TBI Consumer Report: Coping with Substance Abuse After TBI Mount Sinai Medical Center Page 2 of 2

Identifying with a disability group. Because of the double challenges associated with TBI and substance abuse, a major problem people face is not knowing where to find the best support. When individuals sought help from community substance abuse programs, professionals and participants in these programs tended to underestimate TBI-related problems (cognitive, physical, and personality changes), making remarks such as, "Oh, we all have problems like that." Conversely, when people sought help from TBI-focused programs, professionals and members of the TBI community were often uncomfortable talking about the person's drug history or attempts at sobriety. Many members of the group felt that each source of potential help fully understood only half of their problems and challenges, which was often more frustrating than helpful. The group recommended a solid solution to the problem. People with post-TBI substance abuse problems should take advantage of inpatient and outpatient rehabilitation programs that offer a combined approach to TBI/substance abuse prevention. Further, the group encouraged individuals with TBI to find a mentor with TBI who is currently attending a community-based program such as Alcoholics Anonymous. This person can shepherd the individual in the community and help vouch for the specific challenges of TBI, which otherwise are likely to be misunderstood within this setting.

Ways of staying clean. The focus groups discussed ways of living life after TBI without using/abusing drugs or alcohol. Many individuals spoke of a strong reliance on 12-step programs, such as Alcoholics Anonymous or Narcotics Anonymous. Others emphasized the need to change the "persons, places, and things" that had acted as triggers for continued drug/alcohol use - for example, avoiding friends who were users/abusers and activities in which use/abuse typically occurred. Many found solace in spirituality, either through seeking a higher meaning on their own or finding an organized religious group. The latter created a new social bond that provides positive and meaningful activities rather than the harmful "persons, places, and things" associated with continued substance use. Finally, some members of the group discussed their attachment to pets - finding meaningful connection and affection in caring for animals.

What Are the Implications?

In sum, our findings and those of other researchers suggest that people who experience brain injuries often have a prior history of substance use/abuse. After TBI, a drop in use/abuse occurs, but a significant number of individuals - too many - use drugs/alcohol at some time after injury. The voices of people with TBI who had successfully kicked the habit point to several needed next steps. First, all individuals with TBI should be screened for prior drug/alcohol use patterns at the time of injury. Second, all individuals, regardless of prior usage, should be educated about the negative consequences of continuing, or starting, to use drugs or alcohol after injury. Third, those with TBI who have drug/alcohol problems need rehabilitation programs that provide dual treatment - not aimed just at TBI or at substance use, but at both. Finally, linkage with community-based prevention programs, such as AA, via a mentor (that is, a person with a TBI already involved in the community program) was encouraged.

More Information

This article was based on research conducted by the RTC: Ashman, T.A., Spielman, L.A., Hibbard, M.R., Silver, J.M., Chandna, T., and Gordon, W.A. (2004). Psychiatric challenges in the first 6 years after traumatic brain injury: Cross-sequential analyses of Axis I disorders. Archives of Physical Medicine and Rehabilitation, 85 (4, Suppl 2), S36-S42.

Hibbard, M., Uysal, S., Kepler, K., Bogdany, J., and Silver, J.M. (1998). Axis I psychopathology in individuals with TBI. Journal of Head Trauma Rehabilitation, 13(4), 24-39.

This article was based also on research conducted by others: Allen D.N., and Landis, R.K. (1998). Neuropsychological correlates of substance use disorders. In P.J. Synder and D.K. Nussbaum (eds), Clinical neuropsychology: a pocket handbook for assessment. Washington, D.C.: American Psychological Association.

Fann, J.R., Katon, W.J., Uomoto, J.M., and Esselman, P.C. (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injury. American Journal of Psychiatry, 152, 1493-1499.

Kreutzer, J.S., Wehman, P.H., Harris, J.A., Burns, C.T., and Young, H.F. (1991). Substance abuse and crime patterns among persons with traumatic brain injury referred for supported employment. Brain Injury, 5, 177-187.

Van Reekum, R., Bolago, I., Finlayson, M.A.J., Garner, S. and Links, P.S. (1996). Psychiatric disorders after traumatic brain injury. Brain Injury, 10, 319-327.

TBI Consumer Report is a publication of the Research and Training Center on Community Integration of Individuals with Traumatic Brain Injury, supported between 1993 and 2004 by Grant Nos. H133B30038 and H133B980013, to the Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York City, from the National Institute on Disability and Rehabilitation Research, United States Department of Education.

From Mount Sinai Medical Center. www.mssm.edu.

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