RehabWire - Volume 7, Number 6, July 2005

 

The effects of substance abuse combined with a pre-existing disability can be particulary devastating. RehabWire for July highlights substance abuse and alcoholism as it relates to disability and rehabilitation.

NIDRR Projects: Research in the New Millennium.

Ohio Regional TBI Model System. Ohio Valley Center for Brain Injury Prevention and Rehabilitation (H133A020503) led by John D. Corrigan, PhD. Delores Watkins, Project Officer.
Abstract: This model system includes two local research projects on substance abuse and persons with TBI. Study 1 is a randomized clinical trial testing interventions to promote retention in substance abuse treatment. This study employs intervention strategies found effective for clients with TBI when first engaging with a treatment program. Study 2 tests the concurrent validity of an instrument that documents the extent of a person's prior history of TBI objectively. This instrument is intended for research on TBI as a mediating factor in substance abuse treatment. This model system utilizes innovative community integration programs: Team Brain Injury (follow-up case management), the TBI Network (substance abuse treatment), and Community Capacity Building (education and advocacy operated in conjunction with the Brain Injury Association of Ohio).
Find out more at: www.ohiovalley.org

four blond heads looking down at the camera

Rehabilitation and Training Center on Community Integration of Persons with TBI. The Institute for Rehabilitation and Research (TIRR) (H133B031117) led by Angelle M. Sander, PhD and Margaret Struchen, PhD. A. Cate Miller, PhD, Project Officer.
Abstract: The research program of this Center includes, among several projects, a randomized clinical trial to assess the effectiveness of a brief substance abuse intervention; a qualitative exploration of intimacy following TBI. Training projects include: a National Information, Educational Resources, Dissemination, and Technical Assistance Center for the Community Integration of Individuals with TBI; development of educational materials for increasing community awareness of TBI and reducing attitudinal barriers; adoption of a social action network program from disability studies for improving positive identity; partnering with artists in the community to implement a Center for Creative Expressions for Persons with TBI; training of community healthcare professionals in the community integration needs of persons with TBI; a rehabilitation fellowship in community integration of persons with TBI; and a state-of-the-science conference and book on community integration.
Find out more at: www.tbicommunity.org

Rehabilitation Research and Training Center on Substance Abuse, Disability, and Employment. Wright State University (H133B040012) led by Dennis C. Moore, EdD. Edna Johnson, Project Officer.
Abstract: This RRTC builds on previous findings to positively impact persons with disabilities who also experience substance use disorders, as well as the service providers upon whom they depend. The highly integrated program of research addresses the following goals and objectives: (l) Promote widespread use of substance use disorder screening among persons with disabilities who utilize disability-related employment services. This is accomplished by developing and validating a new substance abuse screener called the "SASSI-VR". Following two stages of development and validation, the SASSI-VR is evaluated in three vocational rehabilitation (VR) programs on a statewide basis. (2) Conduct a randomized clinical trial of a model of supported employment, Individualized Placement and Support (IPS), to test its efficacy among persons with traumatic brain injury or other severe disabilities that also have a substance use disorder. Utilization of the IPS model with the study populations holds tremendous potential or impacting services delivery for consumers who experience very low rates of employment. (3) Research policy and practices relative to their impact on VR services for persons with a disability and coexisting substance abuse. The roles of policies, statutes, guidelines, and VR service delivery practices are investigated within the larger community of public agencies. (4) Investigate factors that specifically contribute to unsuccessful case closure among consumers of VR services. This component studies recent VR unsuccessful closures and their counselors, and the study has particular sensitivity to the role of "hidden" substance abuse among unsuccessful closures.
Find out more at: www.med.wright.edu/citar/sardi/

New Research: Selections from REHABDATA

Bombardier, C. H., Stroud, M. W., Esselman, P. C., Rimmele, C. T. (2004) Do pre-injury alcohol problems predict poorer rehabilitation progress in persons with spinal cord injury? Archives of Physical Medicine and Rehabilitation, 85(9), 5. NARIC Accession Number: J46712. Project Number: H133N50025.
Abstract: Study investigated whether a history of alcohol-related problems is associated with progress during inpatient rehabilitation among people with SCI. Analysis revealed that problem drinkers had significantly lower Functional Independence Measure admission, discharge, and efficiency scores and a longer rehabilitation length of stay than those without a history of problem drinking.

Tate, D. G., Forchheimer, M. B., Krause, J. S., Meade, M. A., Bombardier, C. H. (2004) Patterns of alcohol and substance use and abuse in persons with spinal cord injury: Risk factors and correlates. Archives of Physical Medicine and Rehabilitation, 85(11), 11. NARIC Accession Number: J46778.
Project Number: H133G020218; H133N000003; H133N000009; H133N000015.
Abstract: Article describes patterns of alcohol and substance use and abuse as they relate to demographic and injury characteristics, as well as to key medical and psychosocial outcomes, among participants with SCI from 16 Model SCI Systems. Analysis of the data revealed that 14 percent of the subjects were likely to abuse alcohol, based on the CAGE questionnaire responses, and 11 percent reported using illegal drugs, mainly marijuana. At-risk drinkers and substance users tended to be younger, single, male, less educated and reported more pain and lower satisfaction with life. Those who drank without indication of problem drinking had better occupation outcomes.

Ashman, T. A., Schwartz, M. E., Cantor, J. B., Hibbard, M. R., Gordon, W. A. (2004) Screening for substance abuse in individuals with traumatic brain injury. Brain Injury, 18(2), 12. NARIC Accession Number: J47343.
Project Number: H133B30038; H133B980013.
Abstract: Article describes studies examining the accuracy, sensitivity, and specificity of the CAGE questionnaire, the Brief Michigan Alcohol Screening Test (BMAST), and the Substance Abuse Subtle Screening Inventory (SASSI) in screening for substance abuse disorders in individuals with TBI. Data from the instruments were compared with diagnoses obtained from a clinical interview, the Structured Clinical Interview for DSM-IV. Results indicate that the CAGE is a sensitive measure for detecting current alcohol abuse in individuals with TBI. However, its sensitivity was poor when it was modified to detect drug abuse or when it was used to determine the presence of pre-TBI substance abuse. While the sensitivity of both the BMAST and SASSI was significantly less than reported in previous studies, the sensitivity of the face valid drug abuse subscale from the SASSI was high, suggesting that it could be an effective screen for drug abuse in individuals with TBI.

a woman in a prayerful position

Knudsen, H., Roman, P., Ducharme, L. J. (2004) The availability of psychiatric programs in private substance abuse treatment centers, 1995 to 2001. Psychiatric Services, 55(3), 4. NARIC Accession Number: J47398.
Abstract: Article describes the availability of psychiatric programs in private substance abuse centers for clients with substance abuse and severe mental disorders. National survey data on privately funded substance abuse treatment centers were used to identify the proportion of centers that offered psychiatric programs in 1995 to 1996, 1997 to 1998, and 2000 to 2001. Results showed that about 59 percent of private centers offered a psychiatric program and this proportion did not significantly change over time. The proportion of centers that referred clients with severe mental illness to external providers increased significantly from 57 percent to 67 percent. For-profit centers and hospital-based centers were significantly more likely to offer psychiatric programs and were less likely to refer severe cases to other providers.

Drake, R. E., Mueser, K. T., Brunette, M. F., McHugo, G. J. (2004) A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27(4),15. NARIC Accession Number: J47595.
Abstract: Article reviews research that supports the integration of substance abuse and mental health treatment and focuses on tailoring services to individuals’ stage of readiness to change. Key issues regarding dual disorders treatment that are currently under investigation include relapse prevention, implementation, costs, specificity of interventions, treatment algorithms, and special populations, such as women with trauma histories.

Heinemann, A., Corrigan, J., Moore, D. (2004) Case management for traumatic brain injury survivors with alcohol problems. Rehabilitation Psychology, 49(2),11. NARIC Accession Number: J47813.
Abstract: Study evaluated the effectiveness of a community-based approach to substance abuse using comprehensive case management for individuals with TBI. Clients in two programs that provided case management services were compared to a group that did not receive case management services on the following outcomes: self-reported substance abuse, community integration, employment status, and health-related quality of life. Community integration increased for both the case management and the comparison groups. The case management group reported significantly lower physical well-being than the comparison group at baseline; both groups made significant gains by the nine-month follow-up. No significant changes in substance use were evident in the case management group at follow-up.

Becker, D., Drake, R. E., Naughton Jr., W. J.(2005) Supported employment for people with co-occurring disorders. Psychiatric Rehabilitation Journal, 28(4), 7. NARIC Accession Number: J48898.
Abstract: Article presents guidelines for providing supported employment services to people who have both a mental illness and a substance use disorder. Authors first review the general principles of supported employment and then discuss specific guidelines that apply to individuals with co-occurring disorders.

Calendars of Events for substance abuse related conferences are listed on the Substance Abuse and Mental Health Services Administration (SAMHSA) website at alt.samhsa.gov/conferences/calendar.asp