Intersection between traumatic brain injury and opioid use disorders: Recommendations for substance use treatment providers

INTERSECTING RESEARCH ON OPIOID MISUSE ADDICTION, INTERSECTION BETWEEN TBI AND OPIOID USE DISORDER

AND DISABILITY SERVICES – INROADS PROJECT RECOMMENDATIONS FOR SUBSTANCE USE TREATMENT PROVIDERS

INROADS PROJECT inroads@brandeis.edu

Institute for Behavioral Health & http://heller.brandeis.edu/ibh/research/inroads/

Lurie Institute for Disability Policy funded by NIDILRR grant #90DPGE0007

INTERSECTION BETWEEN TRAUMATIC BRAIN INJURY AND OPIOID USE DISORDER

ECOMMENDATIONS FOR SUBSTANCE USE TREATMENT PROVIDERS

History of traumatic brain injury (TBI) is common among clients being treated for opioid use

disorder, and standard treatment approaches can be challenging. Adaptations for people

with TBI increase the likelihood of successful recovery from opioid use disorder.

Traumatic brain injury (TBI) is common among people who have a substance use disorder. Over 20% of

non-institutionalized adults in the United States have had at least one TBI with a loss of consciousness,

and this estimate more than doubles among people with a substance use disorder. Individuals with co-

occurring substance use disorders and mental health problems are even more likely to have a history

of TBI. The increased vulnerability for misuse and addiction to other substances (e.g., alcohol) among

people with TBI suggests the same may be true with opioids.

People with a history of TBI have risk factors for opioid use disorder.

• More frequent headaches

• More likely to experience chronic pain

• More likely to be prescribed opioids

• Increased impulsive behavior that makes it difficult to self-regulate substance use, due to

damage to the prefrontal cortex during the traumatic brain injury

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Opioid use disorder may increase risk for future brain injury.

• Opioid overdoses can cause “anoxic” brain damage due to lack of oxygen to the brain, often

leading to repeated brain injuries

• Opioid overdose can also lead to falls due to loss of consciousness, causing TBI

The defining feature of TBI is damage to the frontal lobes of the brain which can reduce concentration,

memory, planning, problem-solving or communication, as well as self-regulation skills like impulse

control, emotional inhibition and self-awareness. These executive function skills are the building

blocks for successful opioid use disorder treatment.

Additional physical and mental health conditions may be present.

It is also important to remember that TBI and opioid use disorder may not be the only disabilities or

health conditions your clients have. They may also live with mental health conditions, pain, sleep

disorders, and other physical health conditions.

Strategies for determining the unique needs of clients with co-occurring TBI and

opioid use disorder include:

• Identifying clients’ communication and learning styles. Do your clients comprehend written and

spoken language? What other forms of communication can they use? How do they learn best?

• Finding out what compensatory strategies worked or did not work for clients in the past.

• Asking clients what helps them accomplish specific executive functioning tasks. For example,

“What helps you pay attention?”

Clients with a history of TBI need long-term support for successful opioid use disorder

treatment. “When you think you’re done with treatment, you’re likely not.”

Insight and the intention to stop using opioids will not ensure that clients sustain recovery and healthy

functioning. Other factors should be taken into account, including medication treatment,

organizational supports, trigger-free environments, and more time to allow remission to become

recovery.

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Strategies to address specific executive functioning problems include:

• For people who struggle with paying attention, presenting information in smaller chunks,

providing simple and straightforward instructions, and offering opportunities for hands-on

learning can help them stay engaged with their treatment program.

• People who have difficulties processing information may benefit from extra time, repetition,

and simple instructions.

• People who have problems remembering things can benefit from written summaries,

repetition of important material, and other forms of reminders.

• Initiating tasks can be hard for some people with TBI. Break tasks down into manageable

portions.

• Sometimes people with TBI can be impulsive. Work with clients on anticipating impulses, goal-

setting and thinking about the consequences of their actions.

• People with TBI can struggle with planning and organization. Help clients by working with them

to keep routines, use organization systems (e.g., smartphone apps), and make lists.

• Mental flexibility can also be a challenge for people with TBI. Remember that clients may get

stuck on one way of thinking, and may struggle to come up with solutions to unexpected

problems.

• TBI can affect people’s self-awareness and ability to make good decisions. Work with clients to

plan ahead, and practice positive social interactions.

INTERSECTING RESEARCH ON OPIOID MISUSE ADDICTION, INTERSECTION BETWEEN TBI AND OPIOID USE DISORDER

AND DISABILITY SERVICES – INROADS PROJECT RECOMMENDATIONS FOR SUBSTANCE USE TREATMENT PROVIDERS

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Adapted from:

John D. Corrigan and Rachel Sayko Adams (2019). The Intersection of Lifetime History of Traumatic

Brain Injury and the Opioid Crisis. Addictive Behaviors; 90: 143-145.

https://doi.org/10.1016/j.addbeh.2018.10.030

Accommodating the Symptoms of TBI. Ohio Valley Center for Brain Injury Prevention and

Rehabilitation. http://heller.brandeis.edu/ibh/pdfs/accommodating-tbi-booklet-1-14.pdf

Traumatic Brain Injury Resources

Brain Injury Association of America. https://www.biausa.org/

BrainLine. https://www.brainline.org/

Authors

Rachel Sayko Adams, PhD, MPH, Institute for Behavioral Health, Brandeis University

John D. Corrigan, PhD, Department of Physical Medicine and Rehabilitation, Ohio State University

With contributions from Mary Brolin, PhD; Finn Gardiner, MPP; Monika Mitra, PhD; Joanne Nicholson,

PhD; and Sharon Reif, PhD.

Funder

The contents of this issue brief were developed under a grant from the National Institute on Disability,

Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPGE0007). NIDILRR is a

Center within the Administration for Community Living (ACL), Department of Health and Human

Services (HHS). The contents of this issue brief do not necessarily represent the policy of NIDILRR, ACL,

or HHS, and you should not assume endorsement by the Federal Government.

Heller School for Social Policy and Management, Brandeis University – http://heller.brandeis.edu

INROADS Project – inroads@brandeis.edu – http://heller.brandeis.edu/ibh/research/inroads/

April 1, 2019