Substance Use After Brain Injury

Similar symptoms, different causes

Be aware that common symptoms of both brain injuries and substance use disorders can be similar, including:

• Sleep problems
• Fatigue
• Change in mood or personality
• Memory problems
• Difficulty with balance and walking
• Impaired thinking, including decision-making and judgment
• Impulsivity
• Disinhibition
• Lower frustration tolerance

Special risks for misuse

People with brain injuries contend with risk factors for developing a substance use disorder, including:

• Social isolation or not feeling connected to others
• Boredom or having few activities or interests
• Difficulty adjusting to change
• Easy access to substances
• Not having helpful tools for managing stress
• Cultural factors
• Spending time with a peer group that encourages substance use
• Not getting needed medical or mental health care
• Family stress
• Having a substance use disorder before brain injury
• Having immediate family members with substance use disorders

How ongoing substance use affects families

Family members of patients coping with a substance use situation may:

• Experience a range of challenging emotions, such as fear, anger, sadness, and guilt
• Have trouble getting their own needs met
• Experience increased arguments or trouble communicating.
• Not know how to react to substance use.

Ways family members can take care of themselves include:

• Learning about substance use disorders.
• Caring for your own physical and psychological needs. Exercise, balance your diet, set and accomplish goals, maintain a healthy routine, etc.
• Considering connecting with your own therapist
• Finding a community support group for concerned significant others, such as Al-Anon or another similar group)

Ways that family and friends can help a loved one using substances include:

• Gently reminding the person how substance use can affect recovery from brain injury
• Calling attention to your concerns by focusing on how things affect you using, “I statements,” such as “I feel powerless when I can’t help you make healthier choices” or “I feel hurt when I am ignored.”
• Encourage your family member to speak with a medical professional about their substance use.
• Set healthy boundaries – make them reasonable, specific, and enforceable and have specific consequences.
• Engage in enjoyable activities with your loved one that do not involve substance use.
• Praise the actions that you do want to see, such as “It meant a lot to me that you came to our daughter’s play with me instead of going to the bar last night.”

Getting help

If alcohol and drugs do become a problem, find help immediately. Here are some resources that can aid in recovery from alcohol and drug abuse.

• Contact your physician for a referral to a helping professional with a specialty in the treatment of substance abuse.
• Find Alcoholics Anonymous and Narcotics Anonymous meetings in your area. These are free support groups for people with substance abuse problems.
• Read more about substance use after brain injury at the Model Systems Knowledge Translation Center (MSKTC) website.

With the identification of these areas of concern, the problems that can develop when an individual with a brain injury abuses alcohol and drugs become clear. Be aware of approaches for prevention before serious problems develop.

Information and education

The more you understand about potential problems, the more able you are to identify a possible problem or recognize if you are at increased risk for a substance abuse problem.

Developing skills to cope with disability

The more independence and coping skills a person has, the less need there is for self-medicating with alcohol and drugs. Coping skills include development of a support system and identifying specific people in your support network who can help with adjustment issues like depression, grief, anxiety, and isolation.

Think of alternative behaviors and activities that can take the place of drinking or doing drugs such as recreational activities, such as joining the local YMCA, or participation in social clubs or groups with a focus on independence and increased self-esteem.

Talk to your physician if you think the brain injured family member is depressed, anxious, or experiencing other adjustment problems. As an option, there are many safe and effective medications to help with these common problems.

Persons who have sustained an acquired brain injury must not use any drugs or alcohol as they pose particular risks that include:

• Medication interactions: Individuals with brain injury often take prescribed medications that may cause a dangerous reaction, which could include seizures or even death, when combined with alcohol and other drugs. Substances can decrease effectiveness and/or safety of medications. Some medications may not work as well or may not be safe to take when taken with other substances, such as drugs or alcohol.
• Healing interference: Substance use can get in the way of the brain healing or cause more harm to the brain.
• Lower tolerance: Brain injury lowers tolerance for substances. This means a small amount can have a greater effect than expected.
• Decreased inhibition: Using substances impairs decision-making. When people are under the influence of substances, they may be less likely to make good choices and more likely to act on impulse.
• Increased risk of side effects: Substance use may increase risk for seizures, depression, and problems with walking, speaking, balance, and more.
• Risk for additional injury: The use of alcohol and drugs may further impair functioning and cause the person with a brain injury to fall or somehow injure themselves again when intoxicated.
• Decrease in the level of functioning and independence: The use of alcohol and drugs will limit or decrease independence due to increased feelings of isolation, less coordination for self-care, and impaired thinking, which may already be compromised.
• Reduced control of emotional responses: Using alcohol or drugs will make depression and anxiety worse. It can make a person more aggressive and more likely to strike out or use a weapon.
• Increase in family stress and increase in caretaker’s responsibilities: An individual’s disability affects the entire family, causing increased stress. When the brain injured family member uses alcohol and/or drugs, it exacerbates the loss of functioning and can increase the stress level even more among other family members, increasing the level of help needed for basic care.
• Decrease in chances of returning to work, school, or vocational training: Alcohol and drug abuse hinders one’s ability to regain independence. The importance of rejoining the community, regaining a place in the world, and becoming a contributing, more capable individual is tremendously helpful in terms of the person’s self-esteem and self-worth.

Talk to your pharmacist or doctor about any questions you have about side effects or medication interactions.