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Affective modulation
Behavioral planning
Cognitive resource allocation
The A-B-Cs of Self-Regulation
Affective modulation
Behavioral planning
Cognitive resource allocation
Delay Discounting:
70%
26%
20% 22%
14% 16%
0%
none 1 or 2 3 or more
# binging occasions last 30 days
% Rehabilitation Patients with Prior
Histories of Abuse
70%
61%
60% 58% 58%
54% TBI Model
50% 48% Systems
43%
40% 39%
Ohio State
34%
30% 29% University
20% University of
Washington
10%
0%
Alcohol Other Either
Drugs
Intoxication and Occurrence of TBI
(Savola, Niemela & Hillbom, 2005)
12.00
9.23
10.00
Odds Ratio for Having a TBI
8.00
6.00
3.20
4.00
1.24 1.64
2.00
0.00
.01-.999 .10-.149 .15-.199 .20
Blood Alcohol Content
% Clients in Substance Abuse Treatment with
Histories of TBI
70%
63% Alterman & Tarter
60% 58%
53% Hillbom & Holm
50% 48%
30%
Gordon, et al.
20% (upstate NY)
Gordon, et al.
10% (NYC)
0%
% Clients in Substance Abuse Treatment with
Histories of TBI
80%
72%
70%
Adolescent resid.
60% tx
53% 50% Adult resid., IOP
50%
40%
Prisoners in TC
30% 23%
20% Dual dx tx program
10%
0%
TBI and at least ER Treatment
8000
7000
Female SUD
5000
4000
U.S. Males
Male SUD
3000
2000
1000
7000
Female SUD
5000
4000
U.S. Males
Male SUD
3000
2000
1000
P300 Amplitude
16
14
12
10
8
6
4
2
0
Controls Alcohol TBI TBI+Alcohol
Ventricle to Brain Ratio
[from Bigler, et al., 1996 and Barker, et al., 1999]
4
3.5
3
2.5
2
1.5
1
0.5
0
Response to Substance
Abuse Treatment
Cognitive Impairment in the Match Study
(Bates et al. 2006)
Symptoms past 12 months of Clients Admitted for Substance
Abuse Treatment in Kentucky (N=7,932)
0 10 20 30 40 50 60 70 80
Serious anxiety
Serious depression
Violent behavior
No TBI
Suicidal thoughts
1 TBI/loc
Attempted suicide
>1 TBI/loc
Hallucinations
TBI among participants in IDDT
(Corrigan & Deutschle, 2008)
28.5
30
24.11 TBI (N=36)
Non-TBI (N=14)
20.14
20
Days
14.43
13.06
10 7.69
4.36 4.97
1.79 1.07
0
Alcohol Cannabis Cocaine Analgesics Meth/Amphet
Age of First Drug Use
20 TBI
15.29 (N=36)
15 12.28 No-TBI
(N=14)
Age
10
0
1
Psychiatric DX on Axis I
60
50
TBI Non-TBI
40
33
Percentage
28
25
21
19
20 16
14 14 14
8 7 8 7
0 0
0
Diagnosis on Axis II 100
100
80 75
TBI Non-TBI
Percentage
60
40
20 11
5 8.3
0 0 0
0
Hospital Days
3.5
3.12
3
2.5
Days per Month
2
1.81
1.65
1.5
0.5
0.26
0
Pre-Involve Act-Involve
0.8
Monthly Contacts
0.68
0.6
0.4 0.39
0.24
0.2 0.17
0
Pre-Involve Act-Involve
10
9 9.03
8
7
Days per Month
6
5 4.9
4
3
2
1.29
1
0.31
0
Pre-Involve Act-Involve
16
14 13.4
12
Contacts per Month
10 8.212
8.87
8 8.37
6
4
2
0
Pre-Involve Act-Involve
50
44.4
TBI
NonTBI
40
35.7 35.7
33.3
P e rc e n ta g e
30
20 16.7
14.3 14.3
10
5.6
0
Deteriorated Stable w/ sufficient Stable w/ little/no Not enough info
unstable support support
Age at First TBI
0 - 12 (N=9)
13 - 18 (N=13)
>18 N=11)
16 13
11
12 9
0
1
Current Functioning by Age at First Injury
60
55.6
50 0 - 12
50
13 - 18
40 >18
36.4 35.7 35.7
33.3 Non-tbi
Percentage
30 27.3 27.3
22.2
20
14.3 14.3
11.1 11.1
9.1
10 8.3 8.3
0
Deteriorated unstable Stable W/ sufficient Stable w/ little/no support not enough info
support
Accommodating TBI in
Substance Abuse Treatment
Two Consistent Clinical Observations:
In substance abuse treatment there is a greater
disconnect between TBI clients intentions and
their behavior.
Quadrant I Quadrant II
Quadrant I Quadrant II
Acute Medical Settings and Rehabilitation Programs &
Primary Care Services
Quadrant I Quadrant II
Acute Medical Settings and Rehabilitation Programs &
Primary Care Services
Education,
Screening & Brief Screening, Brief
Interventions Interventions &
Linkage
Quadrant I
Quadrant II
Acute Medical Settings and Rehabilitation Programs &
Services
Primary Care
Education,
Screening & Brief Screening, Brief
Interventions Interventions &
Linkage
Quadrant I Quadrant II
Acute Medical Settings and
Primary Care
Rehabilitation Programs &
Services
Screening & Brief
Interventions Education, Screening
Brief Interventions &
Linkage
Quadrant I Quadrant II
Acute Medical Settings and Rehabilitation Programs &
Primary Care Services
Education,
Screening & Brief Screening, Brief
Interventions Interventions &
Linkage
Quadrant I Quadrant II
Acute Medical Settings and Rehabilitation Programs &
Primary Care Services
Education,
Screening & Brief Screening, Brief
Interventions Interventions &
Linkage
Website:
www.SynapShots.org
e-mail:
corrigan.1@osu.edu