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
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.

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