While JD Piper was on work release from prison in Las Vegas in 2011, he fell 35 feet from a tree onto his head, causing a traumatic brain injury. 

But a brain injury coupled with a history of opioid and methamphetamine addiction meant Piper's road to recovery was that much more difficult. His treatment would have to encompass not only relearning how to manage his life again, but Piper, 48, would also have to address his addictions to heroin, cocaine and methamphetamine.

At the Centre for Neuro Skills in Bakersfield, therapists and counselors recognize that brain injuries often don't occur in isolation — the complex condition is often exacerbated, or even caused, by substance misuse.

What's unique about the Center for Neuro Skills is that it's fully equipped to treat both brain injury and substance addiction, whether it's alcohol or opioids. Unlike a 12-step program, CNS, a facility that provides intensive rehabilitation and medical programs for individuals recovering from all types of brain injury, focuses on what treatment is needed based on the brain injury and related deficits.

According to CNS, about 66 percent of people who suffer from a brain injury were under the influence of a substance at the time of the injury. While this doesn't necessarily mean they're struggling with addiction, a large percentage of those have a history of substance misuse, which needs to be addressed, said Dr. Gary Seale, regional director of clinical services for CNS. 

Interventions, or ways CNS staff try to better their patients using a stages of change model — a five-step process to maintaining sobriety — are much more comprehensive than a typical 12-step program for addiction, because the added complexity of brain injury can produce a host of challenges for patients. 

"Drug and alcohol rehabs don't want to accept brain injury patients because they don't want to tailor their programs to those with these deficits," Seale said. "Obviously, we're treating the whole person, so they may have physical, cognitive, or language deficits that go along with the substance abuse.

"The beauty to this approach is that it allows us to plant seeds for change." 

'Seeds for change'

CNS addresses substance misuse in a way that meets the patients where they are individually and doesn't require a patient to take on another diagnostic label, like "alcoholic" or "addict."

According to Seale, brain injuries are associated with drug and alcohol misuse.

After Piper fell 35 feet from a tree, he was hospitalized for about five months and fought for his life. His traumatic brain injury caused his ability to speak, walk and ultimately manage his life to become impaired. After he was released from the hospital, he was brought back to prison in Las Vegas, where prison staff "didn't know what to do with him," said Jeannine Macias, substance abuse counselor at CNS.

Piper was then brought to the CNS location in Bakersfield, where he battled his almost 20-year drug addiction while he relearned how to talk. His whole life changed — a man who previously lived a violent and criminal lifestyle was now depending on people at CNS to build himself back up. 

But one thing that was for sure was Piper was not getting back into the cycle of drug addiction. 

"That drug stuff is done for me," Piper said. 

Seale said CNS staff look at a patient's history of substance abuse and then create an individualized plan to treat all deficits. 

In the beginning of his treatment at CNS, Piper likened it to another type of prison, because he was tied down to structure and routine. 

"Without treatment, a large percentage are going to go back to drinking and drugging and will sustain a second injury," Seale said. That can be devastating for someone who has already suffered from one. 

What it comes down to, Seale said, is disengaging in these types of addictive behaviors and establishing that change as the norm. 

Shawn Frank, head of counseling at CNS, said addiction and brain injury behaviors can mirror each other.

"Everyone likes to point the finger at the other one," Frank said. If someone is acting angry, it may be because of an addiction problem, but someone might blame it on the brain injury, or vice versa. Regardless, both of those issues have to be treated, Frank said, because addiction can negatively impact the treatment of or recovery from a brain injury, especially since brain injuries are likely to get worse as people get older.

"You may age quicker or develop other diseases," Frank said. "All of that can be linked to the original (brain) injury." 

'I'm glad for this'

Piper's whole life was different before his brain injury. Before he fell, he was engaged in a violent and criminal lifestyle, he had been to prison, and he had a serious drug addiction problem. 

He's been sober for 14 years, and he plans to stay that way. 

He relocated to Bakersfield because he had to for treatment at CNS, but now, he chooses to stay here — in a house that's his and with a community to which he belongs. Not only a community within his church, or his city, but within CNS. 

"This," pointing to the scars on his head, "changed my life," Piper said. "I wouldn't be here today without it. I'm glad for this." 

And now Piper, who was discharged from CNS in February 2018, says he owes a lot to the facility that helped him get his life back. The program allowed him to break the cycle of addiction and become who he always wanted to be.

"I'm 48, and I'm a man finally," Piper said. 

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