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About TBI & Substance Use

Assessing Substance Use


ABUSE Screening

This utility is designed for use by non-substance abuse professionals during interviews with persons who have experienced traumatic brain injury. Its purpose is to help professionals frame questions and identify responses that may indicate the presence of a substance abuse problem or the risk of a future problem.

Amount

Ask about...

  • Substances used
  • Quantity of use
  • Frequency of current (or most recent) use

Listen for...

  • Use of more than one chemical or substance
  • Intoxication or "getting high" as goal or result on a regular or consistent basis
  • Daily or binge-type use. Increasing use or changing drug use to get the same effect (i.e. switching from beer or wine to hard liquor, mixing drugs switching to crack or cocaine

 Background

 Ask about history of use...

  • Use at time of injury
  • Age at first use, first intoxication and abuse
  • Previous substance abuse treatment

Listen for...

  • Under the influence at the time of injury
  • First use or intoxication prior to the age of 15
  • Reports of prior treatments for alcohol or other drug-related problems 

Use Related Effects

Ask...
Since you were injured, have you had:

  • Legal consequences
  • Family/Social consequences
  • Job/School consequences
  • Financial consequences
  • Medical consequences
  • Emotional consequences
  • Spiritual consequences

Listen for...

  • Arrests for DUI or OMVI, public intoxication, open container, disorderly conduct, possession/distribution of illegal substances, or other use-related arrests
  • Giving up social activities, avoiding family gatherings, repeated arguments, fights, separation, divorce, and relationship problems as a result of use
  • Poor job or school performance, reprimands, attendance problems, terminations,demotions, suspensions, or quitting/dropping out as a result of use
  • Financial problems due to poor decisions, gambling, fines, jail time, lost jobs, or poor credit as a result of use
  • Blackouts, withdrawal symptoms (sweats, nausea, shakes and cravings), ulcers, high blood pressure, strokes, injuries, certain cancers, or cirrhosis as a result of use
  • Depression, paranoia, aggression, crying or angry outbursts when using
  • Sense of hopelessness or worthlessness. Reducing usual spiritual practices. Attacking religious practices of others when using 

Social

Ask about...

  • Social engagements involving alcohol/other drugs
  • Friends' type, quantity and frequency of use
  • Recreational activities have alcohol/other drugs present
  • Alcohol/other drugs are used to relax, unwind, or feel comfortable with others

Listen for...

  • Preference for or attendance at only social activities in which alcohol and/or other drugs are present
  • Most friends are reported to use frequently or heavily.
  • Recreational activities are planned around use
  • Reports of feeling unable to relax, unwind, or be with others without using 

Environment

Ask about...

  • Family history of substance abuse/dependence
  • Use is a regular part of family activities or get-togethers
  • Use is a regular part of job or job-related activities either during or after work

Listen for...

  • One or more substance-dependent family members in the current generation or two preceding generations
  • Identification of using being a regular part of family get- togethers and activities
  • Job-related using, such as after-work get-togethers, lunches, meetings, or customer relations

 

Definition of Terms

Substance Use

Substance use includes the consumption of alcohol, other non-prescribed drugs, or the misuse of prescribed medications. Due to the effects on the brain, any substance use following brain injury should be avoided, even if it does not lead to intoxication.

Substance Abuse

Any of the following consequences recurring within the last few months:

  • Failure to fulfill major obligations at home, work, or school;
  • Engaging in potentially hazardous behavior;
  • Legal problems; or
  • Social or interpersonal problems.

Substance Dependence

More severe manifestations of abuse, including signs of physiologic dependence.


(From Ohio Valley Center with permission)