Ruth WilcockExecutive Director

Addictions and Brain Injury

Completing the Picture

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To enhance the lives of Ontarians living with the effects of ABI through education, awareness and support

Mission of OBIA

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6 continuing education courses

Over 6000professionals have completed our courses

Education – In collaboration with Brock University

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Brain Basics

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OBIA Support Services

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1-800-263-5404

Income Support Programs ODSP (Ontario Disability Support Program) CPP (Canada Pension Plan) WSIB (Workers Safety Insurance Board) Disability Tax Credits

OBIA Services - Personal Advocacy

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Access to Services

Quality of Care and Services

General Information

Personal Advocacy (Con’t)

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21 Affiliated Community Associations across the Province

Provide: Information Support Prevention

Provincial Network

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Addictions and Brain Injury

Completing the Picture

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1. What is Brain Injury

2. Addiction and Substance Abuse

3. Relationship Between Brain Injury and Substance Use/Abuse

4. What You Can Do

Outline

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A Fragmented View

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Complex Issues

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ADDICTION

BRAIN INJURY

What is Acquired Brain Injury?

Definition:

“Damage to the brain that occurs after birth and is not related to a congenital disorder or a degenerative disease such as Cerebral Palsy Alzheimer’s disease or Parkinson’s disease”.

Traumatic and Non Traumatic

A brain injury can occur from:

A traumatic event

Non traumatic event

Trauma All brain injuries are traumatic to the person

who sustained the injury Trauma is often experienced:Physically

Mentally

Emotionally

Prevalence of Brain Injury

There are almost a half a million people living in Ontario with a brain injury

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Incidence of Brain Injury

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Brain injury is the number one cause of death and disability for Canadians under the age of 45.

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The cost of ABI is measured in the hundreds of millions of dollars for medical care, rehabilitation and life long supports.

Cost of ABI

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The cost in terms of human suffering and lost potential is immeasurable.

Fiction All brain injuries are

alike

Fact – No two brain injuries are alike

ABI Facts and Fiction

Fiction All brain injuries heal

with time

Fact Many times the

damage to the brain is permanent

ABI Facts and Fiction

Fiction When one

physically recovers the brain has healed itself

Fact Person may look

fine but cognitive dysfunctions are compromised

ABI Facts and Fiction

ABI – The Invisible Disability

In many cases the injuries are invisible and the person suffers in silence

Brain Injuries Often Go:

Undiagnosed

Misdiagnosed

Misunderstood

Brain Injury and Homelessness

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Source: S.W. Hwang, A. Colantonio, S. Chiu, G. Tolomiczenko, A. Kiss, L. Cowan, D.A. Redelmeier, & W. Levinson

53% of homeless people in Toronto have a history of brain injury.

Of the 53% of people who have a history of brain injury 70% sustained a brain injury prior to becoming homeless

It is estimated that the prevalence rates for co-morbid psychiatric disorders in ABI may be as high as 44%.

Brain Injury and Mental Health

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Arrests and Brain Injury

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US study found that 2% of general population arrested annually

31% of brain injury survivors (5 years post injury)had one or more arrests

Brain Injury and Prison Population

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44% of people in our Ontario prison system have a history of brain injury

86% of prison inmates in New Zealand 87% of county jail inmates in Washington In a sample of 15 convicted murderers

sentenced to death, Lewis and colleagues (1986) found that 100% of this death row sample had a history of severe head injury.

The brain controls virtually everything humans experience, including:Movement

Sensing our environment

Regulating our involuntary body processes such as breathing

The Brain Controls Everything

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Lobes of the Cerebral Cortex

Takes information from other parts of the brain

Formulates responses

Frontal Lobe – (Executive)Function of the Lobes

Cognition and memory Ability to concentrate “Gatekeeper” on behaviour

(judgment and inhibition) Personality and emotional traits Movement Sense of smell Taste Planning, sequencing and organizing Self-awareness Word formation

Frontal Lobe

The Stigma and Tragedy of Addiction

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Any repeated behaviours, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on her/his life and the lives of others"

Definition of Addiction

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Compulsive engagement with the behaviour and a preoccupation with it

Impaired control over the behaviour Persistence or relapse, despite evidence of

harm Dissatisfaction, irritability or intense craving

when the object- drug or other activity is not immediately available

Addiction Involves:

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One-third of ABI survivors have a history of substance abuse prior to their injury

One third of incidents that cause brain injury are drug or alcohol related

20% of survivors who do not have a history of substance abuse problem become vulnerable to an abuse problem

Substance Abuse and Brain Injury

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As much as 43% of people with brain injuries can be classified as moderate to heavy drinkers

Substance abuse is reduces immediately following injury but often returns to pre-injury levels within two to five years post-discharge

Half of people with ABI and substance use problems have parents with substance use problems

Quick Facts

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Alcohol 72%

Cannabis 13%

Crack and Cocaine 10%

Sedatives 2%

Heroin 1%

Other 2% *Ohio Valley Center for Brain Injury

Drugs of Choice Include:

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Existing Problem with Substance Abuse

Withdrawal:

Physical withdrawal

Psychological withdrawal

Issues pre-injury not addressed

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Nearly all addictive drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine

Cocaine reduces dopamine receptors

Can take months/years for receptor numbers in the brain to return to pre-drug use figures

The Role of Dopamine

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Alcohol or illicit drugs were used before the injury

Drug and alcohol use can develop after a brain injury

Tolerance levels of substances are decreased

Social groups change

Relationship of Substance Use to Brain Injury

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Some reasons for substance misuse and abuse can be:

A result of chronic pain Cognitive problems Reduced ability to cope with life's new

challenges. Impaired insight Lack of self awareness Not understanding the consequences

A Vulnerable Population

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Diminished volume of grey matter

Show impaired functions of the pre-frontal cortex

The Brain on Drugs

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Impedes recovery

Exacerbates problems with balance, walking and talking

Increased disinhibition

Interferes with cognitive skills and processing

Why Substance Use After Brain Injury is a Bad Idea

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Alcohol increases depression because it is a depressant drug

Interaction with prescribed medications

Increased risk of another injury*Ohio Valley Center for Brain Injury Prevention and Rehabilitation

Other Considerations

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Service Providers are trained to identify and treat either brain injury or substance abuse, not both

Lack of insight by the survivor to the seriousness of the problem

Many substance abuse programs do not take clients who are identified as having a brain injury

Symptoms of brain injury and substance abuse can presentin similar ways and include:

Why Substance Users Fall Through the Cracks

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Memory problems Difficulty concentrating Balance and co-ordination Impulsivity Mood swings (diminished emotional control) Personality changes Diminished judgement Fatigue Anxiety and or Depression Sleep problems Decreased frustration tolerance

Symptoms Common to Brain Injury and Substance Abuse

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Many addiction programs are based on behaviour modification which will not work with a survivor with certain impairments

Lack of motivation

Why Substance Users Fall Through the Cracks

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Have you ever had a concussions? Multiple concussions? (sports related or other)

Have you ever been involved in a motor vehicle collisions

Have you ever had a stroke? Have you ever had fall and hit your head? Have you ever had a blow to the head? Have you ever had periods of unconsciousness? Have you ever been hospitalized? Be specific.

When? How many times?

What You Can Do – Ask Questions

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Know what brain injury is and the consequences of brain injury

Knowledge and understanding of brain injury will change your approach and how you work with and problem solve with your client who has a brain injury

What You Can Do – Educate Yourself About Brain Injury

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Educate the client early and often about the problems of alcohol and other drugs after brain injury

Provide information and support

Educate the family about the risks of clients with brain injuries using substances

What You Can Do

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Engage family/social network in actively supporting the client to address the issue.

Take a history of client’s prior and current use Ask what effect use is having on client’s life Ask about the social context of use Ask about family’s history of use and/or abuse Help client find meaningful substance-free

activities. Establish ongoing contact with professionals in

substance abuse programs

What You Can Do (con’t)

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Stage One – Denial

Unaware problem exists

No intention of changing

Resistant to any type of intervention

Five Stages of Change In Substance Use

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Stage Two – Contemplation

Beginning to become aware

Weigh’s pro’s and con’s

Still ambivalent

Five Stages of Change in Substance Use

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Stage Three – Preparing for Change

Major turning point

Begins to recognize potential losses

Reduce amount they are using

Five Stages of Change In Substance Use

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Stage Four – Action

Make significant changes

Alter their environment

Five Stages of Change In Substance Use

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Stage Five – Maintenance

Successful at avoiding triggers

Has coping skills in place

Has a solid support system

Five Stages of Change In Substance Use

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Make the substance abuse provider aware of: The survivors person's unique communication and

learning styles and deficits Known and specific triggers such as over

stimulation, fatigue, noise, bright lights Disinhibition problems due to a frontal lobe injury

and encourage specific feedback regarding inappropriate behaviour

Lack of motivation may be due to cognitive impairments.

Tips to Give Professionals

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Referral to treatment settings include: Detoxification programs Residential treatment Intensive Outpatient Care Counselling Self-help groups 12 step programs Psychotherapy Substance Use Brain Injury Bridging Project www.subi.ca

Further Interventions

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Dealing with the client where they are at

Reduce risks associated with substance use

Increase’s persons sense of control and personal choice

Opens up options Move out of a state of

chaos into control

Harm Reduction

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Assists in dealing with root issues of the addiction

Need to embrace the person as a whole including pre-injury

Psychotherapeutic Interventions

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Thank You!

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www.obia.ca1-800-263-5404