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Introduction

Certain drugs cause chemical changes in the brain that can persist long after the drugs are gone. According to Gould, those changes can make it difficult for an individual to perform basic memory tasks and inhibit sound decision making skills as well. Alcohol abuse and repeated overdoses of drugs cause serious changes in the brain that can catalyze cognitive disorders. Occupational therapists can play a major role with individuals with substance abuse disorder, using cognitive training techniques as a tool to improve their memory performance and other cognitive impairments, such as inattention.

Theory

Psychoeducational theory is a humanistic approach to changing the behavior patterns, values, interpretation of events, and life outlook of individuals who are not adjusting well to their environment. In this approach, Brown explained how client education is provided about their illness, symptoms, stressors, and empowering them through education how to manage their illness better. By teaching Maggie about her substance abuse disorder and the effects it may have on her cognition, we are empowering her to be proactive in improving her deficits in order to fulfill her responsibilities as a mother and improve her overall QoL.

Evidence

Research suggests that drugs can directly impact brain activity including cognitive function. Drug-use, more specifically, alcohol abuse is “associated with a clear and consistent pattern of general cognitive deficits” (Vik, Cellucci, Jarchow, & Hedt, 2004). Memory, attention, executive functioning and problem solving skills are some of the skills mostly affected when living with a substance abuse disorder. Studies done on the abuse of other drugs such as amphetamines and cocaine found that “performance on working memory tasks, including short-term memory, attention to relevant detail, and cognitive manipulation of information” (Vik, Cellucci, Jarchow, & Hedt, 2004). It has been discovered that patients with substance abuse who have impaired cognition have shown improvement with group interactions rather than with CBT.

Case Study

Maggie is a 32-year-old women that works as an emergency room nurse in a hospital located in Chicago. She is a single mother with two young children under the ages of five. She has been dealing with her addiction to stimulants, specifically adderall, in order to improve her job performance for several years. Maggie has recently been experiencing problems with short-term memory secondary to her many years of drug addiction. She has been forgetting to bathe and pack her children’s lunches. The school faculty has been in contact with her due to her children’s appearance, no packed lunches, or money for food. She struggles to find methods in improving her short-term memory. Maggie is currently receiving psychotherapy from her psychiatrist and receiving occupational therapy focusing on cognitive training.

Intervention Plan

Problem Statement:

Maggie has difficulties with child rearing secondary to memory deficits and inattention.

Short-Term Goals:

1. Maggie will attend to her child while helping her with a school assignment for 30 minutes without getting distracted in 2 weeks.
2. Maggie will complete 3 out of 5 tasks of her morning routine with minimal verbal cues in 2 weeks for improving memory.
3. Maggie will utilize at least 3 environmental modifications (i.e.checklists, visual schedule, alarms) in order to compensate for memory deficits in 2 weeks.

Long-Term Goals:

1. Maggie will create and follow a daily routine in order to improve child rearing before discharge.
2. Maggie will be able to recall 4 responsibilities that are necessary independently for improved memory performance before discharge.

Intervention Format:

Individual

Setting:

Maggie will meet with the occupational therapist in an outpatient clinic for 1 hour 3x per week for 1 month.

Supplies:

1. Large white dry-erase board with dry-erase markers
2. Daily Journal

Agenda:

• Therapist administers cognitive screening, testing for attention and memory (10 min)
• Therapist interviews Maggie to find what her concerns are (10 min)
• Therapist educates Maggie on substance abuse and the effects it is having on her memory(10 min)
• Therapist presents today’s session outline and discusses the plan of action (5 min)
• The therapist introduces a variety of strategies to help Maggie improve her short-term memory (20 min)

• • • To-do lists
    • Routines
    • Whiteboard calendar with times for daily tasks
    • List of chores for children to complete

• Provide a summary of the discussion (5 min)

Documentation

S: Maggie states she has difficulties remembering that she has to take care of her young children’s responsibilities on top of her own responsibilities. She mentions that she has gotten calls from the school due to the kid’s untidy appearance on a daily basis, and how they are left without lunch more than twice a week. She wants to feel more in control and be able to take care of herself as well as her children.

O: Maggie participated in a cognitive screening to test her memory and attention. Results showed poor attention span and short-term memory deficits. Therapist provided and demonstrated 4 strategies that she can use to enhance her memory performance.

A: Based on screening results, it is evident that Maggie would benefit from cognitive strategies to improve her memory performance.

P: Maggie will continue cognitive impairment training in order to increase her short-term memory for improvement in child rearing. Evaluate improvement in client’s memory progression; continue to enhance tx activities when necessary. Client is to see OT 3x per week for 1 month.

References:

Brown, C. (2011). Cognitive Skills, in Occupational Therapy in Mental Health: A Vision for Participation. Brown, Stoffel, Editors. FA Davis: Philadelphia

Gould, T. J. (2010). Addiction and Cognition. Addiction Science & Clinical Practice, 5(2), 4–14.

Rapeli, P., Kivisaari, R., Kähkönen, S., Puuskari, V., Autti, T., & Kalska, H. (2005). Do individuals with former amphetamine dependence have cognitive deficits?Nordic Journal of Psychiatry, 59(4), 293-297. Retrieved from http://ezproxy.fiu.edu/login?url=https://search-proquest-com.ezproxy.fiu.edu/docview/620892921?accountid=10901

Vik, P. W., Cellucci, T., Jarchow, A., & Hedt, J. (2004). Cognitive impairment in substance abuse. Psychiatric Clinics of North America, 27(1), 97-109. http://dx.doi.org.ezproxy.fiu.edu/10.1016/S0193-953X(03)00110-2