Emotional Issues Associated with BI
Substance Abuse and Brain Injury
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Substance abuse is more prevalent among persons with disabilities than society in general[i] yet research and treatment specific to this segment of the population has been minimal. Among disability groups with unique issues of substance abuse are those individuals who have experienced traumatic brain injury (TBI). There has always been acknowledgment of the relationship between intoxication and injury but only more recently has attention been given to the mediating effects of substance abuse on rehabilitation outcomes following TBI. Clinicians and researchers have repeatedly observed that cognitive and emotional impairments caused by brain injury present unique problems when addressing co-existing substance abuse problems.
Young adult males are among the highest risk groups, with most injuries occurring as the result of moving vehicle crashes. Alcohol is a major contributor to the occurrence of injuries. Equally troubling is the proportion of adolescents and adults hospitalized for TBI who have pre-injury substance use disorders. Among patients receiving acute medical rehabilitation, as many as two-thirds have evidence of premorbid substance use disorders. A longitudinal study underway at Ohio State University found 58% of the consecutive sample of 350 patients admitted to the Brain Injury Unit had prior histories of substance use disorders using DSM-III-R criteria.
There is growing evidence that persons with TBI and substance abuse problems have significantly worse problems than persons with TBI alone. Among patients with the most severe brain injuries, alcohol or other drug consumption declines in the immediate post-injury period; however, many people tend to return to pre-injury levels of use by two years post-injury. Approximately 20% of persons who abstained or were light drinkers pre-injury, become high volume users after]. Persons with traumatic brain injury and substance abuse problems are less likely to be working and have lower life satisfaction.
Persons with TBI face several challenges when seeking treatment from substance abuse providers. Cognitive impairments may affect a person's learning style, making participation in didactic training and group interventions more difficult. Misinterpretation of memory problems as resistance to treatment can undermine a treatment relationship. Damage to the frontal lobes affects executive thinking skills and promotes socially inappropriate behavior. Environmental cues may not be perceived, creating consternation for fellow clients and staff. It is easy to interpret these behaviors as intentionally disruptive, particularly when the individual with a brain injury shows no visible signs of disability.
Dr. Corrigan is a Professor and Director of the Division of Rehabilitation Psychology in the Department of Physical Medicine and Rehabilitation at Ohio State University. Dr. Corrigan is the founder and director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. He also directs the TBI Network, a community-based treatment program for substance abuse after brain injury. Dr. Corrigan has served on the board of directors of the Brain Injury Association of America and the Commission on Accreditation of Rehabilitation Facilities (CARF). He serves on the Advisory Committee on Injury Prevention and Control at the Centers for Disease Control and Prevention. Dr. Corrigan is board certified in Rehabilitation Psychology and is a Fellow of the American Psychological Association, as well as the American Congress of Rehabilitation Medicine. In 2001 he received the William Fields Caveness Award from the Brain Injury Association of America for lifetime research contributions to the quality of life of persons with brain injury.
Gary L. Lamb-Hart, M.Div., CCDC III, ICADC, is the Center Manager for the Ohio Valley Center for Brain Injury Prevention and Rehabilitation at Ohio State University. He is also a Team Leader for the Center’s efforts in substance abuse prevention and education following brain injury. He makes presentations to a wide range of professionals, survivors and family members about the issues of substance abuse and brain injury throughout the United States and has co-authored several articles, a book chapter and materials on this subject. He has a Bachelor of Science degree in Social Science from Northern Arizona University, Flagstaff, Arizona and a Master of Divinity degree from the Iliff School of Theology, Denver, Colorado.
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