Substance use and TBI Flashcards
TBI and substance misuse
2/3 of people had a history of TBI and substance misuse combined
compared to TBI or substance use alone
TBI and substance misuse risk of returning to substance
If an individual misused alcohol or other drugs prior to their injury, the risk of returning to substance misuse after injury is 10 times higher
TBI impacts on misuse
increased severity of misuse,
more exposure/ chance to starting younger,
higher likelihood of other disorders
substance misuse
the consumption of alcohol and illegal drugs and the use of prescription drugs exceeding the prescribed amount or use of another person’s prescription drugs
substance use disorder
involves continued use despite health, psychological, or social consequences
hazardous use
the use of substances in a manner that is associated with higher risk of physical, mental, or social consequences and therefore represents a public health concern
psychoactive misuse
the use of any psychoactive drug for non-medical purposes
high risk drinking
the amount of alcohol use considered to be unhealthy for most of the U.S. population
- For healthy men, more than 4 drinks in a day or 14 drinks in a week
- For healthy women, more than 3 drinks in a day or 7 drinks in a week
assessment of substance misuse
Use of open-ended questioning can be used to obtain necessary information and begin process of supporting behavior change
Open-ended questions: questions that require the person to give more than just a single word answer
Example: “Tell me about how you first started to drink.”
Reflective Listening: Check your understanding by restating the person’s response in your own words
standardized assessment of substance misuse
CAGE
ever felt you should CUT down on drinking?
ever felt ANNOYED by others telling you to stop / cut?
ever felt GUILTY about amount of drinking?
ever used a drink first thing in morning as an EYE opener?
Substance abuse + TBI quadrants
This four quadrant model describes the various settings where people with TBI and substance misuse could receive treatment
Quadrants are divided by whether the TBI and substance misuse are more or less severe
Quadrant I
seen in acute care or primary care and with substance misuse
low severity TBI ; low severity substance misuse
Quadrant I treatment
Screening and Brief Intervention methods
- Persons who recently had an injury caused by substance misuse may be more open to reducing use
- Trained professional screens for amount of misuse, then provides information about risk for future problems due to misuse
- Professional uses motivational interviewing to support readiness to change
Referral provided if necessary
These methods are likely to be effective for people with less severe TBI without severe cognitive deficits
Quadrant II
TBI rehab program + services / substance misuse addressed by screening, counseling, linking services
All persons receiving TBI rehabilitation should be screened for risk of substance misuse
high severity TBI, low severity substance misuse
Quadrant II treatment
All patients should be provided with education regarding the harms associated with substance use AFTER TBI
High risk patients should receive a brief intervention, while those with more severe SUD should be appropriately referred
Rehab teams must determine their message – often no use is the safest recommendation
Teams must pay special attention to the referral process and make sure patients obtain appropriate treatment (setting up appointments, checking insurance coverage, transport, reminders, etc.)
