The prevalence of cognitive impairment in rural substance treatment participants: The implications for treatment approaches

Cognitive impairment (CI) includes acquired or traumatic brain injury, intellectual disability or Fetal Alcohol Spectrum Disorder (FASD). Cognitive impairment is a hidden disability which, for example, affects encounters with people in their surroundings, and can lead to difficulties in relations and contacts with society.

A high prevalence of substance use problems has been identified in cognitively impaired people and alcohol use is a frequent contributing factor to acquired brain injury. Some of the behaviours described as common features of CI such as poor self-monitoring and self-regulation and dependence/lack of initiative are seen to be causes and consequences of addiction thereby prescribing a moral rationale to behaviour that may have a physical cause.

To increase staff awareness of the prevalence of CI, screening of all consenting clients with the Addenbrooks Cognitive Examination – Revised (ACE-R) for a 3 month period was conducted. Analysis of the ACE-R total scores included qualitative variables (indigenous status and gender) and quantitative variables (age and effective years of education). Logistic regression was used to analyse the effect of all variables at once. The analysis of fifty completed ACE-R screens found that 40% of participants were likely to have a cognitive impairment (scored <88 88="88" age="age" and="and" below="below" br="br" clients="clients" effect="effect" gender="gender" had="had" indigenous="indigenous" likely="likely" more="more" no="no" on="on" p="0.0241)" results.="results." score="score" that="that" the="the" to="to" were="were">
These results have significant implications for the way drug and alcohol treatment interventions are provided, particularly in residential settings. The agency identified two strategies to improve accessibility for clients with cognitive impairment, a quality improvement plan with a training component and a resource review. 

These strategies will be discussed by
Dr Julaine Allan at the:

4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

Web:  http://anzmh.asn.au/rrmh          Email: ruralhealth@anzmh.asn.au

Drug and Alcohol Addiction

Drug and alcohol are related to 80% of mental issues. They are powerful chemicals able to change our pattern of thought and our behaviour. Most of us would have experienced in our lifetime the effect of these powerful drugs on the brain chemicals.

According to the Human Givens model the reasons why humans are not only attracted to them and enjoy a glass of wine but become addicted to alcohol and drugs is because of the unmet psychological needs. Addiction is a trance state and unless the psychological needs are met via other means the addiction will continue. The way to deal with it is to break the trans-state.

Studies conducted in addicted lab rats or soldiers returning from Vietnam showed that once their physical or psychological needs were met their addiction stopped without any further help.

Negative thoughts of isolation and withdrawal from problems and responsibilities are typical of the addictive behaviour.

The neurochemical systems mediating motivation and reward are the dopamine and the opioid one. Dopamine is appetitive opioid is consumatory.

According to the neurochemical model the amygdala is the organ deputised to advice the brain of the lack in a chemical substance, can be nicotine, alcohol or any addictive chemical. Once the system is activated a distressing signal is sent to the anterior cingulate where it is analised and pattern matched to previous events in the lymbic system for significance.

If that is significant a further signal will be sent to the neocortex to decide on the way of action, otherwise an immediate response will follow and before the concious mind can realise what is happening an action will be taken (i.e. lighting a cigarette before we can contiously realise it).
Treatment:
a) change lifestyle
b) plan for high risk situations
c) counter-condition expectations

Dr Angelo Cacciato is a GP working in a rural setting in New Zealand. He moved to Waikanae in April 2007 after spending thirteen years in UK.

He started developing an interest in Mental Health during his military service in Italy in1989.
Once he moved in Britain he got involved in a rotation to complete his postgraduate studies in General Practice. As part of his rotation he joined the psychiatric unit at Royal Doncaster Infirmary where he worked for six months.

Once he completed his medical studies he started working in the Yorkshire region, and the settings of General practice allowed him to become involved in psychotherapy with the Mindfields College.
After completing the course in Human Givens therapy he got his qualifications in psychotherapy in 2007 and the same year he achieved the prestigious postgraduate diploma of the Mindfields College.

He is the only Human Givens therapist working in New Zealand and will speak at the:
12th International Mental Health Conference
Radisson Resort, Gold Coast - Wednesday 24th August – Friday 26th August 2011.