Elfie du Toit, who heads up Wedge Gardens Treatment Centre’s occupational therapy department, explains that the brain is a specialised, integrated and complex organ that is responsible for every thought and movement produced by the body.
When a part of the brain is injured, the ability to move, speak, process thoughts or generate appropriate reactions may be compromised.
“Studies show that using substances cause an imbalance of chemicals in the brain, compromising the homeostatic environment which is essential for healthy brain function,” says Du Toit.
“Some studies reported that obvious deterioration of cognitive functioning was present long after the effect of intoxication and withdrawal symptoms have cleared up. It has also been established that the use of substances has a tremendous effect on the functioning of the frontal and temporal lobes of the brain. These areas of the brain are responsible for perception, modulation, sustained attention, flexibility, working memory, response inhibition, emotional regulation, planning, organisation, time management and self-monitoring.
“These are a set of mental skills/cognitive abilities needed to control and regulate behaviours, initiate and stop actions, monitor and change behaviour as needed, and to plan future behaviour when faced with novel tasks and situations.”
Du Toit explains that executive functions can be defined as high-level abilities that influence more basic abilities like attention, memory and motor skills. Executive function is necessary for goal-directed behaviour, successful adaptation and performance in real life situations.
“This enables individuals to cope effectively with life stressors. Individuals with poor executive functioning often struggle with work, interpersonal relationships and managing daily life challenges due to an inability to inhibit inappropriate behaviour due to poor impulse control.
“Chronic substance abusers often show impairments with regards to executive functioning. These deficits appear to be directly related to the substance abuse, but it should also be considered that poor executive functioning can increase an individual’s susceptibility to substance dependence. The extent in which executive functioning is affected can also be related to the quantity and duration of drugs used, as well as the specific substance used, and the number of previous hospitalisations.
“When considering executive dysfunction in patients with substance abuse problems, the failure of some patients to change their lifestyle can be related to the inability of cognitive flexibility. Although patients are aware of their destructive behaviour they struggle with controlling and changing these behaviours and persist on the same path,” she says, explaining why the Rand Aid Association rehabilitation centre places much emphasis on occupational therapy.
“Significant impairment in executive functions such as the lack of ability to complete tasks, arrange events, maintain attention and resisting irrelevant stimuli can contribute to the failure of patients to maintain abstinence, marriage or work. Patients with executive dysfunction struggle with the ability to detect and fix errors. Thus, they do not learn from their mistakes and do not develop affective learning.”
Other studies have also shown that the toxic effect of substances cause structural damage to the hippocampus (part of the limbic system, often known as the emotional brain), which is responsible for memory formation and behavioural inhibition. Substances such as stimulants, marijuana and opiates target dopamine receptors in the brain, and can result in life-long damage to the development of impulse control and the capacity to experience reward, which leads to immature or under-controlled emotional responses.
“Strategies for increasing and improving executive functioning abilities include creating a structure, following daily routines, developing a reminder system, and to practise impulse control and emotional self-regulation by becoming aware of triggers and learning to avoid them. Patients should be stimulated to access positive emotions in order to cope with, and manage negative emotions, by learning self-soothing techniques,” she stresses.
* Wedge Gardens can be reached at 011 430 0320. You can also ‘like’ Wedge Gardens on Facebook (www.facebook.com/WedgeGardensTreatmentCentre) or follow them on Twitter (@WedgeGardens)