5 Things You Should Know About Substance Use After Brain Injury

If you or someone you care about has a brain injury, learning about the effects of substance use with brain injury is an important first step toward improving the chances for recovery.

• Why do so many individuals with brain injury have problems with substance use?
• How does alcohol and drug use affect a person who has had a brain injury?
• How much alcohol is safe after brain injury?
• What is appropriate substance use treatment for a person with brain injury?
• Living in recovery

Why do so many individuals with brain injury have problems with substance use?

Substance use problems prior to injury

Many people with brain injury have problems with the use of alcohol or other drugs prior to their injuries. It is not surprising that there is a strong link between being intoxicated and having a serious injury. Being intoxicated puts a person at greater risk for a brain injury due to problems with motor control, blurred vision, and poor decision-making. People who are intoxicated are also at greater risk of being victimized. Even adolescents and adults who are not intoxicated at the time of injury tend to be much heavier drinkers than their peers who have not had a brain injury. Up to 60% of those requiring inpatient rehabilitation for brain injury may have had prior problems with alcohol and other drug use. Individuals with these problems before the injury are at risk for even greater problems if they continue to drink or use drugs after the injury. 

New substance use problems after injury

In addition, some studies have shown that between 10% and 20% of persons with brain injury develop a substance use problem for the first time after their injury. A brain injury can lead some people to drink more alcohol or use more drugs than they intend. In comparison to others the same age, people with brain injury tend to drink more alcohol. 

After the honeymoon

Some people initially stop drinking or using drugs after the injury. They may recognize that the use of alcohol and other drugs will affect their recovery. The support of family and friends can also help people stay away from alcohol and other drugs. Unfortunately, after a while, some people start to drink or use drugs again. Many people think that it is 'safe' to use alcohol or other drugs after a certain amount of time has passed. However, there is no evidence indicating that there is a safe time to use.

How does alcohol and other drug use affect a person who has had a brain injury?

Persons with brain injury who use alcohol or other drugs show greater problems with brain structure and function.

1. Don't Recover As Well

People who use alcohol or other drugs after they have a brain injury don’t recover as well.

2. Problems in Balance, Walking and Talking

Brain injuries cause problems in balance, walking or talking that get worse when a person uses alcohol or other drugs.

3. Say or Do Things Without Thinking First

People who have had a brain injury often say or do things without thinking first, a problem that is made worse by using alcohol and other drugs.

4. Problems With Thinking, Concentration or Memory

Brain injuries cause problems with thinking, concentration or memory, and using alcohol or other drugs makes these problems worse.

5. More Powerful Effect of Substances After brain injury

After a brain injury, alcohol and other drugs have a more powerful effect.

6. More Likely To Feel Low or Depressed

People who have had a brain injury are more likely to have times that they feel low or depressed and drinking alcohol and getting high on other drugs makes this worse.

7. Can Cause a Seizure

After a brain injury, drinking alcohol or using other drugs can cause a seizure.

8. More Likely To Have Another brain injury

People who drink alcohol or use other drugs after a brain injury are more likely to have another brain injury.

Other reasons to avoid alcohol and other drugs

In addition, persons with brain injury who use substances are more likely to experience:

• Unemployment
• Living alone
• Feeling isolated
• Lower life satisfaction
• Interactions with prescribed drugs or other medical conditions
• Criminal activity and being arrested
• Injury or being victimized
• Additional brain damage

How much alcohol is safe after brain injury?

Some people are surprised by how little is considered to be a safe amount to consume, even for people without brain injury. Based on what we know about how alcohol and traumatic brain injury add together to change brain structure and function, we believe that there is no safe amount after brain injury. We suspect that alcohol and other drugs can interfere with natural healing after a brain injury. The effects of substance use are more severe for individuals with brain injury and can result in further brain damage. We also believe that substance use can have an impact on how a person is functioning many years after the injury.

When to seek help

Many people benefit from professional help when their drinking or other drug use is too much and is creating problems for them. One sign that a person could use some assistance is when they have tried to cut down on their own, but somehow the problem continues. Another sign is when people who care about a person begin worrying that he or she is drinking too much. Finally, if a person is facing legal or medical problems due to use (including having another injury) it is advisable to seek help. 

A tool to assess use is available at Rethinkingdrinking.niaaa.nih.gov

What is appropriate substance use treatment for a person with brain injury?

Impairments caused by brain injury may present unique obstacles to treatment success. There has not been very much research about which substance abuse treatment methods work best for people who have had brain injuries. Most clinicians feel that techniques found effective for people in general can also be effective for people who have had brain injuries. However, it is important to find a treatment provider who is willing to to take into consideration the special needs of the person with brain injury.

Involving family and friends

Substance abuse treatment often includes both the individual and family or friends. The greater a person's cognitive impairments after brain injury, the more important it becomes that people in his or her surroundings are willing to be involved in the treatment process. Similarly, for people who do not see themselves as having a problem, it is more important that family and friends be willing to join professionals to get a person started in addressing their substance use.

Accommodating symptoms of brain injury in treatment

Special considerations or accommodations may be needed to make the treatment useful and effective. It is important that the substance use counselor understand the unique challenges that persons with brain injury face in substance use treatment. It may be helpful to share the following information with your counselor:

• Suggestions for Professionals (printable PDF)
• Accommodating the Symptoms of brain injury

Stages of change

How ready a person is to address problems related to their alcohol or other drug use can be described in the following stages:

1. Precontemplation (a person sees no problem with his or her alcohol or other drug use when there is one)
2. Contemplation (the person is weighing the pros and cons of changing substance use)
3. Preparation (the person has decided that a change is needed, but does not yet have a specific goal)
4. Action (the person is making changes in order to reduce or eliminate the use of alcohol and other drugs)
5. Maintenance (the person is sustaining successful change despite urges to use again). 

Substance abuse counselors usually tailor treatment to a person's Stage of Change. Regardless of a person's readiness to address an alcohol or other drug use problem, there is always something a professional substance abuse counselor or treatment program can provide.

Treatment methods for substance use problems

Effective treatment is usually tailored to a person's readiness to address substance use problems. To be effective, the treatment method chosen must be acceptable to the person being treated.

Treatment method options may include:

• Motivational interventions
• Cognitive-behavioral therapy
• Therapeutic communities
• Prescription medications
• Self-help groups

A treatment facility locator tool developed by SAMHSA can help you find treatment at a location near you.

Living in recovery

Learning about the effects of alcohol and other drugs after brain injury can help people to make choices that will help them to recover more fully. Family and friends can help support an alcohol and drug-free lifestyle. People can also obtain support through treatment. We believe that people can continue to show improvements for several years after a brain injury, as long as they are living a healthy lifestyle, which includes avoiding alcohol and other drugs.