change focuses on: 1) focuses on: 1) howhow individuals individuals change and, 2) identifies change and, 2) identifies key key change dimensionschange dimensions involved in this involved in this process. process.
TTM Model of Intentional Behavior Change
PrecontemplationPrecontemplation – not seriously considering change in the near future
ContemplationContemplation – considering change, experimentation, increasing the pros for change and decreasing the cons PreparationPreparation –
commitment to change, planning
ActionAction – implementation, revising the plan
Maintenance Maintenance – integrating change into lifestyle, coping
TerminationTermination
Lapse & Lapse & RelapseRelapse
How Addictions Develop PrecontemplationPrecontemplation – person is not seriously
considering engaging in the behavior (i.e., drinking) in the near future. Lack of
interest can be due to: 1) little information or knowledge, 2) value system that excludes consideration of behavior, or 3) a conscious decision not to engage in behavior
Protective factors include: religious involvement, good family relations/interactions, parental monitoring, peers with similar views/values, good self-regulation, economic and social stability
How Addictions Develop (continued)
ContemplationContemplation – person begins to consider engaging in behavior (i.e., drinking); begins to consider positive/negative aspects of behavior (i.e., images, media messages, modeling, etc.); experimentation
Task of this stage is to gather information and weigh pros/cons
Experiments with behavior until a decision is made to move ahead to Preparation or back to Precontemplation
How Addictions Develop(Continued)
PreparationPreparation – continued experimentation and gradual (but deliberate) setting of the stage for regular engagement of the behavior (i.e., drinking).
Based on experiences and positive/negative consequences, person may modulate or stop behavior, or develop less controlled (out of control) use
Powerful physiological and psychosocial reinforcers; pros for continuing behavior increase and cons decrease; hard to believe negative messages from peers, parents, media, etc.
How Addictions Develop(Continued)
Action Action – regular and predictable engagement in behavior (i.e., drinking); behavior can be well controlled/modulated with few or no negative consequences. Negative consequences triggers re- evaluation and self-regulation
Behavior may be poorly regulated with negative consequences. Behavior occurs in many situations (more cues); over use becomes normalized and peer group, attitudes & beliefs shift to support behavior
Alterations in self-regulatory feedback; negative consequences normalized
How Addictions Develop(Continued)
Maintenance Maintenance – the behavior is an integral part of the persons life (can be well regulated; “social drinking”)
Poor self-regulation; out of control behavior; behavior continues despite negative consequences; failure to change despite change is possible and in the best interest of the person
DeflectionsDeflections (negative consequences = technical problems) and DisconnectionsDisconnections (between behavior & consequences)
How People Recover
PrecontemplationPrecontemplation – not seriously considering change in the near future
ContemplationContemplation – considering change, experimentation, increasing the pros for change and decreasing the cons PreparationPreparation –
commitment to change, planning
ActionAction – implementation, revising the plan
Maintenance Maintenance – integrating change into lifestyle, coping
TerminationTermination
Lapse & Lapse & RelapseRelapse
Screening & EvaluationScreening & EvaluationSubstance Abuse and TBISubstance Abuse and TBI
Establish criteria to determine who should Establish criteria to determine who should receive receive substance abuse treatmentsubstance abuse treatment
Record review (positive blood chemistry at Record review (positive blood chemistry at the time of the time of accident; positive history of accident; positive history of CD treatment)CD treatment)
Clinical interview with patient and family Clinical interview with patient and family (pre/post (pre/post injury use patterns, substance of injury use patterns, substance of choice, choice, consequences of use, previous consequences of use, previous treatment or treatment or attempts to stop, attempts to stop, patient/family view of substance patient/family view of substance use)use)
Formal assessment (SASSI, Formal assessment (SASSI, CAGE, AUDITCAGE, AUDIT))
Evaluate Readiness to Evaluate Readiness to ChangeChange
Pre-contemplation (not aware a problem exists)Pre-contemplation (not aware a problem exists)Recovery Goal: problem recognition; accurate Recovery Goal: problem recognition; accurate
appraisalappraisal Contemplation (“turning point”/ “hitting Contemplation (“turning point”/ “hitting
bottom”)bottom”) Recovery Goal: decisional balance favoring changeRecovery Goal: decisional balance favoring change
Preparation (what is the plan?; what are the Preparation (what is the plan?; what are the resources?)resources?) Recovery Goal: develop a plan; ID resourcesRecovery Goal: develop a plan; ID resources
Action (commitment to plan; strategies)Action (commitment to plan; strategies) Recovery Goal: teach strategies; implement planRecovery Goal: teach strategies; implement plan
Maintenance (lapse & relapse prevention)Maintenance (lapse & relapse prevention) Recovery Goal: sustaining change in many contextsRecovery Goal: sustaining change in many contexts
Termination Termination
Goals and Strategies for PreContemplation
Planting Seeds for Change
Precontemplation = not seriously considering change in the near future. Usually due to one of the following “R’s”- Reluctance- Rebellion- Rationalization- Resignation- Revelry
Goals & Strategies for PreComtemplation
(continued) RevelryRevelry – having too much fun. Consequences
have not accumulated or are not severe; decisional balance not tipped toward change
- GoalGoal: arouse concern; help person see negatives of behavior and positives of change
- StrategiesStrategies: how behavior affects others; engage emotional arousal (portrayal of
consequences: example, new smoking commercials); “YET”
Goals & Strategies for PreContemplation
(continued) RebellionRebellion – passionate about their ability
to make choices; don’t want anyone telling them what to do.
- GoalGoal: link freedom and autonomy with change; shift energy dedicated to the behavior to Contemplation and Preparation stages of change
- StrategyStrategy: point out they are not free, but slaves to the behavior (Motivational Enhancement therapies and Motivational Interviewing techniques)
Goals and Strategies for PreContemplation
(continued) ResignationResignation – hopeless and helpless
about change; overwhelmed by problems (including drinking); have tried to change and failed; “been addicted too long – it’s too late for change”
- GoalGoal: infuse hope and a vision of the possibility of change
- StrategiesStrategies: focus on resilience in other areas of life; show data that “bad addicts” recover; “letter from the future”
Goals and Strategies for PreContemplation
(continued) ReluctanceReluctance – hesitant about prospects of
change; change means leaving comfort zone (friends, routines, etc.)
- GoalGoal: increase confidence in the ability to change; provide reassurance they will be able to function without drinking.
- StrategyStrategy: focus on past successes with difficult tasks; enlist support of individuals who have made similar changes (and been successful)
Goals and Strategies for PreContemplation
(continued) Rationalizing Rationalizing – the person with all the
answers, for example “..might be a problem for others, but not me”, “I’ll quit when I have serious responsibilities like a wife and kids”, “I only drink beer and never drink before noon”- GoalGoal: more accurate self-appraisal and recognition of consequences- StrategiesStrategies: don’t argue; reflect back looking for ambivalence or discrepancies with the behavior and the person’s values beliefs; provide resources and have them research for themselves; natural consequences
General Strategies for PreContemplation
Remember – the overarching goal is problem problem identificationidentification
Patience and persistence Try not to argue, nag, threaten, etc. Time your conversation – don’t attempt it
when the person is drunk Listen, reflect back, provide support for
change (be ready if they ask for help) Honest, accurate, objective feedback Reasonable boundaries; natural consequences
Goals and Strategies for Contemplation
ContemplationContemplation – thinking about change. Caution: rushing in without considering
costs, or getting stuck in chronic contemplation
- Goal- Goal: gathering information, examining the information, engaging in a comparative
process (while moving toward pros for change)
- Strategy- Strategy: Decisional Balance Exercise; reinforce self- efficacy (they have the “stuff” necessary for change – BAT exercise)
Goals and Strategies for Preparation
PreparationPreparation – preparing for action = planning
- GoalGoal: making and strengthening the commitment to change; developing a sound, reasonable plan for action that is likely to be successfully implemented by the individual
- StrategyStrategy: conduct risk assessment; ID strengths and weaknesses; develop strategies and assess resources; complete change plan work sheet
Goals and Strategies for Preparation
(Continued) Plan should be built around the person –
self knowledge and patterns of behavior Consider social relationships, role
expectations, recreational activities, vocational pursuits, living arrangements
Complete a Brief Situational Confidence Questionnaire – arrange scenarios in
a hierarchy Determine skills needed for success in
each scenario (relaxation, assertiveness, etc.)
Goals and Strategies for Action
ActionAction – taking action to interrupt the habitual pattern of the behavior; person separates from the old pattern of behavior and begins to create a new one (establish a new pattern of behavior)- GoalGoal: break free from the behavior by using the strategies of the plan; revise the plan in the face of difficulties; manage temptations and slips that can provoke relapse- StrategyStrategy: Implement the Change Plan
Strategies for Action(continued)
Set a start (target) date for implementation Change routines and manipulate environment
where possible Teach coping strategies until mastery is reached
(ok to use technology – Tactical Breathing Trainer)
Instructions may need to be specific (written scripts); therapist may need to model behavior
Reward approximations Manage slips (lapses) as an “event” not a failure
Goals and Strategies for Maintenance
MaintenanceMaintenance – making change permanent; notnot engaging in the behavior becomes established as the norm- Goal: actively counter any threats and temptations; check and renew commitments; ensure decisional balance remains negative for re-engaging in the behavior; establish protective environment and satisfying lifestyle- StrategiesStrategies: revisit reasons to change; recognize progress and success; generalize behavior across settings
Other Skills TrainingOther Skills TrainingUsing the treatment team to establish positive everyday Using the treatment team to establish positive everyday
routinesroutines
Advanced activities of daily living Advanced activities of daily living (ADL’s)(ADL’s)
Social Communication SkillsSocial Communication Skills Leisure/RecreationLeisure/Recreation Productive ActivitiesProductive Activities Compensatory StrategiesCompensatory Strategies Adjustment to disabilityAdjustment to disability
HomeworkHomeworkSubstance Abuse and TBISubstance Abuse and TBI
Homework tasks provide a link between Homework tasks provide a link between clinical clinical intervention in structured settings intervention in structured settings and the “real” and the “real” world world
Objective is to promote generalizationObjective is to promote generalization Examples of homework assignments include: Examples of homework assignments include:
using using relaxation techniques in a stressful relaxation techniques in a stressful situation; using situation; using assertive responses on a assertive responses on a job trial; practicing job trial; practicing problem-solving in a problem-solving in a dispute with a room-mate, etc.dispute with a room-mate, etc.
Provides opportunities for team interaction Provides opportunities for team interaction (i.e., putting (i.e., putting homework assignments on “to homework assignments on “to do” list)do” list)
Structured Structured GeneralizationGeneralization
Substance Abuse and TBISubstance Abuse and TBI Allows opportunities to practice strategies in Allows opportunities to practice strategies in
actual actual community settings where substance community settings where substance abuse might abuse might occur (involve other disciplines)occur (involve other disciplines)
Therapist accompanies patient to a setting Therapist accompanies patient to a setting where use where use might occurmight occur
Therapist coaches patient to engage in Therapist coaches patient to engage in competing competing behavior or use strategies behavior or use strategies practiced in therapy practiced in therapy sessionssessions
Patient is heavily reinforced for appropriate Patient is heavily reinforced for appropriate behaviorbehavior
Patient experiences successPatient experiences success
Patient EducationPatient EducationSubstance Abuse and TBISubstance Abuse and TBI
Typically takes place in a group settingTypically takes place in a group setting Information on a variety of topics is Information on a variety of topics is
presented/discussed: common myths and presented/discussed: common myths and fallacies fallacies about substance use; about substance use; relationship relationship of substance use of substance use and TBIand TBI; effect of ; effect of substances on brain and substances on brain and behavior, and behavior, and recovery; identifying triggers; and recovery; identifying triggers; and relapse relapse preventionprevention
Identification of community supports Identification of community supports (including (including attending an attending an AA meeting)AA meeting)
Placement of written materials in a notebookPlacement of written materials in a notebook
Family EducationFamily EducationSubstance Abuse and TBISubstance Abuse and TBI
Information provided on a variety of Information provided on a variety of topics: the topics: the relationship between relationship between substance abuse and substance abuse and TBI; effect of TBI; effect of substances on the brain and substances on the brain and behavior; medication interactions, etc.behavior; medication interactions, etc.
Signals of impending lapse (relapse)Signals of impending lapse (relapse) Sharing of the Change Plan Sharing of the Change Plan Identification of community supportsIdentification of community supports
(for both (for both patient and familypatient and family
Follow-upFollow-upSubstance Abuse and TBISubstance Abuse and TBI
Follow-upFollow-up contact is made at identified contact is made at identified intervals intervals following discharge (ex. following discharge (ex. 1, 6, and 12 1, 6, and 12 months post discharge).months post discharge).
Patient and/or family can contact the Patient and/or family can contact the facility at facility at any time between any time between scheduled follow-up if a scheduled follow-up if a problem problem occurs.occurs.
TLC Addiction & Substance Abuse TLC Addiction & Substance Abuse ProgramProgram(ASAP)(ASAP)
Sample size = 12Sample size = 12 Male/Female ratio = 11:1Male/Female ratio = 11:1 Injury severity = severe (GCS, TFC, PTA)Injury severity = severe (GCS, TFC, PTA) Injury etiology = MVA (5), Fall (3), GSW Injury etiology = MVA (5), Fall (3), GSW
(2), (2), Work injury (1), Aneurysm (1)Work injury (1), Aneurysm (1) Average Age: 31 (range = 20-47)Average Age: 31 (range = 20-47) Length of time since injury: 4.5 mo (1-12)Length of time since injury: 4.5 mo (1-12) SASSI results = all were high probabilitySASSI results = all were high probability 7 were under the influence at injury; 6 7 were under the influence at injury; 6
had previous had previous CD treatmentCD treatment
TLC - ASAPTLC - ASAPTreatment ServicesTreatment Services
Activities of Daily Living – 10-12 hrs/wkActivities of Daily Living – 10-12 hrs/wk Physical Therapy – 5-10 hrs/wkPhysical Therapy – 5-10 hrs/wk Speech/Language Therapy – 1-3 hrs/wkSpeech/Language Therapy – 1-3 hrs/wk Neuropsychology – 2-4 hrs/wkNeuropsychology – 2-4 hrs/wk Neurocognitive therapy – 5-7 hrs/wkNeurocognitive therapy – 5-7 hrs/wk Leisure/Recreation – 8-12 hrs/wkLeisure/Recreation – 8-12 hrs/wk Productive Activities – 5-30 hrs/wkProductive Activities – 5-30 hrs/wk ASAP – 1-3 hrs/wkASAP – 1-3 hrs/wk
TLC - ASAP TLC - ASAP Data Outcomes – 6 Month Follow-upData Outcomes – 6 Month Follow-up
Chemical use since discharge: 75% reported Chemical use since discharge: 75% reported no use; no use; 25% reported some use25% reported some use
Of those who reported use after discharge, 2 Of those who reported use after discharge, 2 reported reported “controlled drinking”; one resumed “controlled drinking”; one resumed heavy illicit heavy illicit drug use and was jailed; one drug use and was jailed; one was referred for was referred for inpatient detox and inpatient detox and treatmenttreatment
Living status improved: 1 living in own home, 9 Living status improved: 1 living in own home, 9 in the in the family home, 1 in a treatment center, family home, 1 in a treatment center, 1 in jail1 in jail
Productive activity improved with 4 patients Productive activity improved with 4 patients engaged in engaged in work/school, and 6 seeking workwork/school, and 6 seeking work
TLC - ASAPTLC - ASAPOutcome AnalysisOutcome Analysis
Analysis of 6-month outcomes revealed Analysis of 6-month outcomes revealed only 2 only 2 patients were attending AA patients were attending AA meetings meetings regularly and attributed regularly and attributed abstinence to 12-step abstinence to 12-step support support meetingsmeetings
Other patients who were abstinent Other patients who were abstinent reported reported using other strategies: using other strategies: exercising; exercising; meditation/relaxation; meditation/relaxation; attending church; and attending church; and attending attending alternative community support alternative community support groups (i.e., Rational Recovery)groups (i.e., Rational Recovery)
Substance Abuse and TBISubstance Abuse and TBIConclusionsConclusions
There is no single method of treatment for There is no single method of treatment for substance substance abuse that is universally abuse that is universally applicable and successfulapplicable and successful
Counselors and therapists should be familiar Counselors and therapists should be familiar with with traditional as well as alternative traditional as well as alternative treatment models treatment models and methodsand methods
Cognitive-behavioral techniques and Cognitive-behavioral techniques and comprehensive comprehensive treatment approaches treatment approaches that incorporate Stage that incorporate Stage Change Theory Change Theory (TTM) and Motivational (TTM) and Motivational Interviewing have Interviewing have demonstrated some success for demonstrated some success for persons persons with TBIwith TBI
What to do if Someone You What to do if Someone You Know has a Problem with Know has a Problem with
AlcoholAlcohol Stop all “cover ups”Stop all “cover ups” Time your intervention (talk while the Time your intervention (talk while the
person is person is sober & right after an sober & right after an incident)incident)
Be specific (how drinking is affecting you)Be specific (how drinking is affecting you) State limits (be prepared to follow State limits (be prepared to follow
through -through - don’t make threats)don’t make threats) Provide resources or refer person to Provide resources or refer person to
someone in someone in recoveryrecovery Get support for yourselfGet support for yourself
What to do if Someone You What to do if Someone You Know has a Problem with Know has a Problem with
AlcoholAlcohol Examine benefits of stopping Examine benefits of stopping
unhealthy unhealthy drinking patternsdrinking patterns Set a goal (to stop or cut down)Set a goal (to stop or cut down) Examine situations that trigger Examine situations that trigger
drinking and find drinking and find new ways to new ways to handle that situationhandle that situation
Get social supportGet social support Relapses are a part of recovery and Relapses are a part of recovery and
should be should be treated as single treated as single episodes, not failure (no episodes, not failure (no guilt)guilt)
Resources
- The Houston Council on Alcohol and Drugs303 Jackson Street, Houston, Texas
77007713-942-4100
- The Texas Commission on Alcohol and Drug Abuse (TCADA) http://www.dshs.state.tx.us/mhsa
- Substance Abuse and Mental Health Services Administration (SAMHSA)
http://www.samhsa.gov
Resources - Continued
Substance Abuse/Brain Injury (SUBI) Bridging Project (140-page workbook with exercises)
Ohio State University Brain Injury Substance Abuse Education Project – John Corrigan, PhD
Questions?Questions?(hopefully, some answers)(hopefully, some answers)
““Thank you, Thank you, thank you very thank you very
muchmuch!”!”
ReferencesReferences
Sparadeo, FR, Strauss, D, Barth, JT. Sparadeo, FR, Strauss, D, Barth, JT. The The Incidence, Impact, and Treatment of Substance Incidence, Impact, and Treatment of Substance Abuse in Head Trauma RehabilitationAbuse in Head Trauma Rehabilitation. . Journal Journal of Head Trauma Rehabilitation,of Head Trauma Rehabilitation, 1990; 5 (3): 1-8 1990; 5 (3): 1-8
Strauss, D. Strauss, D. An Overview of Substance Abuse An Overview of Substance Abuse and Brain Injuryand Brain Injury. . Brain Injury Source,Brain Injury Source, 2001; 2001; 5(4): 8-11;40-415(4): 8-11;40-41
Ruff, RM, et. al. Ruff, RM, et. al. Alcohol Abuse and Alcohol Abuse and Neurological Outcome of the Severely Head Neurological Outcome of the Severely Head Injured.Injured. Journal of Head Trauma Journal of Head Trauma RehabilitationRehabilitation, 1990; 5 (3): 21-31, 1990; 5 (3): 21-31
ReferencesReferencesContinuedContinued
Miller, WR & Rollnick, S. (1991). Motivational Miller, WR & Rollnick, S. (1991). Motivational Interviewing: Preparing people to change Interviewing: Preparing people to change addictive behavior. New York: Guillford Press.addictive behavior. New York: Guillford Press.
Jones, GS. Jones, GS. Substance Abuse Treatment for Substance Abuse Treatment for Persons with Brain Injuries: Identifying Models Persons with Brain Injuries: Identifying Models and Modalities.and Modalities. NeuroRehabilitationNeuroRehabilitation, 1992; , 1992; 2(1): 27-342(1): 27-34
Langley, MH, Lindsay, WP, Lam, CS. Langley, MH, Lindsay, WP, Lam, CS. A A Comprehensive Alcohol Abuse Treatment Comprehensive Alcohol Abuse Treatment Programme for Persons with TBIProgramme for Persons with TBI. . Brain InjuryBrain Injury, , l990; 4(1): 77-86.l990; 4(1): 77-86.
ReferencesReferencesContinuedContinued
Corrigan, JD & Mysiw, WJ (2013). Corrigan, JD & Mysiw, WJ (2013). Substance Misuse Among Persons with Substance Misuse Among Persons with Traumatic Brain Injury.Traumatic Brain Injury. In: Brain Injury In: Brain Injury Medicine – Principles and Practices, 2Medicine – Principles and Practices, 2ndnd Ed. Ed. Zasler, Katz & Zafonte, Eds. Demos Medical Zasler, Katz & Zafonte, Eds. Demos Medical Publishers, New YorkPublishers, New York
DiClemente, CC. (2006). Addiction and DiClemente, CC. (2006). Addiction and Change: How Addictions Develop and Change: How Addictions Develop and Addicted People Recover. Guilford Press, Addicted People Recover. Guilford Press, New York.New York.
Duhigg, C. (2012). The Power of Habit. Duhigg, C. (2012). The Power of Habit. Random House, New York.Random House, New York.