Rocky Mountain MIRECC TBI Toolkit - MIRECC / CoE
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Rocky Mountain MIRECC TBI Toolkit

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Justice Involved Pages: Home | TBI & Incarceration | TBI-Related Problems |
Screening/Assessment | Management & Intervention | Resources



Jump to: Executive Dysfunction | Mental Health and Substance Abuse

Executive Dysfunction

Components of Executive Dysfunction and Impact on Functioning In Criminal Justice Populations

Language & Communication

  • Problems extracting the gist of speech
  • Difficulty understanding and following legal proceedings

Attention, Memory & Processing Speed

  • Difficulty focusing on tasks, following directions
  • Slowed responses to directives
  • Difficulty learning routines

Anger, Irritability and Impulse Control

  • Difficulties inhibiting aggressive behavior, "thinking before acting"
  • Increased conflict with other inmates

Initiation, Planning and Problem-Solving

  • Difficulty initiating requests for assistance
  • Interfere with complex goals such as finding housing and employment
  • Difficulties coming up with alternative solutions to barriers

Judgment and Decision-Making

  • Difficulties in these areas may reduce capacity to detect and avoid dangerous situations

Incarcerated individuals with a history of TBI may experience significant challenges at different points of involvement with the criminal justice system. Many of these challenges are related to problems in executive functioning.

Executive functioning describes a set of higher-order cognitive functions that including attention, planning and organization, decision-making, problem solving, and impulse control. These functions are crucial for self-regulation and goal-directed behavior.

In justice-involved populations, deficits in these areas have been associated with:

  • Higher rates of infractions and disciplinary action,
  • Difficulties complying with parole and probation, and
  • Greater rates of re-offending and recidivism


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Mental Health and Substance Use

Justice-involved individuals with TBI are at increased risk of psychiatric disorders and substance abuse. Individuals with multiple TBIs have significantly higher levels of alcohol and/or drug use prior to incarceration and higher risk of psychological disorders.

Substance-related issues have been identified in over 60% of adult offenders and 77% of juvenile offenders (with over half of male and female offenders having been found to have a substance use disorder). Prisoners with TBI and co-morbid drug abuse are at a significantly increased risk of depression, anxiety and difficulties in regulating anger.

In juvenile justice populations, youths with TBI (compared with those reporting no TBI) had:

  • Greater psychiatric symptoms and psychological distress
  • Earlier onset of criminal and substance-using behaviors
  • Greater lifetime substance abuse problems and suicidality
  • More frequent past-year criminality
  • Greater lifetime exposure to violent traumatic events
  • Increased likelihood of being diagnosed with a mental health disorder
  • Increased participation in fights

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