The inter-relationship between acquired brain injury, substance use and homelessness; the impact of adverse childhood experiences: an interpretative phenomenological analysis study

Abstract

Purpose

Acquired Brain Injuries, caused by a range of illnesses and injuries, can lead to long-term difficulties for individuals; mental health problems, cognitive and executive impairment and psychosocial problems including relationship breakdown, substance abuse and potentially homelessness. The study aimed to seek and gain a more definitive understanding of the inter-relationship of Acquired Brain Injury, substance abuse and homelessness by identifying key themes associated with the inter-relationship between these variables.

Materials and methods

The study recruited eight participants through homeless organisations and treatment centres. Participants were screened for suitability (Brain Injury Screening Index; Drug Abuse Screening Tool; Alcohol Use Disorders Identification Test and then participated in recorded semi-structured interviews, transcribed and analysed using Interpretative Phenomenological Analysis.

Results

The study identified five master themes: Adverse Childhood Experiences and Trauma; Mental Health; Cognitive Decline and Executive Function; Services; Relationships.

Conclusion

Healthcare professionals need to engage with children, their families, and adults, who have been exposed to adverse childhood experiences and should employ routine screening tools for brain injury to ensure their presence is factored into developing appropriate models of intervention.

IMPLICATIONS FOR REHABILITATION

• Need person-centred approaches to intervention for those with acquired brain injury who are homeless and have substance abuse issues.

• Need to screen for the presence of acquired brain injury when engaging with individuals who are homeless or have substance abuse.

• Need screening of acquired brain injury and adverse childhood experiences to improve access to services post-brain injury.

Keywords:

• Brain injury
• adverse childhood experiences
• homelessness
• mental health
• rehabilitation

Acknowledgements

Thank you to the homelessness organisations who helped with recruitment and to our participants for sharing their difficult stories.

Disclosure statement

The authors confirm that they have no declarations of interest in this area except that the third author is a brain injury case manager.

Data availability statement

Data can be obtained through contacting the first or second author.