A CHOICES Substance Abuse Program for Adults with Acquired Brain Injury

Transcription

1 A CHOICES Substance Abuse Program for Adults with Acquired Brain Injury BISH Conference February, 2012 Dr. Bruce Linder, Psychologist, Pryor, Linder & Associates Adjunct Assistant Professor, McMaster University Clinical Director Brain Injury Services of Hamilton

2 Presentation

3 Non-Medical Approaches & Treatments for SA that work for non-tbi individuals

4 Does substance abuse nonmedical-treatment work in TBI 3 strong studies: Case Management Financial Incentives Removing barriers Motivational Counselling

5 Ohio TBI Network Dr. John Corrigan, Psychologist Community-based Interdisciplinary team Holistic Case Management Community & family involvement Use community services Low cost

6 TBI Network Case Management Bogner et al (1997) 72 clients

7 Financial Incentive & Barrier Reduction Corrigan & Bogner (2007) (1 phone call)

8 Motivational Counselling Cox et al (2003) 12 sessions

9 Limited research on CBTGroups

10 Choices Dr. Lynn Lightfoot -Psychologist Correctional Services Canada

11 ABI CHOICES PROGRAM Small group 7 participants 3 group facilitators Dr. Linder, Sue Brophy, Case Facilitator, Christine DeVries, Program Supervisor 30 sessions over 7 months November, 1999 July, hour sessions with 15 break Group Services Room at BISH

12 Session Structure

13 Session Process

14 Weekly Drug Use Survey Name: Date: How often did you use each drug over the last 7 days? /more time times times Type of Drug None Time Times / day / day / day 1. Alcohol. 2. Inhalants (glue, spray paint, toluene, liquid paper, etc.) 3. Marijuana / Hashish.. 4. Hallucinogens/LSD/ Psychedelics/PCP/ mushrooms/peyote. 5. Crack/ Freebase. 6. Cocaine (by itself).. 7. Heroin and Cocaine (mixed together)..

15 Non-Medical Approaches & Treatments for SA

16 Cognitive Behaviour Therapy (CBT): A Program Philosophy

17 CHOICES

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19 SUBI Dr. Carol Lemsky Dr. John Corrigan

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21 Curriculum Overview

22 Drug Education

23 Drug Education

24 Goal-Setting Weighing Consequence

25 Physical Short Term Long Term Positive Negative Positive Negative Social Short Term Long Term Positive Negative Positive Negative Psychological Short Term Long Term Positive Negative Positive Negative

26 PERSONAL COST BENEFIT EXERCISE Pro s Con s What Drugs Do For Me How Drugs Harm Me & Others

27 Drugstore Cowboy (1977)

28 Goal Setting Abstinence is not required

29 Behaviour Change

30 Cognitive Coping

31 Problem Solving

32 Slip vs Relapse

33 5 High Risk Situations

34 Coping with High Risk Situations

35 Coping with cravings

36 Develop written individual plan for slip management and relapse prevention

37 Modifications for ABI Clients (partially based on Dennis James et al, Brain Injury and Substance Abuse: The Cross Training Advantage Many more sessions Slow down sessions Simplify language Information in small bites Repeat information using short, simple phrases Hand outs (binder)

38 Modifications for ABI Clients (partially based on Dennis James et al, Brain Injury and Substance Abuse: The Cross Training Advantage Anticipate off-topic remarks Keep instruction brief and clear Get feedback Do you understand? Summarize ideas and points often Redirect off topic, excessive talk, and inappropriate behaviour

39 Does it work?

40 7 Group Participants

41 Paul 40 yrs. old, single, son, employed part-time, living on own TBI due to assault, right cerebral damage Alcohol abuse, heavy codeine use, several community drug programs.

42 Mel 35 yrs. old, single, living on own, unemployed multiple MVA s, closed head injury premorbid history of minor criminal offenses heavy marijuana use.

43 Seth 35 yrs. old, single, son, unemployed, living on own, MVA, cerebellar and brain stem damage, motor problems, regular alcohol use, past AA, NA, and Alternatives for Youth involvement.

44 Richard 56 yrs. old, single, child, MVA alcohol related, depression, somatization sleep medication dependency.

45 Jill 57 yrs. old, deceased husband, no children, unemployed, apartment program, ABI due to stroke chronic depression, heavy alcohol and cocaine use, past inpatient drug treatment

46 Len 38 yrs. old, apartment program, single, unemployed MVA alcohol related, episodic depression infrequent but intense alcohol episodes.

47 Ben 55 yr. old, divorced, one child, living alone, unemployed, TBI due to fall cocaine related past heavy cocaine use.

48 Measures of Alcohol & Drug Use

49 Client Substance Use Profiles Severe Moderate Low None Missing

50 Triggers for Alcohol Use -IDTS Jill Mel Ben Emotions/Physical Social (-) Emot P.Discom (+) Emot Testing Urges Conflict Pressure Pleasant NO DATA X Seth X X X X X X Paul X Len X X X X X X Richard NA

51 Triggers for Drug Use -IDTS Emotions/Physical Social (-) Emot P.Discom (+) Emot Testing Urges Conflict Pressure Pleasant Jill X X X X X X Mel NO DATA Ben X X X X Seth X X X X Paul X X X X X Len Richard X X X X X X X

52 Results -Participation 5 of the 7 completed the program Mel dropped out after 9 sessions Lack of insight regarding negative consequences of marijuana use Rigid, perseverative, angry, paranoid belief system around money and illegality of marijuana use Ben dropped out after 17 sessions Felt group wasn t needed

53 Results -Participation % of Sessions Attended Mel 30% Seth 97% Len 93% Ben 57% Paul 100% Richard 93% Jill 100% Mean 81%

54 Total Weekly Use at Beginning and End of Program, Attendance, and Knowledge Average Attendance = 81% Average % Correct on KT = 69%

55 Weekly Drug Use -Seth Se th 5 A lco h o l M ar iju an a Oth e r 4 W eekly U se Se s s io n 81% Average Reduction 0 = None 3 = 1/Day 1 = 1 time 4 = 2-3/Day 2 = 2-6 times 5 = 3/Day

56 Weekly Drug Use -Richard Richard Weekly Use Sleep Meds Session 71% Average Reduction 0 = None 3 = 1/Day 1 = 1 time 4 = 2-3/Day 2 = 2-6 times 5 = 3/Day

57 Weekly Drug Use -Mel Mel Marijuana Cocaine Other 5 4 Weekly Use Session 0 = None 3 = 1/Day 1 = 1 time 4 = 2-3/Day 2 = 2-6 times 5 = 3/Day

58 Weekly Drug Use -Ben Ben Alcohol Marijuana Libruim Other Weekly Use Session 0 = None 3 = 1/Day 1 = 1 time 4 = 2-3/Day 2 = 2-6 times 5 = 3/Day

59 Weekly Drug Use -Len Len Alcohol Weekly Use Session 0 = None 3 = 1/Day 1 = 1 time 4 = 2-3/Day 2 = 2-6 times 5 = 3/Day

60 Weekly Drug Use -Paul P a ul W eekly U se A lco h o l L ib r iu m Oth e r Se s s io n Other 20% Decrease; Librium 0% Alcohol 650% Increase 0 = None 3 = 1/Day 1 = 1 time 4 = 2-3/Day 2 = 2-6 times 5 = 3/Day

61 Hypothesis: Correlation between program knowledge & use

62 No correlation between knowledge levels and change in weekly use.

63 Client Satisfaction with Information (134 Sessions)

64 Long Term Follow-Up years after group

65 Seth Prolonged relapse for several years during and after breakup of live-in relationship Recovered from relapse with renewed support.

66 Weekly Drug Use 1999 & 2007-Seth S e th Alc ohol M a rijua na Othe r Weekly Use / S e s s ion 81% Average Reduction, but relapsed

67 Paul Only periodic use No major relapses Still uses prescribed Librium Unemployed; living independently.

68 Weekly Drug Use 1999 & 2007-Paul W eekly U se P a ul A lco h o l L ib r iu m Oth e r /

69 2007 Follow-up 7 years after Group Richard Maintained reduced sleep med usage for several years; major relapse; dementia; fully supervised living. Len-significant relapse 5 years after group; left service against advice. Ben Maintained levels for several years; maintains successful fully independent living.

70 2007 Follow-up 7 years after Group Mel No change in significant drug use. Jill Maintained drug free for several years with infrequent slips; discharged to fully independent living; sporadic, mild alcohol use.

71 Conclusions CHOICES program can be adapted successfully for ABI population Drop-out rate 15 30% 50% show positive results during and after the group but require intensive support. Slips and full relapses in most cases

72 Recommendations

73 Future Research

74 Questions?

75 The End BISH Conference February, 2012 Dr. Bruce Linder, Psychologist, Pryor, Linder & Associates Adjunct Assistant Professor, McMaster University Clinical Director Brain Injury Services of Hamilton