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Ruth Wilcock Executive Director Addictions and Brain Injury Completing the Picture 1.

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Presentation on theme: "Ruth Wilcock Executive Director Addictions and Brain Injury Completing the Picture 1."— Presentation transcript:

1 Ruth Wilcock Executive Director Addictions and Brain Injury Completing the Picture 1

2  To enhance the lives of Ontarians living with the effects of ABI through education, awareness and support 2

3  6 continuing education courses  Over 6000professionals have completed our courses 3

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6  Income Support Programs  ODSP (Ontario Disability Support Program)  CPP (Canada Pension Plan)  WSIB (Workers Safety Insurance Board)  Disability Tax Credits 6

7  Access to Services  Quality of Care and Services  General Information 7

8  21 Affiliated Community Associations across the Province  Provide: Information Support Prevention 8

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11  1. What is Brain Injury  2. Addiction and Substance Abuse  3. Relationship Between Brain Injury and Substance Use/Abuse  4. What You Can Do 11

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20  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”.

21  A brain injury can occur from:  A traumatic event  Non traumatic event

22  All brain injuries are traumatic to the person who sustained the injury  Trauma is often experienced:  Physically  Mentally  Emotionally

23  There are almost a half a million people living in Ontario with a brain injury 23

24 24 Incidence of Brain Injury 24

25 25 Brain injury is the number one cause of death and disability for Canadians under the age of 45.

26 26 The cost of ABI is measured in the hundreds of millions of dollars for medical care, rehabilitation and life long supports. Cost of ABI

27 27 The cost in terms of human suffering and lost potential is immeasurable.

28  Fiction  All brain injuries are alike  Fact – No two brain injuries are alike

29  Fiction  All brain injuries heal with time  Fact  Many times the damage to the brain is permanent

30  Fiction  When one physically recovers the brain has healed itself  Fact  Person may look fine but cognitive dysfunctions are compromised

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

32  Undiagnosed  Misdiagnosed  Misunderstood

33 33 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

34  It is estimated that the prevalence rates for co-morbid psychiatric disorders in ABI may be as high as 44%. 34

35 35  US study found that 2% of general population arrested annually  31% of brain injury survivors (5 years post injury)had one or more arrests

36 36  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.

37  The brain controls virtually everything humans experience, including:  Movement  Sensing our environment  Regulating our involuntary body processes such as breathing 37

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39  Takes information from other parts of the brain  Formulates responses

40  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

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42  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" 42

43  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 43

44  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 44

45  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 45

46  Alcohol 72%  Cannabis 13%  Crack and Cocaine 10%  Sedatives 2%  Heroin 1%  Other 2% *Ohio Valley Center for Brain Injury 46

47  Withdrawal:  Physical withdrawal  Psychological withdrawal  Issues pre-injury not addressed 47

48  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 48

49  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 49

50  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 50

51  Diminished volume of grey matter  Show impaired functions of the pre-frontal cortex 51

52  Impedes recovery  Exacerbates problems with balance, walking and talking  Increased disinhibition  Interferes with cognitive skills and processing 52

53  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 53

54  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 present in similar ways and include: 54

55  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 55

56  Many addiction programs are based on behaviour modification which will not work with a survivor with certain impairments  Lack of motivation 56

57  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? 57

58  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 58

59  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 59

60  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 60

61  Stage One – Denial  Unaware problem exists  No intention of changing  Resistant to any type of intervention 61

62  Stage Two – Contemplation  Beginning to become aware  Weigh’s pro’s and con’s  Still ambivalent 62

63  Stage Three – Preparing for Change  Major turning point  Begins to recognize potential losses  Reduce amount they are using 63

64  Stage Four – Action  Make significant changes  Alter their environment 64

65  Stage Five – Maintenance  Successful at avoiding triggers  Has coping skills in place  Has a solid support system 65

66  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. 66

67  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  67

68  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 68

69  Assists in dealing with root issues of the addiction  Need to embrace the person as a whole including pre-injury 69

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