brain function assessment

Brain Function Assessment and

Emotional Profile of Young Persons

with Substance Use Disorders

Dr. Andrew M.H. Siu

Co-authors

Dr. Alex Wong, Prof. Chetwyn Chan,

The Hong Kong Polytechnic University

Ms. Debby Wong, Mr. Charlie Chan,

Caritas Youth & Community Service

Outline

Model of Service for Young Persons with

Substance Use Disorders

Research:

Brain Function Assessment

Emotional Profile: Depression & Anxiety

Motivation for Change

SERVICE FOR YOUNG PERSONS

WHO ABUSE DRUGS

Design of ServiceOutreach (Disco,

Night Club, Pub/Bar)Referral

Brain Function & Emotional Evaluation +

Motivational Interviewing

Case Follow-up Peer Counseling Life Partnership

Medical Check-up

Health Monitoring, Drug Counseling,

family Support, Emotions Management

Structure

Organizations People

Applied Cognitive

Neuroscience

Laboratory (ACNL)

of PolyU

Dr. Andrew Siu

Dr. Alex Wong

Prof. Chetwyn Chan

The Caritas Youth

and Community

Service, A Journey of

Awakening (Beat

Drugs Fund)

Ms. Debby Wong

Mr. Charlie Chan

Brain Function & Emotional Evaluation

Motivational Interviewing

Follow-up

Participants

Age

Range: 14 – 25

M = 19.6 (SD = 2.8)

Gender

Females (69.1%)

Education

F3 or Below : 47.4%

F4 to F5: 49.5%

Above F5: 3.1%

Work Status

Sales & Service, 16%

Clerical, 10%

Catering & Food, 9%

Construction & Engineering,

5%Transportation & Logistics, 4%Beauty &

Salon, 2%

Unemployed, 28%

Student, 26%

First Time They Take the Drug (n = 97)

Drug First contact

M SD

Hallucinogin

Cannabis (草) 15.2 2.1

Stimulant

Cocaine (可樂) 17.9 2.4

MDMA: Ecstacy (搖頭丸) 15.1 1.8

Amphetamine (冰) 16.1 2.5

Tranquilizer

Diazepam (5仔) 16.2 2.2

Triazol-lun (白瓜子) 15.2 1.6

First Time They Take the Drug (n = 97)

Drug First Contact

M SD

Ketamine (K仔) 15.1 1.9

Others

Cough medicine 15.8 1.9

Alcohol 13.6 2.8

Tobacco 13.0 2.2

Thinners, Cough tablets 15.2 1.8

BRAIN FUNCTION TESTING &

MOTIVATIONAL INTERVIEWING

Brain Function Assessment

We conducted a series of tests on selected brain

function, e.g. processing speed, attention, memory, etc.

The test package normally take 1.5 to 2 hours to

complete (with rest periods in between).

Compared with norms, 64.9 % of participants had at

least one deficit among all the functions tested.

Brain Function Tests

Processing Speed Symbol Digit Modalities Test

Concentration Digit Vigilance Test

Sustained attention Stroop Test

Verbal Memory Chinese Auditory Verbal Learning Test

Visual Memory Continuous Visual Memory Test

Reasoning Test of Non-verbal Intelligence Test

Verbal Fluency Verbal Fluency Test

Figural Fluency Ruff Figural Fluency Test

Mental Flexibility Trail Making Test

Assessment Tools

Function Normal (%) Mild

(%)

Moderate

(%)

Severe

(%)

Has Deficit

(%)

Processing Speed 86.6 3.1 8.2 2.1 13.4

Concentration 69.1 15.5 9.3 6.2 31.0

Sustained attention 90.7 3.1 4.1 2.1 9.3

Verbal Memory 88.7 7.2 4.1 0 11.3

Visual Memory 77.3 5.2 15.5 2.1 22.8

Reasoning 94.8 3.1 2.1 0 5.2

Verbal Fluency 90.7 5.2 2.1 2.1 9.4

Figural Fluency 64.9 16.5 10.3 8.2 35.0

Mental Flexibility 91.8 4.1 3.1 1.0 8.2

Assessment Results

Brain Function Assessment Results

EMOTIONAL PROFILE:

DEPRESSION & ANXIETY

Assessed using Beck Depression

Inventory II

According to cut-off scores, 62.2% are

depressed.

Overseas studies showed that 24 to 30

％ of persons with substance abuse had

depression

Depression

Depression (BDI-II scores)

Anxiety

• Assessed using State-Trait Anxiety

Inventory (STAI)

• 15.8% had anxiety symptoms in state

scale.

• Overseas studies showed that 16 to

20% of persons with substance abuse

has anxiety disorders, many had Post-

Traumatic Stress Disorders

Anxiety (STAI scores)

Trait (%) State (%)

Normal 87.4 84.2

Mild 9.5 9.5

Moderate 3.1 5.3

Severe 0 1.0

Deficits

Total

12.6 15.8

Motivational Interviewing

Works by activating

patients’ own motivation

for change and

adherence to treatment.

Evocative: elicit what

the client already has,

(e.g. values, dreams,

goals, personal & social

resources), not what

s/he hasn’t.

Honoring patient autonomy

Evocative

Collaborative

Motivational Interviewing

protocol1. Present brain function assessment & emotional

profile

2. Explain & clarify test results

3. Invite participant to give feedback & comments

4. Listen to how the participant interpret the results

5. Listen to Ambivalence and elicit Change Talk

6. Explore Change Talk and Summarize the big picture

(forces of change)

7. Identify Key Struggles, Motivation for Change, and

Stage of Change)

Report Booklet

報告

Explanation on Brain Function

「梗係唔可以集中精神去完成一件事，忽然間會遊咗去唔知邊度。」 (Sustained Attention 注意力持久度)

Case 1:「係公司點點下貨忽然間停咗落嚟，遊晒魂，有幾次仲比同事拍我先識回魂！」

Impact of Deficits on Daily Activities

MOTIVATION FOR CHANGE

Method

Content analysis of interviews with 22

(around 30%) participants

Analysis of cases by counselor

Based on Motivational Interviewing &

Stage of Change Model

MI Model

Commitment

Taking Steps

Desire

Ability

Reasons

Need

Behavioral

Change

Listen to Change Talk

Commitment

(PC, C)?

Taking Steps

(A, M)?

Behavior Change

Desire

What do you want, like, wish,

hope?

AbilityWhat is possible? What can you do?

ReasonsWhy change?

What benefits? What risks?

NeedHow important is this change? How much

you like to do it?

Reasons for Drug Abuse (n = 22)

Drug Abuse

Family（n＝ 8）

Peer Influence

(n = 10)Manage Emotions

（n = 7)

Motivation (Reasons) for

Change

Motivation for

ChangeFinances

(13.6%)

Social Support

(18.2%)

Family:

Love, Support & Pressure

(45.5%)

Health:

(81.8%)

Achievement: work or study

(27.3%)

Dating, Marriage, Motherhood

(18.2%)

Stage of Change (n = 22)

Precontemplation (n = 5; 22.7%)

Contemplation (n = 12; 54.5%)

Action (n = 2; 9.1%)

Maintenance (n = 3; 13.6%)

Summary

Drug abuse is associated with poor

brain function and emotional health

64.9% of participants had at least one type

of cognitive deficit.

Deficits in concentration, visual memory, &

figural fluency are common

More than 60% of participants had

depressive symptoms, 15% had anxiety

symptoms.

Summary

Cognitive deficits could have great

impact on daily life or work functioning.

Need to develop a set of cognitive

training or compensation strategies for

addressing cognitive deficits

Need to address depression as co-

morbid illness to drug abuse

Summary

Clients need to develop alternative

strategies in managing emotions

Health, family issues, & emotions

management issues are important foci

in motivating client for change

Many clients need assistance to move

from Contemplation to Preparation and

Action

Contributions

1. Establish a model of assessment addressing

common cognitive & emotional issues in

drug users

2. Provide an understanding of cognitive &

emotional profile of young persons who

abuse drugs

3. Discuss Service Implications

Reference

Connors, G. J., Donovan, D. M., & DiClemente, C. C.

(2001). Substance abuse treatment and the stages of

change: Selecting and planning interventions. New

York: The Guildford Press.

Estroff, T. W. (Ed.) (2001) Manual of adolescent

substance abuse treatment. Washington, DC:

American Psychiatric Publishing, Inc.

Rollnick, S., Miller, W. R., & Butler, C. C. (2008).

Motivational interviewing in health care: helping

patients change behavior. New York: The Guildford

Press.