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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
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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
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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”.
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Traumatic and Non Traumatic
A brain injury can occur from:
A traumatic event
Non traumatic event
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Trauma All brain injuries are traumatic to the person
who sustained the injury Trauma is often experienced:Physically
Mentally
Emotionally
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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.
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Fiction All brain injuries are
alike
Fact – No two brain injuries are alike
ABI Facts and Fiction
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Fiction All brain injuries heal
with time
Fact Many times the
damage to the brain is permanent
ABI Facts and Fiction
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Fiction When one
physically recovers the brain has healed itself
Fact Person may look
fine but cognitive dysfunctions are compromised
ABI Facts and Fiction
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ABI – The Invisible Disability
In many cases the injuries are invisible and the person suffers in silence
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Brain Injuries Often Go:
Undiagnosed
Misdiagnosed
Misunderstood
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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
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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
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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.
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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
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Takes information from other parts of the brain
Formulates responses
Frontal Lobe – (Executive)
Function of the Lobes
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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
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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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