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Bob Hogan, MS, Program Development Specialist, NeuroRestorative Florida
Sobering Thoughts about TBI and Substance Abuse
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Scope of the problem…TBI
• 1.6 million a year • 3.1 million now living with a TBI • 20% of our 1.8 million soldiers who
recently served have sustained a TBI • Untold others who suffered “shell
shock” in previous wars
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Direct costs and indirect costs such as lost productivity resulting from a TBI totaled an estimated $76.5 billion a year. Lifetime cost Severe > $3 million+ Moderate > $1 million+ National Centers for Disease Control
Costs
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Whatever the cost is each year:
*13% is for new injuries *25% for ongoing care *63% is related to costs such as lost productivity
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Scope of the problem…Substance abuse
• 120, 000 users of “hard” drugs in the US: – 51,000 Opioids – 4,300 Cocaine – 3,800 Amphetamines
• Deaths from drug use 43,982 (CDC 2013) • 16.6 million adults • Alcohol related deaths 88,000 (NIH 2013) • Cannabis…0 reported deaths (CDC 2013)
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Costs
The National Institutes on Drug Abuse estimates the yearly cost of substance abuse in the US at: $480,000,000,000 a year!
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So let’s consider: • The identified survivor • The prison population • The homeless • The military • Wow! Who else?
TBI/Substance Abuse
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Definition…Brain Injury Association
“TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force.” biausa.org 2010 (Adding mind-altering substances to an already altered brain…just can’t be a good thing)
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Inmates and TBI
• In various studies of prison populations anywhere from 25% to 87% of inmates reported at least one previous TBI
• In a study of 13 adolescents residing on death row in US prisons, only one common factor was revealed… all had some history of TBI!
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Women in prison
• One study looked at women incarcerated for violent crime and found them more likely to have suffered a brain injury from domestic abuse prior to their crime.
• 90% of all injuries caused by domestic violence involve the neck and head
• 48 – 87% are substance abuse related
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Homeless
• It is estimated that nearly half of all individuals experiencing homelessness, and 70% of Veterans experiencing homelessness, suffer from substance abuse issues.
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Long-term Costs
“In studies of survivors who were several years post injury, many were depressed, placing a significant burden on caregivers…usually the family. The rate of suicide was higher than the national average.” Of the 700,000 returning vets currently in the VA system, at least 1 in 5 are depressed.
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Wounded Warriors
• New screening-old problem • Mild brain injuries from concussive
events…360,000 at last count… • 45-90,000 needing long term care Just the tip of the iceberg (over 25,000 in 2014)
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Military Use and Abuse
• 1 in 4 soldiers now admit that they have a substance abuse problem • Prescription drug abuse doubled by 2005 and then tripled by 2010 • 6 months after deployment 27% meet criteria for alcohol abuse • Alcohol is related to more than 30% of all suicides and 45% of
attempted suicides
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“If you deal with brain injuries…you deal with behavior.” Now add alcohol to the mix…
Old saying…
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Skull – Brain Protection (our helmet)
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Auto accident, motorcycle, bicycle, fall, explosion, football
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Followed by Swelling
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Skull—Brain protection
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Location of increased damage due to swelling
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Frontal area
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Most common part of the brain to get hurt is…?
Frontal Lobes!
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What’s the big deal about the frontal lobes?
Your frontal lobes are the boss of you…!!!
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What’s the big deal about frontal lobes?
I have described them as the: Boss Case Manager Air traffic “control center” The Conductor Elegance out of chaos
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The frontal lobes…Just add alcohol (control?)
Bill at work Bill at Christmas party
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Frontal Lobes and Alcohol (lost control?)
Bill at work Bill after the party
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Talk about control!...What if a mild TBI takes control away?
70% of all TBI’s are considered “mild”…Ask someone who’s life has been turned upside down by a “mild brain injury” and they will tell you there is nothing mild about it!
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Common symptoms: • Attention/Concentration • Short term memory • Slowed thinking • Poor organization skills • Disconnected—”Foggy” • Fatigue—physical and cognitive • Lack of initiation and apathy • Anger/frustration and aggressive behavior • Paranoia/Anxiety—fear of going crazy • Substance abuse • Sleep disturbance • Poor self esteem • Headaches, back and neck pain • Sensory issues—vision/hearing
Common Consequences of MBI
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Secondary Consequences
Unanticipated consequences of the injury that was… “just a bump on the head” or “had his bell rung” • Unable to return to work, or active duty • Try to return to work or active duty, but fail • Family, friends, peers and medical professionals do not
understand • You look the same, but are the not same • Normal relationships deteriorate… • Increased isolation and substance use
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Secondary Consequences
• Increasing disconnect from your “normal” • Pain, anxiety, etc. often equal increase in medications • Medications often equal further decrease in cognitive function • “Patient” “Wounded Warrior” status slowly replaces “worker,”
“soldier,” “father,” “husband,” “friend,” “comrade” • Increasing frustration—more disconnect
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Secondary Consequences
• Increasing loss of sense of self, spirit, heart, character, purpose • Increased need to mask symptoms of depression or PTSD • Increased likelihood of turning to drugs and alcohol to deal with
all of the above…
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Mild TBI…But…
• It was just a bump, a bang, or a thud! • I was up and walking in no time! • Nothing broken!...no limbs lost!
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But look at me! My world is falling apart.
What just happened to me?
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What happened to me? It was only a bump…or a boom!
Day Of
injury
Recovery Timeline
Sense of Self
Symptoms
Neuro Damage
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Common Consequences of MBI
Common Symptoms • Attention/Concentration • Short term memory • Slowed thinking • Poor organization skills • Disconnected— “foggy” • Fatigue—physical and cognitive • Lack of initiation and apathy • Anger/Frustration and aggressive behavior • Paranoia/Anxiety—fear of going crazt • Substance abuse • Sleep disturbance • Poor self esteem • Headaches, back and neck pain • Sensory issues—vision/hearing
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Common Symptoms
Mild Brain Injury • Attention/concentration • Short term memory • Slowed thinking • Poor organization skills • Lack of frustration tolerance • Disconnected— “foggy” • Fatigue—physical/cognitive • Lack of initiation and apathy • Substance abuse • Paranoia/Anxiety—going crazy? • Sleep disturbance • Poor self esteem • Headache • Back and neck pain • Sensory issues
Depression • Attention/Concentration • Short term memory • Slowed thinking • Poor organization skills • Lack of frustration tolerance • Disconnected • Lack of initiation and apathy • Fatigue—physical/cognitive • Substance abuse • Am I crazy? • Sleep disturbance • Poor self esteem • Confusion • Exaggeration of symptom
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What happened to me? It was only a bump…or a boom!
Depression
Recovery timeline
Day of
injury
Sense of Self
Symptoms
Neuro Damage
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Declining Mental Health…Costs Us a Bundle…
“The presence of a psychiatric illness was associated with more than doubling the cost for both inpatient and outpatient non-mental healthcare.” Journal of NeuroTrauma Jan. 2012
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Health Costs
Negative emotions (unhappiness, boredom, loneliness, helplessness, depression) are strongly linked to diseases such as: • Heart disease • Cancer • Auto Immune Diseases • Ulcers • Arthritis • Alcoholism
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Family crisis and our disappearing support system
Family crisis often provides the opportunity to move either toward greater family cohesion and mental health…or family deterioration and emotional decay.
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Family trauma – Human cost 20 year study
2-6 months – most friends 1-2 years – siblings 1-5 year – Dad or Spouse 8-10 years – only Mom
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Ongoing Risks
It is gratifying to note that most survivors refrain from drinking for the first year following a traumatic brain injury
However, half of those folks who used alcohol prior to a brain injury return to drinking by year two…
And 20% of survivors who never drank begin to use alcohol as well
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Take Control…get informed
Alcohol adversely affects: • Our control center (frontal lobes) • Our brain’s ability to recover and heal • Our physical and cognitive problems • Our likelihood of seizures • Our likelihood of re-injury • Our emotional health (depression) • Our likelihood of incarceration
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Take control…get help!
Treatment options: • Specialty TBI/substance abuse programs
– (treatment facility locator…http://dasis3.samhsa.gov/) • Cognitive/Behavioral therapy
– (may incorporate Stages of Change Model) • Adapted Mindful Meditation Program
– (MBSR Mindfulness-Based Stress Reduction Programs)
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Take control…get help!
12 Step Programs • Seek treatment early • Changes your peer group • Changes your environment • Uses reliance or a “higher power” • Research local groups, seek advise from local rehabilitation
providers and professionals • Have a partner or companion to go with you • Seek out a sponsor
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Take control…get help!
• Prepare for the “gap” between programs for substance abuse and programs for TBI.
• Some TBI programs don’t allow for substance use and demand abstinence…or discharge.
• Some substance abuse programs won’t admit folks with TBI complications like occasional relapse or ongoing behavioral issues…or discharge!
• Look at…www.rethinkdrinking.niaaa.nih.gov take the test and think about it
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What to look for in TBI program strategies
• A robust and program wide understanding of the functioning of the brain and brain/behavior relationships and substances
• Cognitive/Behavioral counseling and therapy • A host of memory and organizational strategies (smart phone, Ipad,
Day-Planner/Org, GPS etc. • Augmentative, adaptive and compensatory strategies for long term
success • Activity…Activity…Activity…Physicality!
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Program strateiges:
• Physical activity (light aerobics, light strength training, tai chi, yoga, walking…with as many people as possible!)
• Anger mgt. strategies • Stress mgt. (mindful meditation, deep relaxation, visual imagery) • Pain mgt. (exercise, myofacial, cranial-sacral, massage, etc.) • Medication mgt. (reduction where appropriate) • When appropriate…12 Step programs
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Preconceived Notions…Attitudes?
For Adults Only!
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Preconceived Notions…Attitudes?
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Preconceived Notions…Attitudes?
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Preconceived Notions…Attitudes?
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CNN Documentary
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Preconceived Notions…Attitudes?
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As of August 2015 Medical use of cannabis is legal in:
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• Colorado • California • Arizona • Connecticut • Alaska • Delaware • Illinois • Hawaii • Massachusetts • New Jersey • Michigan • Vermont • Rhode Island • New Mexico • Washington State & DC
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Effective for:
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• Seizures (Charlotte’s Web) • Nerve Pain • Glaucoma • Multiple Sclerosis • Nausea from Chemotherapy • What else…?
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Addiction Potential?
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In the US…1 overdose every 19 minutes from prescription drugs 0 cases of pot overdose reported Not everyone is in favor…Chris Christie, President Obama, Jeb Bush, Institutes for Health Addiction potential…medical risks and benefits
Needs more research
(Caution ! …$$)
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In summary... For your own good…
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• Get education for all involved • Get in control of your life • Get moving!...Physicality! Ideal treatment for Pain, Depression, substance abuse, anxiety…Etc.
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Substance abuse resources and information websites
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• Drugabuse.gov • Samhsa.gov • Drugfree.org • Dpri.com • Drugpreventionresource.org • Drugfreeworl.org
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Mild Brain Injury resources and information
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• National Institute of Health (NIH) • Center for Disease Control (CDC) • The Brain Injury Association (BIAUSA) • North American Brain Injury Society (NABIS) • National Institute of Neurological Disorders and Stroke
(NINDS)
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Websites & Contacts
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• Cdc.gov • Hrsa.gov • Nashia.org • Ed.gov • Edenalt.org • Tbindsc.org • Nih.gov • Brainline.org • Headinjury.com • NeuroRestorative.com • Biausa.org • Bobthogan@[email protected] • Pdhealth.mil/nl_signup.asp
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Questions?