Ohio Valley Center for Brain Injury Prevention and Rehabilitation

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Substance Abuse and Brain Injuries

Suggestions for Substance Abuse Treatment Providers Working with
Persons Who Have Limitations in Cognitive Abilities

The substance abuse provider should determine a person’s unique communication and learning styles.

Ask how well the person reads and writes; or evaluate via samples.
Evaluate whether the individual is able to comprehend both written and spoken language.
If someone is not able to speak (or speak easily), inquire as to alternate methods of expression (e.g., writing or gestures).
Both ask about and observe a person’s attention span; be attuned to whether attention seems to change in busy versus quiet environments.
Both ask about and observe a person’s capacity for new learning; inquire as to strengths and weaknesses or seek consultation to determine optimum approaches.

The substance abuse provider should assist the individual to compensate for a unique learning style.

Modify written material to make it concise and to the point.
Paraphrase concepts, use concrete examples, incorporate visual aids, or otherwise present an idea in more than one way.
If it helps, allow the individual to take notes or at least write down key points for later review and recall.
Encourage the use of a calendar or planner; if the treatment program includes a daily schedule, make sure a "pocket version" is kept for easy reference.
Make sure homework assignments are written down.
After group sessions, meet individually to review main points.
Provide assistance with homework or worksheets; allow more time and take into account reading or writing abilities.
Enlist family, friends or other service providers to reinforce goals.
Do not take for granted that something learned in one situation will be generalized to another.
Repeat, review, rehearse, repeat, review, rehearse.

The substance abuse provider should provide direct feedback regarding inappropriate behaviors.

Let a person know a behavior is inappropriate; do not assume the individual knows and is choosing to do so anyway.
Provide straightforward feedback about when and where behaviors are appropriate.
Redirect tangential or excessive speech, including a predetermined method of signals for use in groups.

The substance abuse provider should be cautious when making inferences about motivation based on observed behaviors.

Do not presume that non-compliance arises from lack of motivation or resistance, check it out.
Be aware that unawareness of deficits can arise as a result of specific damage to the brain and may not always be due to denial.
Confrontation shuts down thinking and elicits rigidity; roll with resistance.
Do not just discharge for non-compliance; follow-up and find out why someone has no-showed or otherwise not followed through.