APNA 28th Annual Conference Session 4027: Saturday, October 25

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Isaac DaramolaNurse Practitioner Candidate

Credentialed Mental Health NurseMACNP – MACMHN – MACN – University of Newcastle, NSW Australia

Australian Government, Canberra

www.worldatlas.com

www.telegraph.co.uk

www.telegraph.co.uk

www.zoo.org.au

APNA 28th Annual Conference Session 4027: Saturday, October 25

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www.zoo.org.auwww.zoo.org.au

www.zoo.org.auwww.zoo.org.au

Australia ‐Marsupials

www.zoo.org.au

www.zoo.org.au

APNA 28th Annual Conference Session 4027: Saturday, October 25

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Isaac Daramola

Program Contents

Research Study of Drug-related ABI in PrisonsImplications of Study Findings

The Slippery Slope of AddictionABI & Frontal Lobe Dysfunction

Discussion/Questions/Quiz/Recess

This speaker has no conflict of interest to disclose

Drug-Related Acquired Brain Injury (ABI) in Prisons

Study Purpose:*To gain an understanding of the prevalence of ABI among Victorian Prisoners

*To test for under-identification of drug-related ABI among Victorian Prisoners

Rationale for Study

*In Australia & internationally, correctional agencies have not identified ABI as being an issue of specific concern (WHO)

*The understanding of the prevalence of ABI is limited to head trauma rather than drug-induced

Drug-Related Acquired Brain Injury (ABI):

Participant Recruitment: *(n=146) adult male prisoners – from Melbourne Assessment Prison (MAP) invited*(n=149) adult female prisoners – from Dame Phyllis Frost Centre (DPFC prison) invited

Recruitment Materials & Procedures*Participants were recruited through the Sentence Management Unit (SMU) of MAP & DPFC*Staff training conducted on ABI & the application of the ABI Screening Tool prior to commencement

Recruitment Criteria:*Sentenced Prisoners only (via SMU)- not in transit/remand*Exclusions: Prisoners with I.D & C.A.L.D

Drug-Related Acquired Brain Injury (ABI):

*One hundred and nine out of 146 adult male prisoners consented to participate in the study (75% of male invitees)

*Eighty-six out of 149 adult female prisoners consented to participate in the study (58% of female invitees)

www.corrections.gov.au

APNA 28th Annual Conference Session 4027: Saturday, October 25

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www.corrections.gov.auwww.corrections.gov.au

www.corrections.gov.auwww.corrections.gov.au

www.corrections.gov.au

APNA 28th Annual Conference Session 4027: Saturday, October 25

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www.corrections.gov.au

Drug-Related Acquired Brain Injury (ABI):

Method: 3-stage screening process

Aim: To Evaluate the efficacy & validity of a 3-stage process of identifying ABI prevalence data in VIC prisons.

Stage1: Initial Screening of Prisoners with ABI Screening Tool. Stage 1 - Intended to identify participants with positive indicators for ABI & warranted further investigation , thereby reducing the rate of false negatives.

Stage 2: Clinical InterviewStage 2: Intended to refine possible ABI risk factors found at screening

Stage 3: Comprehensive Neuropsychological AxStage 3: Intended to obtain an actual prevalence rate rather than an estimate

Drug-Related Acquired Brain Injury (ABI): Stage 1: The ABI Screening Tool

*Risk Factor Based Checklist *Risk Factors Screen focussed on scientifically proven ABI risk indicators:

- Alcohol use- Drug use- Traumatic Brain Injury (multiple causes)- Hypoxic Brain Injury (multiple causes)

Drug-Related Acquired Brain Injury (ABI): Stage 1: ABI Screening Tool

Jackson, Hardy,  Persson & Holland (2011)

Drug-Related Acquired Brain Injury (ABI): Stage 2: Clinical Interviews

*Semi-structured interview format

*Elicited demographic information, personal medical, psychiatric, alcohol and substance use history

*History of contact with treatment and community support services

*Early developmental history, schooling and occupational history, current physical functioning and cognitive difficulties.

Drug-Related Acquired Brain Injury (ABI): Stage 2: Clinical Interviews

Jackson, Hardy, Persson & Holland (2011)

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Drug-Related Acquired Brain Injury (ABI) : Stage 3: Comprehensive Neuropsychological Assx

*A comprehensive neuropsychological test battery was used for standardised data collection

*The test battery included some of the most commonly used measures in clinical practice and research

*The neuropsychological tests were selected on the basis of their extensive development, psychometric properties and sound normative sample data

*Impairment in a cognitive skill was determined when performance falls below normal limits for age expectation (i.e > 1.5 standard deviations)

Drug-Related Acquired Brain Injury (ABI) : Stage 3: Comprehensive Neuropsychological Assx

Jackson, Hardy Persson & Holland (2011)

Drug-Related Acquired Brain Injury (ABI) : Stage 3: Comprehensive Neuropsychological Assx

*74 male prisoners undertook stage 3

*43 female prisoners undertook stage 3

*Results collated from only participants who completed all 3 stages of the study

What does this mean?

Very High Drop-Out Rates from this Study

Males146 expressed interest109 consented & screened for s190 (82%) participated in s2 74 (67%) participated in s3

Females149 expressed interest86 consented & screened for s153 (61%) participated in s243 (50%) participated in s3

66% of males & 75% of females tested with positive indicators of ABI

63% of males & 79% of females reported at least one current or past psychiatric diagnosis

55% of males & 72% of females had mild drug-related ABI

39% of males & 21% of females had moderate drug-related ABI

6% of males & 7% of females had severe drug-related ABI

Jackson, Hardy & Holland (2011

APNA 28th Annual Conference Session 4027: Saturday, October 25

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Two-percent (general population) vs doublefigures in the prison population→ high prevalence levels in prisons

Study found significant differences in cognitiveprofiles between male & female prisoners

Females → impairment in spatial abilities, complex attention & working memory

Males → more widespread and generalized impairments in all areas

Mild & Moderate levels of drug-related ABI becomesevere upon release from prison

Severe ABI restricts the ability to recognize future consequences resulting from current actions

Upon un-detection and release into the community, the individual carries with them an undetected severe ABI

Recipe for:Almost guaranteed re-offending – someone gets badly HURT

Which May Involve:MurderManslaughterAssaults – physical, sexual or even premeditated rapeSocial Misnomer/Psychopathy – urges for blood/mass killing

Sugar Addiction Drug Addiction

Source: American Journal of Psychiatry

Sugar Addiction

Source: American Journal of Psychiatry

*Biological Anticipation

*Instant Effect from Ingestion of a reasonable quantity

*Satisfaction is immediate with a small quantity

*Repeats = Reward‐motivated behaviour = No Brain Damage

Drug Addiction

Source: American Journal of Psychiatry

*Biological Anticipation

*Very Little or No Effect from Ingestion of a reasonable quantity

*No satisfaction from previous quantity

*Higher Repeats = Reward‐seeking behaviour = Brain Damage

https://www.youtube.com/watch?v=5f1nmqiHIII

https://www.youtube.com/watch?v=CGm5zkYCHkQ (up to 3:10)

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*Higher and higher amounts needed to produce the same effects

*Constant/same amounts over time produces less and less effects

*In order for dopamine to be released, the individual will take more and more and more

*Acquired Brain Injury = Frontal Lobe DysfunctionJackson, Hardy Persson & Holland (2011)

* Inability to recognize future consequences resulting from current actions

*↓Judgement in choosing between good and bad actions (or better and best)

*Inability to Override and suppress socially unacceptable responses

*Poor determination of similarities and differences between things or events.

*Poor retention of memory

*Poor modification of emotions to fit socially acceptable norms

How does a dysfunctional frontal lobe affect daily life?

*Sequencing*Difficulty making decisions*Decreased attention*Changed Personality*Decreased problem solving ability*Difficulty with verbal expression*Latency – lack of spontaneity*Poor emotional control of urges/impulses (e.gsexual)

Australian Government Canberra: Australian Coat of Arms

American Journal of Psychiatry: The onset of addiction

Google Maps: Map of Australia, Map Data 2014

Jackson N et al (2011): Acquired Brain Injury in the Victorian Prison System

www.worldatlas.com: Map of the world

www.telegraph.co.uk: Melbourne city skyscrapers

www.zoos.org.au: Melbourne Zoo

www.dhs.vic.gov.au/__.../Disability_abi_resourcemanual_201205.pdf: World Health OrganisationABI Resource Manual

www.corrections.gov.au – prison pictures

www.bondpix.com: Dame Phyllis Frost Centre Prison – inside