Mr. B. sustained a severe traumatic brain injury after being struck by a vehicle as a pedestrian. Following his acute hospitalization, he was discharged home to the care of his parents, where he resumed earlier habits of alcohol and prescription medication abuse. Previous treatment teams asserted that he had plateaued. Mr. B. wanted to pursue post acute rehabilitation at CORE, but in a screening interview said he could not guarantee his sobriety given his 20+ year history of substance abuse.
Upon admission, Mr. B. agreed to and underwent periodic random urine screens for illicit drug use. He received comprehensive multidisciplinary therapies, including regular individual and group psychotherapy. During his admission, which lasted almost one year, he made significant functional gains, including documented improvement in attention, memory, and social skills. He remained alcohol- and drug-free for the first time in over 20 years. Mr. B. also completed a rigorous course of treatment for his chronic medical condition. Toward the end of his rehabilitation stay, Mr. B. successfully completed certification as a para-educator, working with special needs individuals. He was discharged to a sober living community where he pursued work as a para-educator.
An issue paramount to cases like Mr. B. is continued sobriety in the discharge environment, particularly when faced with triggers for substance use. Once fully developed, functional neuroimaging can allow therapists to determine the strength of associations between these stimuli and substance use in order to predict ongoing sobriety and to target interventions to weaken or extinguish these associations.