By Leslie Davis & Meira Yaer
Patients entering Sierra Tucson treatment center to treat their substance abuse, Post-Traumatic Stress Disorder (PTSD), or other addictions may end up having to deal with something they had not expected – the effects of a traumatic brain injury.
Traumatic brain injury often affects a person’s behaviors in much the same way that substance abuse does, leaving many injuries unnoticed by both therapists and patients. Traumatic brain injuries can affect a person’s memory, language, reasoning, judgment, and behavior.
“Traumatic brain injury often compromises, ironically, the very same things compromised by substance abuse and other addictive behaviors,” said Meira Yaer, R.N., M.A., MFT, CBIS, a family therapist at Sierra Tucson who specializes in brain injury.
The majority of brain injuries occur from a traumatic event, such as a car accident or fall, but they can also result from a brain aneurysm, tumor, or stroke. While many patients are aware of their brain injury, there is a chance that the symptoms are cloaked by a substance abuse addiction, PTSD, or other addictive behaviors, Yaer said.
“The patient often looks fine and presents well, but we see things that just don’t add up,” said Yaer, who is also the founder of Opening the Way, a brain injury program, and facilitator of The Tucson Brain Injury Advocacy Panel.
Effects of Injury on Brain
The effects of a brain injury can often be so subtle that neither the people with the injury nor those around them are aware that one exists. The symptoms may manifest themselves in the injured person acting disinterested or non-compliant. People who are aware of their injuries may be embarrassed by them and unwilling to participate in activities for fear of seeming “different.”
Various functions of the brain are affected by a traumatic brain injury, many of which mirror those affected by substance abuse:
- Cognition: Impairment to cognition can affect attention span, ability to multitask, levels of fatigue, and the ability to cope with noise levels and distractions.
- Memory: Both traumatic brain injury and substance abuse affect short-term memory, which can impair how successful a person is in treatment. If memory is impaired, a patient may not remember which assignments are due or what conversations were conducted. When that happens, the patient may be embarrassed to ask for help or to have the therapist repeat what was said.
- Language: When language is impaired, it affects a person’s ability to understand others and express ideas clearly.
- Reasoning and Judgment: Impairment to reasoning and judgment can cause many behavioral problems, such as impulsivity, inappropriate behaviors, and misunderstanding.
- Executive Function: The executive function of the brain controls a person’s ability to initiate, organize, direct, monitor, and evaluate oneself. This function is most often affected when a person’s frontal lobe is damaged and can be a barrier to a person’s ability to recover from substance abuse. “The executive function is also related to such issues as self-esteem and self-worth, and damage to the brain can keep people from working on these issues successfully,” Yaer said.
Pathways to Self-Empowerment
During her more than 15 years of treating traumatic brain injury, Yaer developed what she refers to as the “Pathways to Self-Empowerment.”
“It provides patients a way to find meaning in suffering and the challenges in life,” she said.
Yaer established 10 components that guide patients to become more self-empowered:
- Intuition: Exploring intuitively what interests you
- Interest: The desire to relate to others and the world and develop your interests. Ideally, treatment will provide a variety of stimuli, such as Equine-Assisted Therapy, hikes, and experiential therapies, to spark that interest
- Inspiration: Inspiration can come from being in and interacting with nature and animals or exploring spirituality. “If you are feeling overloaded or fatigued, connecting with nature and animals can regenerate you,” Yaer said
- Initiation: Once you begin to believe more in yourself and move toward healing, you will have the motivation to initiate activities that interest you. This is the time when you overcome your fears of doing certain things, like sharing about feelings and fears in support groups
- Interaction: This means exchanging thoughts, ideas, and feelings, as well as gaining confidence and collaborating. An essential part of treatment at Sierra Tucson is ensuring that patients interact with one another in a variety of therapeutic ways as they navigate their recovery journey, Yaer said
- Integration: Exploring beliefs about yourself and feeling connected to life. During integration, a deeper version of your self emerges
- Intention: Intention is finding meaning in one’s suffering, and being willing and able to understand your transition from victim to empowered person. It’s the time when you realize that you will live with traumatic brain injury for the rest of your life, and you learn to accept who you are with your injury
- Introspection: Becoming an observer of one’s thoughts, actions, and feelings, and having a sense of mindfulness and accountability. “There is no recovery without accountability,” Yaer said
- Insight: Beginning to trust yourself, recognize your behaviors, realize your sense of purpose, see hope, and trust that you will get through. At this point, it is important to follow your recovery plan and find people who can support you in your recovery
- Intuition: Self-empowerment comes full circle, Yaer said. “You realize you will continue to go through the self-empowerment process throughout your life,” she said.
Treating Traumatic Brain Injury
Because patients enter Sierra Tucson for treatment of substance abuse issues, as well as eating disorders,trauma, chronic pain, sexual addiction, and depression, staff will not necessarily be aware of a brain injury unless the patient is aware of it and shares that information. The brain injury itself may have been the root of the substance abuse disorder, or the patient may have been abusing substances when the brain injury occurred.
Traumatic brain injury can present very subtly, so during intake and throughout treatment, Sierra Tucson staff members can explore possible brain injury effects. Once the therapist realizes a patient has a special need, the therapist will work on addressing that issue.
Sierra Tucson’s Medical Director Robert Johnson, D.O., states, “If we suspect a patient has had a brain injury, we can bring together a variety of modalities to assess the nature and extent of the injury, from neuropsychological testing to functional brain imaging.”
Brain SPECT scanning is used at Sierra Tucson to provide real-time pictures of brain physiology, and these scans often reveal damage to the pre-frontal cortex or other abnormalities due to traumatic injury and substance abuse.
“Knowledge of a brain injury allows us to tailor the treatment plan to address the issue discretely and thoroughly,” Yaer said.
When a brain injury occurs, it often affects the left brain and frontal lobe, which controls rational thinking and executive functions. That leaves available the right brain, which controls more intuitive functions. To tailor treatment, Yaer said, therapists will often work to make new pathways through the right brain by having the patient work with more creative therapeutic modalities, such as animals, music, art, or nature.
“When a pathway is damaged in the brain, the brain can work toward recreating new neural pathways,” Yaer said. “However, this process takes time, persistence, patience, energy, and compassion for self and others.”