Suggestions for Substance Use Treatment Providers

Suggestions for Working with Persons Who Have TBI

Ask how well the person reads and writes; or evaluate via samples.
Evaluate whether the individual is able to comprehend both written and spoken language.
If someone is not able to speak (or speak easily), inquire as to alternate methods of expression (e.g., writing or gestures).
Both ask about and observe a person’s attention span; be attuned to whether attention seems to change in busy versus quiet environments.
Both ask about and observe a person’s capacity for new learning; inquire as to strengths and weaknesses or seek consultation to determine optimum approaches.

Modify written material to make it concise and to the point.
Paraphrase concepts, use concrete examples, incorporate visual aids, or otherwise present an idea in more than one way.
If it helps, allow the individual to take notes or at least write down key points for later review and recall.
Encourage the use of a calendar or planner; if the treatment program includes a daily schedule, make sure a "pocket version" is kept for easy reference.
Make sure homework assignments are written down.
After group sessions, meet individually to review main points.
Provide assistance with homework or worksheets; allow extra time for tasks that involve reading or writing.
Ask family, friends, or other service providers to reinforce goals.
Remember that something learned in one situation may not be generalized to another.
Repeat, review, rehearse, repeat, review, rehearse.

Let a person know a behavior is inappropriate. Do not assume the individual is making a conscious choice to act out or is even aware that he is misbehaving.
Be clear about the behaviors that are expected and provide direct feedback when inappropriate behavior occurs.
Redirect tangential or excessive speech, and establish a method to unobtrusively signal inappropriate behavior in public.

Do not presume that non-compliance arises from lack of motivation or resistance, check it out.
Be aware that unawareness of deficits can arise as a result of specific damage to the brain and may not always be due to denial.
Confrontation shuts down thinking and elicits rigidity; roll with resistance.
Absences or lack of follow-through may be reasons to change treatment strategies. Don't rush to discharge.