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Integrated Treatment for Traumatic Brain Injury and Substance Abuse

Integrated Treatment for Traumatic Brain Injury and Substance Abuse. John D. Corrigan, PhD Ohio Valley Center for Brain Injury Prevention and Rehabilitation Ohio State University. Alcohol Consumption 1 Year after Hospitalization with TBI [Horner, et al, 2005 (South Carolina Follow-up Study)].

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Integrated Treatment for Traumatic Brain Injury and Substance Abuse

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  1. Integrated Treatment for Traumatic Brain Injury and Substance Abuse John D. Corrigan, PhD Ohio Valley Center for Brain Injury Prevention and Rehabilitation Ohio State University

  2. Alcohol Consumption 1 Yearafter Hospitalization with TBI[Horner, et al, 2005 (South Carolina Follow-up Study)]

  3. Binge Drinking 1 Yearafter Hospitalization[Horner, et al, 2005 (South Carolina Follow-up Study)]

  4. Prior History of Substance Abuse among TBI Patients in Acute Rehabilitation Units Three studies: • TBI Model Systems National Database (n=1,262; Corrigan et al., 2003) • OSU Suboptimal Outcomes Study (n=356 consecutive admits to acute rehabilitation) • University of Washington (n=142 consecutive admits to acute rehab, Bombardier, Rimmele & Zintel, 2003)

  5. % Rehabilitation Patients with Prior Histories of Abuse

  6. Substance Use Disorders (SUD) and TBI • 50% of persons hospitalized with a TBI drinking excessively 1 year after injury • 60% of adolescents and adults treated in rehabilitation have prior histories of SUD • 10% to 20% develop SUD for the first time after TBI • After a “honeymoon” use increases to pre-injury levels • Effects of TBI and substance use on brain structure and function are additive • Is associated with unemployment, criminal activity and lower subjective well-being

  7. Addiction changes the pleasure pathways

  8. Areas of contusion in 40 consecutive cases of closed head injury (Courville, 1950) Overlay of 100 consecutive CT scans of patients with closed head injuries (Bigler, 1984)

  9. Intervention and Treatment • Models proposed initially for TBI were designed for residential settings(e.g., Blackerby & Baumgartnen, 1990; Langley, 1991) • Quasi-experimental support for: • community-based case management(Corrigan, Lamb-Hart & Rust, 1995; Bogner, et al., 1997; Heinemann, Corrigan & Moore, 2004) • motivational interviewing(Bombardier & Rimmele, 1999; Cox, et al., 2003) • skills-based treatment(Vungkhanching et al., 2007)

  10. Intervention and Treatment(cont’d) • Painfully little study of the effectiveness of proven treatment interventions with this population, whether behavioral, pharmacologic or systemic. • Need for treatment going unmet--among persons with problems controlling use 1 year after TBI, a high proportion not getting assistance(Corrigan, Whiteneck & Mellick, 2004; Pickelsimer et al, 2007).

  11. Corrigan, Whiteneck & Mellick (2004) Percentage With Needs Unmet at 1 Year

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