Occupational Performance & Substance Use Disorder After Traumatic Brain Injury: Understanding Perceived Triggers as a Step Toward Productive Routines

PURPOSE: To better understand substance-use related triggers and consequences among adults with a co-occurring traumatic brain injury (TBI). TBI and substance use disorder (SUD) commonly co-occur [1], presenting unique recovery challenges. Persons with TBI are known to adapt less well to stressful situations, have greater difficulties with follow through, and have more difficulty making lifestyle changes– all factors relevant to substance use disorder (SUD) treatment success and prevention of relapse [2].

DESIGN: Retrospective medical record review.

METHOD: Data was derived from consecutive admissions to a rural SUD treatment program. Program staff used the Ohio State University TBI Identification Method (OSU-TBI-ID) to screen for possible history of TBI [3]. Those with a positive screen were included in the study. The Mental Health Assessment by a Non-Physician (ASAM) was used as part of the normal program admission intake process.

RESULTS: Data was analyzed for 183 consecutive SUD admissions screening positive for a lifetime history of TBI. 72% of subjects identified as male and 87.9% as white. Participants ranged in age for 18-64 years. The most frequently reported ‘triggers’ to substance use were difficulty dealing with feelings (76.5%), environmental circumstances (74.3%), and boredom (68.3%) with the most commonly occurring ‘consequences’ being legal issues (90.7%), relationship difficulties (89.1%), and negative financial impacts (84.2%).

CONCLUSION: Triggers such as boredom, environmental, and social influences support the importance of productive and meaningful routines as an alternative to substance use. High frequency of negative consequences demonstrates the extent of occupational engagement barriers resulting from substance use.

IMPACT: Findings support the value and importance of occupation-based, client-centered OT to promote meaningful participation in activities that support the establishment of roles and routines to enhance SUD treatment outcomes.

References

McHugo, G. J., Krassenbaum, S., Donley, S., Corrigan, J. D., Bogner, J., & Drake, R. E. (2017). The prevalence of traumatic brain injury among people with co-occurring mental health and substance use disorders. The Journal of Head Trauma Rehabilitation, 32(3), E65–E74. https://doi.org/10.1097/HTR.0000000000000249

NASHIA. (2020). Brain Injury and Substance Use Disorders: Implications for Justice Involved Populations (Dettmer, J.). National Association of State Head Injury Administrators (NASHIA). https://www.nashia.org/trainings/brain-injury-and-substance-use-disorders-implications-for-justice-involved-populations

Bogner, J., & Corrigan, J. D. (2009). Reliability and predictive validity of the Ohio State University TBI identification method with prisoners. The Journal of Head Trauma Rehabilitation, 24(4), 279–291. https://doi.org/10.1097/HTR.0b013e3181a66356

Magura S, Staines G, Kosanke N, et al. (2003). Predictive validity of the ASAM Patient Placement Criteria for naturalistically matched vs. mismatched alcoholism patients. The American Journal of Addictions,12(5), 386–397. PMID: 14660153.