Substance Abuse As Related to Traumatic Brain Injury

Welcome to the TBI-HELP Live Chat

Today's topic is: "Substance Abuse As Related to Traumatic Brain Injury"

Our Guest is: Dr. Robert Katz, Program Director of the Jamaica Hospital Medical Center, Traumatic Brain Injury Unit.

[19:01:12] Mod: Welcome to our professionally moderated chat session. Tonight it is our pleasure to have Dr. Robert Katz, Program Director of the Jamaica Hospital Medical Centers Traumatic Brain Injury Unit. Dr.Katz will be discussing "Substance Abuse As Related to Traumatic Brain Injury. Welcome Dr. Katz..
[19:02:10] Dr.Katz: Thank you for having me tonight Gerri
[19:03:38] Mod: Dr. Katz, What is the most commonly cited predisposing factor in head trauma?
[19:05:31] Dr.Katz: Alcohol use shortly before injury is the most commonly cited and best established predisposing factor in head trauma. It is directly or indirectly involved in motor vehicle accidents, falls, assaults, which are the most common causes of TBI. In fact, alcohol is a major contributing factor in over 50% of head injuries sustained in the United States..
[19:07:26] Mod: Rail: How often is substance abuse observed in the normal course of TBI recovery?..
[19:08:32] Dr.Katz: Good question Rail. The literature shows that 40 to 66% of TBI survivors had pre-injury substance abuse..
[19:10:08] Mod: Mike: How much alcohol must be consumed in order to create a risk of injury?..
[19:11:12] Dr.Katz: That is an excellent question Mike. The truth is that even one drink can impair functioning significantly, especially in smaller body types..
[19:11:47] Mod: Itsme: It is harder for the rehabilitation process for substance abusers?..
[19:12:52] Dr.Katz: These are great questions that we are getting tonight. There are many negative impacts of substance abuse on brain injury recovery. Among them are slowed recovery, diminished benefits from rehabilitation efforts, increased risk for seizures and re-injury through a second TBI, further brain deterioration, and other medical disorders (e.g., liver, kidney disease)..
[19:15:50] Mod: Mike: Do many TBI survivors become hooked on alcohol as a way to cope with their injury?..
[19:17:06] Dr.Katz: While the literature seems to show that most post-injury substance abusers were abusing substance prior to injury, there is an increased risk for substance abuse even in persons who were not abusing beforehand. This could be due to problems adjusting to the injury, but it is also probably due to decreased impulse control as a result of the injury..
[19:18:29] Mod: Sub way: How prevalent is the use of alcohol among caregivers after a loved one has a TBI?..
[19:20:13] Dr.Katz: Another great question. While it is true that TBI caregivers are at increased risk for depression and anxiety disorders, there is no evidence that I know of that TBI caregivers are at increased risk for substance abuse..
[19:20:27] Mod: sub-way: How often do family members become enablers in a patients substance abuse?..
[19:22:34] Dr.Katz: This can definitely become a problem. Often post injury, family members and friends feel sorry for the patient and will anything to make them happier. I have met many family members who have admitted that they have bought alcohol for a substance abusing survivor..
[19:23:22] Mod: Patricia: Is treatment for substance abuse in persons with TBI different than treatment for substance abuse in the general population?..
[19:25:01] Dr.Katz: The treatment needs to be quite different due to the cognitive and interpersonal deficits often exhibited by survivors. In fact, compared to cognitively intact substance abusers, they have poorer treatment outcomes including higher dropout rates, faster relapse rates, and poorer long-term outcomes when they are put in traditional substance abuse programs. What is needed are specialized treatment programs for TBI and substance abuse like the one we have here at Jamaica Hospital..
[19:27:16] Mod: sub-way: How effective would a short term medically managed detox program be for a tbi patient?..
[19:28:35] Dr.Katz: A 7 day detox program would be fine in order to help the patient work through the physical addiction. However, afterward, the patient will need to go to a treatment program that specializes in TBI..
[19:30:57] Mod: Lamont: How effective are insight based programs like AA or NA in helping the tbi patient or family? What type of program do you have at your hospital...I'd like to hear more about it.
[19:32:53] Dr.Katz: Lamont, our program here at Jamaica Hospital is based on the finding that for TBI patients, specialized programs in the context of a holistic TBI rehabilitation program seems to be most effective. Our treatment model is based on the work of Prochaska et al, who have shown that substance abuse treatment is most effective when it is geared to the client's stage of change. Prochaska talks about 5 stages of change, which range from pre-contemplation (where the client has no intention to change) to Action (when the client has made the decision to change). Prochaska has shown that substance abuse treatment is much more effective when you gear the intervention to the client's stage of change. Studies have shown that if you can get the client to move one stage in one month, the chances of successful substance abuse treatment go way up. This technique has been shown to be very helpful for TBI patients. As for NA and AA, they are very important adjuncts to our treatment. We have speakers come regularly to run meetings and encourage our clients to attend meetings in their community..
[19:39:32] Mod: Unknown: Is the program at Jamaica Hospital voluntary for the patients, or is it part of the mandatory rehabilitation process?..
[19:40:21] Mod: Please remember that these are the opinions of Dr. Katz. Always consult with your own doctor. Thank you.
[19:41:59] Dr.Katz: Our program is completely voluntary. If a client refuses to attend program (this client would almost certainly be in the pre-contemplation stage), I will attempt to engage them by providing and discussing educational materials regarding substance abuse and TBI. My goal is to get them to the place where they start to understand the cons of continuing to use and to contemplate changing.
[19:44:34] Mod: Rail: Can the sobering experience of the TBI contribute to the patients ultimate mastery of the abuse syndrome? or is it asking too much?..
[19:45:12] Dr.Katz: You are right on the money with that question. We have found that the experience of having a TBI can boost a substance abuser up one stage (usually from pre-contemplation, where they are not thinking about changing, to the contemplation stage). That it is why it is important to provide substance abuse treatment in the acute phase of TBI rehabilitation so that we can take advantage of this process..
[19:47:08] Mod: MG: I am a later comer. I apologize if you have asked this. How are the goals different with a brain injured population?..
[19:48:20] Dr.Katz: MG, I am not sure what you are referring to by goals, but I think you might be referring to sobriety vs social drinking. In TBI substance abuse, sobriety is strongly recommended. TBI survivors are much more sensitive to the effects of alcohol and other drugs due to the brain injury, including decreased tolerance. Compounding this are the complications of mixing alcohol and other drugs with medications used in rehabilitation, including those for seizure control (alcohol and drugs can render these meds ineffective)..
[19:52:23] Mod: MG: Do you involve the family?..
[19:53:59] Dr.Katz: The family is a very important component of TBI substance abuse treatment. Where possible and with the client's permission, we schedule family therapy sessions to get the family working together on this issue..
[19:54:35] Mod: MG: In your experience are people cured?
[19:55:58] Dr.Katz: We get very good outcomes. I am in the process of conducting a study on this, but I can tell you that our client's are moving one and sometimes even two stages on the behavioral change scale I talked about before. Once they go home, they continue to show good outcomes and continue in treatment..
[19:57:46] Mod: Tartufo: Many times substance abuse has a peer group that is part of the tbi patients socialization patterns...when the patient ceases his abusive behavior he may be friendless...how do you deal with this issue?..
[20:00:56] Dr.Katz: Another good point. Yes, very often our clients need to change the persons that they socialized with prior to the injury because these persons were often using drugs and alcohol. We try to provide our clients with ways of establishing a new support system, but obviously, this can be a tough issue. Often we find though, that even if they were angry at the client before the injury, that once they see the client is serious about changing the abuse pattern, they are only to willing to embrace the person again..
[19:59:24] Mod: Well, it seems that our time is up. This was a very interesting topic of discussion tonight and I would like to thank all of you for the very interesting questions. Also, thank you Dr. Katz for wonderful responses.
[20:01:27] Mod: We would like to invite you back for another session. Good Night, be safe and thank you.
[20:02:03] Dr.Katz: Thank you for inviting me. It was a pleasure to be able to discuss such an important issue.