Howard Jackson - substance abuse abi
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Howard Jackson - substance abuse abi

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Howard Jackson - substance abuse abi Howard Jackson - substance abuse abi Document Transcript

  • 24/09/2012 Alcohol and Brain Injury  People who use alcohol or other drugs after they have had a brain injury do not recover as much. Substance Abuse and  Brain injuries cause problems in balance, walking or talking that gets worse when a person uses alcohol or other drugs. Acquired Brain Injury  People who have had a brain injury often say or do things without thinking first, a problem that is made worse by using alcohol and other drugs. Dr Howard F Jackson  People who abuse alcohol render themselves more likely to encounter Consultant Clinical Neuropsychologist undesirable influences,  Brain Injury increases the vulnerability to further brain injury as a result of Founder and Clinical Director intoxication. TRU Ltd  Excessive intoxication may cause further brain injury Alcohol and ABI Alcohol and Brain Injury  Brain injuries cause problems with concentration, memory, social judgment, executive functioning, self-control, and emotional stability. Using alcohol or other drugs exacerbates these cognitive impairments. Alcohol use was found to be the main factor in getting into trouble with the law after ABI After brain injury, alcohol and other drugs have a more powerful effect. (Jackson, et al, 1992).   People who have had a brain injury are more likely to have times that they feel low or depressed and drinking alcohol and getting high on There are significant problems with supporting other drugs makes this worse in the long-term. individuals with ABI who are intoxicated. Police will often refuse to keep them until they are  After a brain injury, drinking alcohol or using other drugs can increase the likelihood of a seizure. sober and return to a unit with potentially vulnerable other residents is often untenable.  People who drink alcohol or use other drugs after a brain injury are more likely to have another brain injury. Alcohol and ABI Services Social Influences Within the unadapted home and community, the full impact of various deficits may be experienced for the Access to Brain Injury Services are often first time. Rather than deal with the emotional consequences of such awareness (e.g., depression, restricted due to Alcohol Abuse frustration and boredom) the individual may seek refuge in the bottle, especially if such a pattern existed in the past. Access to Substance Abuse Service are often restricted due to ABI. In sharp contrast to the rejection experienced in other social situations, members of the drug culture extend a warm and friendly welcome and cognitive and physical limitations are readily accepted. 1
  • 24/09/2012 Abuse of Other Substances Substance Abuse BLIPS Antidepressants,  BLIPS - Brief Limited Induced Psychosis Pain Killers,  Cannabis Hypnotics  Alcohol  Amphetamines Anticonvulsants  Cocaine  LSD, Psilocybin (Magic Mushrooms) Tobacco  Ecstacy Caffeine  Steriods? Incidence Mistaken Identity Out of 80 clients at TRU 16 of them present  Individuals with acquired brain injury are more with alcohol abuse as a core problem. Of these likely to present as intoxicated (eg slurred, slow 4 had poly-substance abuse. speech, incoherence. emotional lability, etc) Two others have core issues of substance abuse involving substances other than alcohol.  Individuals with acquired brain injury are likely to present with psychiatric symptoms (paranoia, Ponsford (2007) found 25.4% drinking at a delusions, etc), especially under the influence of hazardous level (australian study). Only 9% psychotropic substances – the Case of PD presented with other drug problems. Main abusers were young men. Different Responses to Alcohol Aggressive Response - Case of CM Treatment of Substance At Risk Response - Case of CH Abuse After ABI Passive Response – Case of JC A systemic rehabilitation approach Pleasant (Slightly embarrassing) response – Case of HJ 2
  • 24/09/2012 A Rehabilitation Programme for Substance Abuse after ABI 1. Engagement1 Engagement2 Detoxification Legal Issues (MHA, MCA, Court Order)3 Establishing Operations (an alternative ‘substance-free’ life-style) Motivational Issues4 Addressing Functional Value of Substance Abuse (and substituting) (Incentives, Insight, Commitment)5 Addressing False Attributions/Attitudes6 Helping the client take control (Relapse prevention) Engagement Motivational Interviewing  Short term effect without ongoing MI The Stages of Change Model  Insight or intention does not equate with behaviour (good in theory, bad in practice) STAGE 1: PRE-CONTEMPLATION  Slippage in the MI stages (episodic memory impairments) STAGE 2: CONTEMPLATION  Difficulty with reaching the contemplative stage due to impaired abstract thinking STAGE 3: PREPARATION STAGE 4: ACTION  Difficulty with preparation stage due to impairments in ability to plan. STAGE 5: MAINTENANCE  Difficulty with action stage due to initiative and memory problems.  Difficulty with maintenance due to executive dysfunction STAGE 6: LAPSE / RELAPSE  Resistance of Conceptual Attributions. A Rehabilitation Programme for Substance Abuse after ABI 2. DETOX1 Engagement  Higher risk of epilepsy/death2 Detoxification  Increased risk of delerium tremens3 Establishing Operations (an alternative ‘substance-free’ life-style)4 Addressing Functional Value of Substance Abuse (and  Idiosyncratic response to medication substituting)5 Addressing False Attributions/Attitudes  Increased behavioural problems with withdrawal6 Helping the client take control (Relapse prevention) 3
  • 24/09/2012 A Rehabilitation Programme for 3. Establishing Operations Substance Abuse after ABI1 Engagement  Developing a life-style without substance misuse:-2 Detoxification3 Establishing Operations (an alternative  Sleep/Wake Cycle ‘substance-free’ life-style)  Exercise and Healthy Diet4 Addressing Functional Value of Substance Abuse (and  Goal-orientated activity substituting)  Pain Management, etc  Self-structuring5 Addressing False Attributions/Attitudes6 Helping the client take control (Relapse prevention) A Rehabilitation Programme for 4. (Dys)functional Value of Substance Abuse after ABI Alcohol Misuse1 Engagement2 Detoxification  Initial function may change over time3 Establishing Operations (an alternative ‘substance-free’ life-style)  If the functional reasons for misusing are4 Addressing Functional Value of Substance not addressed then relapse or unhelpful Abuse (and substituting) substitutions are likely.5 Addressing False Attributions/Attitudes6 Helping the client take control (Relapse prevention) 4. Different Typologies of Alcohol 4. Functional Reasons For Abuse – Functional Value Abusing Other Drugs.  Impulsive Intoxication – Case of RM  They relieve my pain (cannabis)  Stimulus Bound Drinking – Case of AA  They help me sleep (cannabis, hypnotics)  Escalating Drinking - Case of NC  They keep me alert (amphetamines,  Suggestible Drinking – Case of CH proplus)  Encouraged Drinking – Cases of JC & KW  They keep me calm and chilled (cannabis)  Social Anxiety Drinking – Case of JSS  They give me confidence (cocaine)  Addicted Drinking – Cases of KW & BW  They help me stay in control (cocaine)  Bored Drinking – Case of JE 4
  • 24/09/2012 A Rehabilitation Programme for 5. False Attributions/Attitudes Substance Abuse after ABI1 Engagement  I can’t get drunk since my ABI2 Detoxification3 Establishing Operations (an alternative ‘substance-free’  It improves my social functioning life-style)4 Addressing Functional Value of Substance Abuse (and  It calms me down substituting)5 Addressing False Attributions/Attitudes  Being normal is getting drunk/stoned6 Helping the client take control (Relapse prevention) 5. False Attributions/Attitudes A Rehabilitation Programme for Substance Abuse after ABI 1 Engagement  Rational Self Analysis (and other CBT 2 Detoxification Approaches) – Adapted for ABI 3 Establishing Operations (an alternative ‘substance-free’ life-style)  Peer pressure discussion groups (EQUIP) 4 Addressing Functional Value of Substance Abuse (and substituting)  Education (Direct, Implicit) 5 Addressing False Attributions/Attitudes 6 Helping the client take control (Relapse prevention) 6. Helping the client take control 6. Contingent Pathways to Self- (Relapse prevention) Management1 Establishing and Maintaining Commitments (WRAP).  No-alcohol contact – non-alcohol related settings2 Identifying Triggers and developing risk assessment  No alcohol contact – alcohol related settings and management.  Planned/Controlled alcohol contact – alcohol3 Coping strategies (Neuropsychological : self- related settings with supervision structuring, problem solving, risk evaluation)  Planned Controlled alcohol contact – alcohol4 Systematic and Contingent Exposure and related settings without supervision Desensitisation (De-conditioning) 5
  • 24/09/2012 General Guidance Substance Abuse and ABI Educate client and family about the risks of clients with Brain Injuries using substances. Knowledge is not the sole answer - Engage family/social network in actively supporting the client to address the issue.  Most interventions for substance abuse Take a history of client’s prior and current use. Be specific — ask, “What’s the most you’ve used? The least?” involve educational or self-exploration approaches as the primary therapeutic Ask client about his/her family history of Substance Use. Ask what effect use is having on client’s life (social, family, job, legal). approach. Gain an understanding of the Model for Change . It may help you move your client through the stages.  Most interventions fail to address habitual behaviours directly. Practical Help Assess stressors and risk factors that might cause client to begin/maintain using (isolation, boredom, depression, job loss, etc). Help client find meaningful substance-free activities. Provide support for behavioural changes before, during and after the Substance Abuse program to build motivation and reinforce new behaviours. Establish ongoing contact with professionals in Substance Abuse programs to exchange information and make sure the Substance Abuse program is meeting the client’s needs. Refer for Specialist ABI substance abuse rehabilitation 6