Vistas Online 2009

VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 900 proprietary counseling articles published from 2004 to 2017.


Traumatic Brain Injuries and Substance Abuse: Implications for Rehabilitation Professionals

David A. DeLambo, Kananur V. Chandras, Debra Homa, and Sunil V. Chandras


Roughly 1.9 million individuals per year incur traumatic brain injury (Chandras & Eddy, 2008; Schmidt & Heinemann, 1999). As many as three quarters of these injuries involved alcohol and drugs at time of onset (Chandras & Eddy, 2008; Corrigan, 1995; Corrigan, Bogner, Mysiw, Clinchot & Fugate, 2001). A sizeable number of traumatic brain injury (TBI) survivors continue to use drugs and alcohol despite the many grave consequences (Chandras & Eddy, 2008; Taylor, Kreutzer, Demm, & Meade, 2003) such as risk of re-injury, seizure, aggressiveness, decreased life satisfaction (Corrigan, 2005); role change, family stress, sense of loss, boredom, and frustration. Substance use also exacerbates the residual effects of TBI, such as deficits in coping, memory, problem solving, social skills, fatigue, and sensitivity to stimulation (Schmidt & Heinemann, 1999). For these reasons, any substance use is strongly discouraged (Corrigan & LambHart, 2004). For example, during early recovery, when the brain is attempting to heal, alcohol can negate this natural healing process. Individuals with a TBI and a coexisting disability of addiction/substance abuse (i.e., dual-diagnosis) typically have higher rates of relapse, re-injury, and medical complications that lead to negative treatment outcomes and less functional stability. They are more likely to have lowered inhibition and difficulty with social relationships. In addition, they are at greater risk of mental health problems, especially depression and suicide (Benshoff & Janikowski, 2000; Corrigan, 2005; DeLambo, Chandras & Eddy, 2005; Schmidt & Heinemann, 1999; Taylor et al., 2003). From a rehabilitation perspective, a vital concern is the dramatic unemployment rates for persons with TBI. Rehabilitation Professionals (RPs) are likely to encounter unique barriers and challenges when working with this population (Benshoff & Janikowski, 2000). Consequently, awareness of these coexisting disabilities and the array of treatment modalities and related issues are necessary for successful rehabilitation.

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