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About TBI & Substance Use

Suggestions for Substance Use Treatment Providers


Suggestions for Working with Persons Who Have TBI

Carefully observe and assess the 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. 

Help the individual compensate for a changed 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 extra time for tasks that involve reading or writing.
  • Ask family, friends, or other service providers to reinforce goals.
  • Remember that something learned in one situation may not be generalized to another.
  • Repeat, review, rehearse, repeat, review, rehearse.

Provide direct feedback regarding inappropriate behaviors.

  • Let a person know a behavior is inappropriate. Do not assume the individual is making a conscious choice to act out or is even aware that he is misbehaving.
  • Be clear about the behaviors that are expected and provide direct feedback when inappropriate behavior occurs.
  • Redirect tangential or excessive speech, and establish a method to unobtrusively signal inappropriate behavior in public.

Remember that non-compliant behaviors may be symptoms of neurological deficits. 

  • 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.
  • Absences or lack of follow-through may be reasons to change treatment strategies. Don't rush to discharge.

pdf of "Suggestions for Substance Use Treatment Professionals Working with Persons with TBI"