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Industry: Email Alert RSS FeedAlcohol abuse and traumatic brain injury
Alcohol Health & Research World, Spring, 1989 by Gregory A. Jones
Because brain injury survivors sometimes have difficulty with abstract thought and more complex concepts, long or complicated assessment tools may be ineffective. Consideration should be given to the use of a brief diagnostic tool such as the CAGE Questionnaire (Ewing 1984). Utilization of data from neuropsychological or rehabilitation evaluations is also suggested.
Changes in functional abilities are often the most reliable and measurable symptoms of alcohol or other drug abuse by head injury survivors. Once the practitioner has determined that such changes are not the result of other medical conditions and can be associated with known incidents of consumption, decreasing skills or increasing patterns of maladaptive behavior may provide observable diagnostic criteria for alcohol abuse. For the survivor, these declines in functional ability can be devastating, limiting involvement in rehabilitation or vocational programming. Threatening to discontinue essential services may motivate the brain injury survivor to respond to intervention.
Intervention and treatment - Insight-oriented approaches are prevalent among treatment models for alcohol and other drug abuse (Logan et al. 1987). However, the usefulness of psychodynamic approaches with brain injury survivors is questionable because of the high incidence of cognitive deficits, such as impaired abstract reasoning and decreased insight. Behavioral difficulties of survivors, such as impulsiveness and disinhibition, may cause conflict or tension in group sessions, reducing the effectiveness of the sessions. Rather than receiving support and affirmation from group members, brain injury survivors may be stigmatized or characterized as disruptive. These problems also may be experienced in meetings of self-help groups, such as Alcoholics Anonymous, where significant neurobehavioral problems attributable to head injury may be viewed as "character defects."
In the case of brain injury rehabilitation, the prevailing behavioral model of intervention relies on achieving positive long-term outcomes through a series of short-term goals (Goldstein and Ruthven 1983; Wood 1987). This approach may be more effective with inpatients than with alcohol-or other drug-abusing outpatients who live in community settings where factors influencing behavior cannot be as easily monitored.
In a manual examining methods of counseling head injury survivors in the community, Blanchard (1984) emphasizes the need for practitioners to understand the cognitive and behavioral consequences of head injury and to rely more on such basic counseling techniques as respect, authenticity, and empathy.
Case management - Agencies and individual practitioners serving brain injury survivors who abuse alcohol or other drugs are responsible for addressing their often complex needs and either providing necessary services or making appropriate referrals. Effective case management usually requires an interdisciplinary approach involving social workers, psychologists, occupational and physical therapists, vocational counselors, and specialists in community reentry. Professionals must acquaint themselves with available programs, since referrals to economic or housing assistance programs and consultation with medical or public health professionals may be necessary. Services for spouses or families of clients also should be considered, because the dual problems of disability and alcohol or other drug abuse put intense pressure on family systems.
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