Welcome to the TBI-HELP Live Chat

Today's topic is: "Substance Abuse"

Our Guest is: Dr. Timothy Feeney, Program Director Neurobehavior Resource Project

[18:56:50] mod1: Welcome everyone to our professional moderated chat room. Tonight as our guest speaker we are pleased to have with us Dr. Timothy Feeney, Programs Director Neurobehavior at Wildwood Institute in Albany.
[18:57:08] mod1: Welcome Dr. Feeney.
[18:57:25] Tim: Thanks for having me!
[19:01:58] mod1: How do I decide what to treat first, brain injury or substance abuse?
[19:03:06] Tim: That's a great question! With a very complicated answer. The short answer is neither. The longer answer is that both issues likely need addressing in a coordinated way. In other words, there are elements of intervention for substance abuse issues that will be effective for working with folks with TBI
[19:03:42] mod1: Rail: Tim - I'm assuming alcohol is the first abused substance-what is the second in TBI cases?
[19:05:13] Tim: To the alcohol 1st question. No, it's not exactly true that alcohol is the most abuse substance. The literature (and our experience) indicates that alcohol and marijuana are the two most common substances abused followed by cocaine and other "harder" drugs
[19:08:12] mod1: Is it unusual for a post TBI patient to abuse drugs/marijuana?
[19:09:14] Tim: Oh no! In fact there is some indication that rates of abuse actually increase in the population of persons with brain injury when compared to non-injured folks
[19:10:16] mod1: Welcome Melanie: How great is the chance of someone that has a TBI becoming addicted to some substance? Isn't it difficult for someone that has a TBI to get marijuana because of their impairment?
[19:10:59] Tim: As I just indicated, the general rates of addiction are higher in this population. And, I'd also have to say that folks with brain injury have no greater difficulty finding avenues to purchase marijuana than the general population
[19:12:00] mod1: Kay4 has a question what can a parent do????
[19:12:58] Tim: To Kay4's question. I guess the first thought I have is - be honest!

[19:13:50] mod1: Welcome Pete: Do any of the drugs like MJ of Etoch help rather than hinder a person with a TBI? How easy is it for patients to accidentally become addicted to prescription drugs that they need to take for their condition?
[19:15:01] Tim: OK Pete, do any drugs help rather than hinder? I'd say nope. Here's why. Often brain injury effects cognition in a very negative way, and drugs, which are used for their effects on cognition alter an individuals thought process in a way that only worsens that problems. As for addiction to prescription drugs I suppose it depends on the drugs that you are talking about so, if you're on a pain-killer, or a narcotic then yes, the risks of addiction will likely increase.
[19:20:05] mod1: Richard: What would you say are the reasons a person with a TBI uses substances. Is it due to anxiety or depression or something else? In that regard, if a person does suffer from anxiety or depression, would you advocate treating this with a psychiatric medication or talking therapy?
[19:20:57] Tim: Great question Richard - here's a short answer to a complex question. 1st, I'd say, that yes, some folks "self-medicate" or use substances in the effort to manage underlying anxiety or depression. 2nd, there is really no one "best" way to deal with these kinds of issues. Some folks, depending on the seriousness of their difficulties may benefit from medications, others will benefit from other therapies, which can include counseling, and a number of other approaches. I would say that no matter what approach is chosen, the only way it'll work is if the individual is included in deciding what to do!
[19:25:14] mod1: Melanie: What about drugs being given to insure that patients behave. Isn't that drug abuse? Many times that is overdone instead of a behavior mod. plan. When does a patient know they are getting too much?
[19:26:13] Tim: Wow Melanie! That's a heck of a question! Let's see, if an individual is given medications alone, with no additional interventions designed to teach important skills then I'd say it's not a great treatment. How does one know if they're getting too much? That's an answer that I couldn't really give in a chat room like this
[19:27:37] mod1: Pete: What is your experience with caregivers and substance abuse? Is there a hight incidence?
[19:28:52] Tim: Pete, the only literature that I know about caregivers and substance abuse indicates that that rate of SA increases with the burden on the family
[19:30:13] mod1: What are some of the signs or symptoms that would be cause for concern for a provider of service or family member of a dully diagnosed (TBI/SA) individual?
[19:31:10] Tim: Signs and symptoms: Unusual behaviors, paranoia lack of interest in activities, general unwillingness to participate in usual activities.
[19:32:47] mod1: Richard: I'd really like to know if a person with TBI can participate in 12-step meetings such as Alcoholics Anonymous? Since they require verbal skills and insight that a TBI patient may not have.
[19:33:17] Tim: Another good one Richard!: In our experience we've had a number of folks participate in AA meetings with some success. It often requires some ongoing coaching and support to put the 12 steps into practice and may take a longer period of time to concretize the 12 steps in daily life. You're right though, it is difficult to work in a 12 step approach that requires insight with a population that often has difficulty with insight.
[19:36:28] mod1: Carol: Is it difficult to dually diagnose patient in an in patient drug rehab. center?
[19:36:51] Tim: Yes, Carol, it is often very difficult to place an individual with brain injury and SA in most rehab programs. In fact, may rehab programs will not accept folks with brain injury. The good news is that this is changing and many programs are willing to accept folks with brain injury.
[19:38:40] mod1: What is done when a consumer/client relapses?
[19:39:07] Tim: Relapse is a big problem. For the most part we've found that lots of folks relapse and rather than see it as failure we interpret it as an indication of a need for greater supports - which may include an additional rehab stay or some other increased community supports.
[19:40:46] mod1: Frank: Are there any drugs that if taken will make the TBI injury worse?
[19:41:19] Tim: Interesting Frank! I'm not really aware of any drugs that will, in the long run,
[19:41:46] Tim: worsen the injury, although I would say that any drug that alters your cognition, and results in behaviors that are not productive worsen the quality of your life.
[19:42:37] mod1: Gus: Why is the relapse rate so high? How do people pay for this with managed care?
[19:43:13] Tim: Whoa Gus! There's 2 BIG questions! 1st, the relapse rate is high, I think because the likelihood that someone will be impulsive following brain injury is high. 2nd, how is is paid for? Now, that depends on where you live. In NY, you get 2 rehab stays per year (I think) paid for by OSAS, now, the community supports can be paid for through the HCBS Waiver. But, you're right managed care makes it hard!
[19:46:45] mod1: Amanda: I have noticed that TBI day programs are also accepting those with previous additions. I don't see any difference in where the TBI came from but how its treated. They seem to be getting the same general counseling as the rest of the group. Shouldn't theirs be more geared toward not going back to the addicting substance?
[19:47:17] Tim: OK Amanda! I would say that you're right to be wary if the treatment for folks with brain injury is no different than other folks although, I think that the treatment should have 2 foci, 1st - yes, stay clear of any substances and 2nd, create a network of support that allows you to create a meaningful life. In other words, what is my identity? Am I an addict? Or am I a positive and powerful person with concrete goals that I'm working towards?
[19:50:46] mod1: Frank: Is there any guidelines that govern the use and non-use of drugs if they are effecting the quality of life in a non-productive way?
[19:51:22] Tim: OK Frank, the rule of thumb we live by is pretty simple: Don't use illegal drugs! If you need psychoactive meds, make sure that you are under the close supervision for a trained medical professional, especially if you have a history of substance use and abuse.
[19:53:31] mod1: Richard:  Smoking/smoking cessation... It's a substance of abuse and it can cause all sorts of medical problems: heart disease, stroke, emphysema, cancer. What techniques are there for patients to get help for this terrible addition.
[19:54:20] Tim: Yikes Richard, there's a can of worms! Seriously now, to be honest, we don't spend a lot of time working with folks to reduce or eliminate smoking, unless they really want that, it's really a quality of life issue, and to be honest, that addiction is the hardest to break.
[19:56:01] mod1: Richard  asks what techniques/treatments do you advocate for this.
[19:56:29] Tim: OK, Richard, what approaches? The most success we've had is with a gradual cessation with some support with nicotine patches, but I've got to say, we're not real successful.
[19:56:38] mod1: Amanda: Have you found that it is harder to get people with a TBI to admit an addition?
[19:58:36] Tim: Yes, Amanda, it is very hard to get folks to admit to addiction.

[19:58:37] mod1: Well, I am sorry but our session is over. I want to thank Dr. Feeney for his participation and invite him to be a guest speaker in the future. Thank you Dr. Feeney. Good Night and be safe!
[19:59:30] Tim: Oh geez, we're done! If you've got any other questions just give me an email at tfeeney@wildwood.edu or you can call me at 518-347-1891 any ol' time!