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Treatment Methods


Motivational Interventions

Motivational interventions have been used to help individuals become ready for treatment. Research in the substance abuse field has shown that "Motivational Enhancement Techniques" are associated with greater participation in substance abuse treatment and positive treatment outcomes. The intervention techniques must be matched to a person's stage of readiness to change. Motivational interventions seem like a promising way to promote positive change for people with substance abuse problems and brain injuries, though like most therapeutic approaches it needs to be adapted to the individual.

Cognitive-Behavior Therapy

Cognitive-Behavioral Therapy uses cognitive and/or behavioral strategies to identify and replace an individual's irrational beliefs that arise from substance abuse (e.g., "the only time I feel comfortable is when I'm high") with rational beliefs (e.g., "it's hard to learn to be comfortable socially without doing drugs but people do it all the time"). Cognitive-Behavioral Therapy can be conducted as part of individual or group treatment. Whether or not someone has had a brain injury, Cognitive-Behavioral Therapies need to be adapted to a person's ability to understand the connections between beliefs and feelings.

Therapeutic Communities

Sometimes substance abuse treatment needs to take place in an environment where there is 24-hour per day supervision and treatment. One of the most common residential treatment approaches is the Therapeutic Community , or "TC". TC has been used to address the needs of people with substance use disorders for more than 30 years and its methods and effectiveness have been well-documented. TC views substance abuse as a problem of conduct, attitudes, moods, values, and emotional management. The approach focuses on creating a community, including other people addressing these problems, that promotes self-evaluation and recovery. For persons who have had brain injuries, the TC approach may need to be adapted to the individual, possibly with more flexibility and decreased intensity.

Prescription Medications

When it comes to the use of prescription medications for the treatment of substance abuse, there are not a lot of choices. The most common addiction-related medications is methadone for the treatment of heroin and other opioid addiction. Methadone cannot be given outside designated methadone treatment programs. A newer drug, buprenorphin, is available for the treatment of opioid abuse and dependence when prescribed and monitored by a certified physician. In our clinical work we have seen that prescription medications for depression or anxiety are sometimes important for getting started on changing alcohol or other drug abuse. Another medication, disulfiram or antibuse, is a well-established medication used to discourage alcohol consumption. However, its use by individuals with brain injuries is generally discouraged. Naltrexone has been used to reduce a person's cravings for alcohol, but there is no research on its effectiveness for people who have had brain injuries.

Self-Help Groups

Professional treatment sometimes has natural limits and continuing care beyond formal treatment is critical to achieving a long-term, satisfactory outcome for individuals affected by substance use disorders. Self-help or peer support programs can be an important resource.

Self-help approaches began with Alcoholics Anonymous(AA) and have grown to address a wide variety of addictions. Rational Recovery and Moderation Management are two other self-help approaches for alcohol problems. Narcotics Anonymous (NA) and Cocaine Anonymous (CA), both based on AA, are two of the largest self-help organizations addressing illegal drug use. AA, NA and CA use the "12-step" method, with its focus on developing personal responsibility within the context of peer support.

AA, NA, or CA groups are not for everyone at all stages of recovery. For those still at a point that they are resistant to exploring their use of alcohol or drugs as problematic, the introduction of AA/NA/CA may be too early and counterproductive. Forcing a self-help group on a person too early may create greater resistance later in the process of recovery when AA/NA/CA could be very helpful. A person may find support in other areas of their life that are as productive as AA/NA/CA, and it may be better to use these natural supports. However, we have found that people who participated in self-help groups before their injury can be more open to involvement after.

When attendance at AA, NA or CA groups is being considered there is a certain amount of planning that should take place. We think it is important for someone to accompany a person who has had brain injury and has never attended self-help groups to the first few meetings. Having someone to share the initial experience with, and talk about it afterward, can make the difference between dropping out or staying with the group.

Nuts and Bolts of Using Self-Help Groups describes what will happen at a meeting.

 

This website has been funded with financial assistance from Grant #H133A120086 awarded by the U.S. Department of Education, National Institute on Disability Rehabilitation Research (NIDRR) to the Ohio Valley Center for Brain Injury Prevention and Rehabilitation for the current funding period of 10/01/2012 - 09/30/2017.