"What do we do with a drunken sailor..."
A few months ago we wrote an article for this newsletter outlining some strategies for talking with people about the use of alcohol and other drugs following a head injury. Some people who have attended our presentations regarding this subject have asked what they can do for (or about) the person who is using alcohol and other drugs at a high level and does not respond to general information about the hazards of continued use. This is an important question because studies have shown that a considerable number of persons who have a head injury also have a serious alcohol or drug use problem. In fact, in many cases it was the alcohol or other drug use that lead to the injury.
Let me first define what is meant by the term "substance abuse". In the simplest of terms, when a person has negative effects as the result of the use of alcohol and or other drugs and continues to use in spite of these effects, this is considered substance abuse. Negative effects can be things such as: common hangover (nausea, vomiting, headache and tiredness), legal problems (arrests for OMVI, UI, public intoxication, etc.), social problems (embarrassing self or family, loss of friends, inability to fulfill family or social responsibilities, etc.), employment or school problems (loss of job, tardiness, poor performance, failure to complete assignments, etc.), and physical problems (ulcers, high blood pressure, cirrhosis, pancreatitis, and some cancers).
Persons who have had a head injury have special needs when it comes to treating substance abuse. Memory problems, lack of awareness, disinhibition and problems with generalization all create unique requirements. Early screening, identification and intervention provide the best opportunity for successful treatment. The family of the survivor is vital to this process. They can provide information to service providers that will help with a proper assessment of the person's status. They also serve a vital role in the intervention process and they can provide support for on-going treatment. The family can just as well be an obstacle to successful treatment, often with the best of intentions. Making excuses for the person's behavior, covering up incidents of use and abuse, drinking with or in front of the survivor, ignoring troublesome behaviors, and giving inconsistent messages about the use of alcohol and other drugs are some of the ways families can provide obstacles to effective treatment.
The treatment process is a highly individualized one, but there are some general items that apply that can be addressed here. Generally speaking, outpatient, community-based treatment is preferred over inpatient treatment. Community-based treatment must be carefully coordinated in order to maximize its effectiveness. We recommend a model of community-based treatment that utilizes a treatment team approach with a resource and service coordinator (case manager) specifically trained in head injury and substance abuse treatment. The team should include the survivor, family members and all service providers that the survivor sees.
As a part of the Ohio Valley Center projects, we are attempting to establish a pilot program for the treatment of substance abuse and TBI in each of the four states in the region. The model for these pilots has been in operation at the Ohio State University in Columbus, Ohio for the past three years. It has produced significant results in helping people reduce and/or eliminate alcohol and other drug use and increase employment and social functioning. A second site is in operation at Miami Valley Hospital in Dayton, called the Consumer Advocacy Model (CAM Program). The CAM Program is completing its first year in operation.
What can we do with a drunken sailor? There is quite a lot we can do. Two things need to happen first: we need to do something and we need to work together. If you would like more information, please feel free to contact Gary Lamb-Hart OVC, 614-293-3802.
Spring 1995 Ohio Head Injury Association Page 7 Reprinted with the permission of OHIA and the author