In this episode of ASAM Practice Pearls, Dr. Peter Selby and Dr. John Corrigan explore the intersection of brain injury and addiction treatment. They introduce the concept of neurologic-informed care and discuss how cognitive impairments from brain injuries impact addiction recovery. The episode explores practical strategies for screening, treatment, and creating supportive environments to enhance outcomes for individuals with co-occurring brain injury and substance use disorder.

----more----

Looking for this episode's transcript? Download it HERE

Have an idea for a future episode? Share it with us at education@asam.org. Host

Peter Selby, MBBS, CCFP(AM), FCFP, FASAM 

Dr. Peter Selby is a Senior Scientist and Senior Medical Consultant at the Centre for Addiction and Mental Health (CAMH) and Vice-Chair, Research, and Giblon Professor in Family Medicine at the University of Toronto. His research focuses on innovative methods to understand and treat addictive behaviors and their comorbidities. He utilizes technology to scale and test health interventions, with his cohort of over 400,000 treated smokers in Ontario serving as an example. Dr. Selby has received over $100 million in grant funding from CIHR, NIH, and the Ministry of Health and has published more than 200 peer-reviewed articles. His most recent research program utilizes a Learning Health Systems approach to investigate how technology-equitable, collaborative care can enhance the delivery of evidence-based interventions to the patient while providing a more satisfying care experience for patients and providers across systems.

Expert

John Corrigan, PhD, ABPP

Dr. John Corrigan is a professor in the Department of Physical Medicine and Rehabilitation at Ohio State University and Director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. His research interests include a focus on education and treatment for individuals with co-occurring brain injury and substance use, a critical area in both clinical practice and public health. Dr. Corrigan is Editor-in-Chief of the Journal of Head Trauma Rehabilitation. He has been the PI and co-PI of the Ohio Regional Traumatic Brain Injury Model System since 1997 and chaired the Executive Committee of the TBI Model Systems Project Directors from 2007-2017. Dr. Corrigan is the National Research Director for the Brain Injury Association of America. Since 2013 he has served as the Director of the Ohio Brain Injury Program, which is the designated lead agency in the state of Ohio for policy and planning related to living with brain injury. He has more than 200 peer reviewed publications and has received many awards for his service and research in brain injury rehabilitation, including the Brain Injury Association of America’s William Fields Caveness Award, the 2007 Robert L. Moody Prize, the Gold Key Award from the American Congress of Rehabilitation Medicine, and the Lifetime Achievement Award from the International Brain Injury Association.

📖 Show Segments

• 00:05 - Introduction 
• 02:20 - Understanding Neurologic-Informed Care
• 05:53 - The Hidden Epidemic in Addiction Medicine
• 08:03 - Anoxic and Hypoxic Brain Injuries
• 15:19 - Practical Screening and Treatment Modifications
• 22:05 - Accommodations and Environmental Factors
• 24:48 - Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Recognize and Screen for Brain Injuries: Brain injuries, including traumatic brain injuries (TBI) and anoxic/hypoxic injuries, are common but often overlooked in mental health and addiction treatment. Standardized screening at intake, using detailed patient histories and cognitive assessments, is crucial for accurate identification and effective care planning. 
• Implement Neurologic-Informed Care: Similar to trauma-informed Care, this approach integrates an understanding of neurologic impairments into all aspects of treatment. It highlights the importance of understanding cognitive limits, modifying care approaches, and fostering an environment that supports recovery for those with neurological impairments.
• Understand Cognitive Impacts on Recovery: Brain injuries often impair attention, memory, processing speed, and executive function—issues that can impact treatment adherence and be mistaken for a lack of motivation. These impairments can also increase the risk of substance misuse and make recovery more challenging.
• Adapt Treatment Environments and Methods: Creating supportive environments, such as reducing noise, adjusting lighting, and allowing for restlessness, along with practical strategies like visual aids, repetition, and hands-on tools, can help individuals with cognitive impairments better engage in treatment, retain information and make the behavior changes needed for successful recovery.
• Address Sleep Disorders: Sleep disturbances are common in both brain injury and substance use populations. Identifying and treating sleep disorders can improve cognitive functioning and support overall treatment success. 
• Individualized Care to Reduce Substance Use Risks: Individuals with brain injuries face an increased risk of substance misuse and relapse. Individualized, neurologically informed accommodations can reduce these risks and support more sustainable recovery outcomes. 

🔗 Resources

• Accommodating the Symptoms of Traumatic Brain Injury: This booklet from the Ohio Valley Center for Brain Injury Prevention and Rehabilitation provides clear guidance on understanding the effects of TBIs and offers practical, individualized accommodation strategies to support full participation in work, school, and community life. 
• INROADS Issue Brief: Opioid Use Among Persons with Traumatic Brain Injury: In this brief, we will discuss the relationship between TBI, opioid use disorder, and targeted policy solutions to improve short- and long-term outcomes. 
• Modifying Clinical Interventions for TBI: This brief from the ACL's Traumatic Brain Injury (TBI) Technical Assistance and Resource Center (TARC) highlights considerations and best practices for diagnosing and treating behavioral health disorders in people with TBI. 
• SAMHSA Advisory: Treating Patients with TBI: This Advisory summarizes key elements of TBI and describes its relevance to behavioral health, including recommendations for behavioral health professionals.
• Traumatic Brain Injury and SUD Series: The Mid-America and Mountain Plains Addiction Technology Transfer Centers (ATTCs), in partnership with the National Association of State Head Injury Administrators (NASHIA), offer recorded webinars and a toolkit on the intersection between brain injury and substance use disorders.
• The ASAM Criteria: The most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. Chapter 19 of the 4th Edition Adult version addresses cognitive impairment and neurologic-informed care. 
• ASAM Criteria Curriculum: Explore the different trainings ASAM offers on both the 3rd and 4th Edition ASAM Criteria.  

📢 Join the Discussion

Share your thoughts using #ASAMPracticePearls — we’d love to hear from you!