Brain Injury & Chemical Dependency “What’s Effective – What’s Not”

Brain Injury & Chemical Dependency“What’s Effective – What’s Not” 25th Annual Conference for Professionals in Brain Injury Crowne Plaza – St Paul April 29-30, 2010 John W. Johnson, Advocate/Trainer, Options Center for Independent Living

Minnesota Model • The philosophy of the Minnesota Model is based on Alcoholic Anonymous (AA) • Main change agent is group affiliation or practice of behaviors consistent with the 12 steps of AA • Chemical addiction is seen as a primary, chronic and progressive disease

Persons ‘Poorly’ Suited For This Approach

“4” Factors That Increase The Risk Of Alcohol Abuse After Brain Injury • Increased discretionary time and boredom • Increased enabling from family and friends • Uncertainty over the ability to return to work or to function at work • Physical limitations and post traumatic mood change

To Provide Support, Family Members Must: • Take substance abuse seriously and avoid thinking of it being a “phase” • Help motivate the person to lead an alcohol-free and drug-free lifestyle • Assist the person in developing plans to cope with situations that have resulted in alcohol and illicit drug use in the past • Rehearse ways to avoid or react differently to such situations so that future abuse can be prevented

Alcohol & Drugs Can Trigger Seizures and Disturb

Professionals state “persons with head injury appear to function normally in most settings, but who are unable to understand the concepts of alcohol or other drug addiction, or to benefit from traditional treatment modalities”… • Impairment of memory • Confabulation • Can’t see behavior/cognitive consequence relationship • AA may view head injury as a ‘character defect’

Red Road To Sobriety/Wellbriety • Combination of ancient spiritual traditions with modern approaches to substance abuse recovery • Talking circle with an eagle feather • Importance of tribal values & spiritual awareness

Emphasis on spiritual guidance and traditional native thinking to encourage dignity and self-worth • “Wellbriety” means both sober and well • Medicine wheel and a 12 step program • Culture is the key to prevention of chemical dependency and other dysfunctional behaviors

Buddhist View Of Addiction • Two Innate Impulses • Desire/attraction (craving) • Repulsion/aversion (hatred) • We Seek Out Pleasure To Avoid Pain • Must live in harmony • Non-harming to self and all beings

“When the self is alone (without the nine qualities: desire, hatred, effort, pleasure, pain, consciousness, virtue, non-virtue and activity) – this is said to be the attainment of liberation.” • Loss of control-surrender to a craving • Build a sense of self/self image • Self-respect – responsibility for ones own actions • Self-identity – based upon self-fulfillment and respect

Do no harm to oneself, encourage a harmonious lifestyle, love, compassion and equanimity, which in turn encourages reflection and self-analysis • Enjoy ordinary life as it is (ability to discover and enjoy oneself)

Islam: Countries Populated By Muslims Are The Driest And Have The Fewest Problems With Alcohol Use

Excessive drinking was an established tradition in 7th century pre-Islamic Arabia • Systematic desensitization when the Divine command came “al-khar (wine/alcoholic drinks, intoxicants) is forbidden” • People will comply with new social norms when they are convinced of their truth & validity • Islam is both a religion and a way of life • No material gain or loss equals God’s pleasure or anger • Islam requires consensus in all matters concerning family, society, or state • No matter how often “man” falters/sins, but repents sincerely, God is most forgiving

Rational Recovery • In 1994, Rational Recovery broke from the established addiction treatment industry • 1)independent recovery from addiction through planned, permanent abstinence; 2)to make self recovery a viable option; 3)to make informed consent to addiction treatment and recovery group participation available to all addicted people.

AVRT = Addictive Voice Recognition Technique is lore of independent recovery from substance addiction • Secure permanent abstinence • No meetings, no treatment centers • No interventions-not a disease • AVRT is incompatible with recovery group format because “support group” contradicts the idea of independent recovery • “the disease concept of addiction is the crippling idea that the act of using alcohol and other drugs is a disease symptom and not subject to moral judgment and beyond voluntary control” • Eating disorders, sexual error, gambling also apply

Enhance & maintain motivation to abstain Cope with urges Manage thoughts, feelings and behaviors Balance momentary and enduring satisfactions SMART RecoverySelf-Management and Recovery Training

Scientific and not spiritual • Not a disease but a maladaptive habit • Meetings-discussion meetings where individuals focus on talk with one another and not to one another • Face to face or on-line • Split with Rational Recovery in 1994

Fergus Falls Grand Rapids (3) Mankato (2) Moorhead New Ulm (2) 16 on-line meetings 500+ world wide face to face meetings Minnesota SMART Chapters

SMART Approach • Teaches self-empowerment and self-reliance • Works on alcoholism and addiction as a complex maladaptive behavior with possible physiological factors • Teaches tools and techniques for self-directed change • Encourages individuals to recover from addiction and live satisfying lives • Provides meetings that are educational and include open discussions

Advocates the appropriate use of prescribed medications and psychological treatments • Evolves as scientific knowledge in addiction evolves • Differs from traditional 12 step programs

Women/Men For Sobriety • Positive reinforcement • Cognitive strategies • Letting the body help • Dynamic group involvement

Six (6) Levels • Accepting alcoholism as a physical disease • Discarding negative thoughts, putting guilt behind, and practicing new ways of viewing and solving problems • Creating and practicing a new self image • Using new attitudes to enforce new behavior patterns • Improving relations as a result of our new feelings about self • Recognizing life’s priorities, emotional and spiritual growth, and self responsibility

Did You Know….. 1/3 of individuals incurring a ‘traumatic’ brain injury were intoxicated at the time of injury Traditional methods of substance abuse treatment programs are often insufficient to meet presenting issues of individuals with ‘traumatic’ brain injury.

Recommended CD Treatment Programs For Individuals With Brain Injury • Substance abuse treatment and brain injury rehabilitation are interwoven-not sequential and not just parallel. • Is holistic-addressing all aspects of lifestyle, not just TBI and substance abuse. • Key staff are skilled in working with TBI and substance abuse disorders.

Consumers collaborate with clinicians to develop an individualized treatment plan. • Clients go through a process over time in which different services are helpful at different stages of recovery. • Clinicians use specific listening and counseling skills to help consumers develop awareness, hopefulness, and motivation for recovery. • Smaller staff caseloads, more experienced staff, and long-term treatment usually required.

Thank You For Your Attention Any Questions?

Brain Injury & Chemical Dependency “What’s Effective – What’s Not”