Substance Abuse and Traumatic Brain Injury

Ohio Valley Center for Brain Injury Prevention and Rehabilitation
Substance Abuse and Traumatic Brain Injury

Who Is at Risk for Developing a Substance Abuse Problem After TBI?

Many people who incur a traumatic brain injury have a substance abuse problem prior to their injury (see 1.3 elsewhere). As a result, it is not surprising that a number of people after they have had traumatic brain injury also have a substance abuse problem. Adolescents and adults who are hospitalized for traumatic brain injury are much heavier drinkers than their peers who have not incurred a TBI. However, for traumatic brain injury as well as for other injuries, there is often a "honeymoon" after the injury when the amount of drinking stops or reduces (Bombardier, Temkin, Machamer & Dikmen, 2003; Corrigan, Lamb-Hart & Rust, 1995; Kreuzer, Doherty, Harris & Zasler, 1990; Krueutzer, Witol, Sander, Cifu, Marwitz & Delmonico, 1996).

A few studies of persons with traumatic brain injury have found that alcohol use gets worse in the period 2 to 5 years after the injury and that unless something is preventing them, many resume their prior levels of alcohol and other drug use (Corrigan, Rust et al., 1995; Kreutzer, Witol et al., 1996; Kreutzer, Witol et al., 1996; Corrigan, Smith-Knapp et al., 1998). Situations that limit resuming use include having to live in an institutional setting where alcohol and other drugs may be less available, or living under closer supervision of family members who help the individual consume less. Of course, use may reduce or stop if the individual is provided information about the effects of alcohol and other drugs after traumatic brain injury or, for people with actual substance abuse problems, being provided treatment.

In addition to the large number of individuals who had a substance use disorder before their injury and return to those levels after, some studies have indicated that between 10% and 20% of persons with traumatic brain injury develop a substance use problem for the first time after their injury (Corrigan et al., 1995; Kreutzer et al., 1996). Thus, taken together, it is a very high proportion of individuals who have been hospitalized for traumatic brain injury who will be at risk for developing a problem after their injury — either because they had one before or because of the vulnerabilities created by the injury itself.

"Substance abuse is a risk factor for having a traumatic brain injury and traumatic brain injury is a risk factor for developing a substance abuse problem." –John Corrigan

How many people who have traumatic brain injuries are intoxicated at the time of injury? 

At least 20% of adolescents and adults who are hospitalized and at least 30% of those requiring rehabilitation are intoxicated at the time of their injury. It is not surprising that there is a significant link between being intoxicated and incurring a serious injury. Whether because of diminished motor control, blurred vision, poor decision making or greater vulnerability to being victimized, a number of persons incur a traumatic brain injury while they are intoxicated. There is a lot of information available about how susceptible to injury people are when they have blood alcohol levels that exceed the legal limit. There is every indication that other drugs also put people at risk for injury. Three studies that have provided estimates of the number of people intoxicated at the time of their injury are shown below:

In persons hospitalized

  • Colorado TBI Surveillance and Follow-up System: 21% BAC .08 (n=2,151 hospital admissions in Colorado 16 years old).

In persons treated in rehabilitation:

  • TBI Model Systems: 37% BAC .10 (n=3,893 admissions to Model Systems acute rehab centers).
  • OSU Suboptimal Outcomes Study: 25% BAC .10, 12% + drug screen, 32% either (n=356 consecutive admissions for acute rehab).

How common is a history of substance abuse before the injury?

Corrigan (1995) reviewed published literature on persons with TBI who were intoxicated at time of injury and those who had a prior history of substance use disorders, whether or not they were intoxicated. Based on articles reporting these variables, having a prior history of substance abuse was more common than being intoxicated at the time of injury. Additionally, clinicians and researchers who used screening tools during the hospital stays found significantly higher rates than those who relied on later medical record review. This result suggests that more people will be identified if a systematic method of inquiring is used; rather than counting on patients to volunteer information or relying on reports of intoxication at injury.

Since that review, there are several additional sources of data on the frequency of prior substance use disorders in adolescents and adults treated in acute rehabilitation. Results from the following articles are graphed below:

  • TBI Model Systems National Database (n=1,262; Corrigan et al., 2003): 43% problem alcohol use or worse, 29% illicit drug use, 48% history of either;
  • OSU Suboptimal Outcomes Study (n=356 consecutive admits to acute rehab): 54% alcohol abuse or worse, 34% other drug abuse or worse, 58% history of either;
  • University of Washington (n=142 consecutive admits to acute rehab, Bombardier, Rimmele & Zintel, 2003): 58% at-risk alcohol use or worse, 39% recent illicit drug use, 61% history of either.

For adolescents and adults who require inpatient rehabilitation–as many as 60% may have a prior history of substance use disorder.

How common is TBI among persons receiving substance abuse treatment?

While there has not been a definitive, population-based study of how many individuals receiving treatment for substance abuse problems have incurred traumatic brain injuries, a collection of studies in the last 20 years suggests that it may be as high as 50%. The studies are summarized below and their results are graphed in the accompanying figure. The lowest rate observed was 38% of persons in treatment, the highest was 63%. Visual inspection of the graph supports an estimate of 50%, if not more.

Articles included in graph (below)

  • Alterman & Tarter (1985) found 53% of a sample of 76 male alcoholics had histories of TBI.
  • Hillbom & Holm (1986) found 38% of a sample of 157 alcoholics had a history of TBI with loss of consciousness or hospitalization.
  • Malloy, et al. (1990) found 58% of a sample of 60 alcoholics had TBI marked by loss of conscious-ness, hospitalization, or major neurological change.
  • Gordon et al. (2002) found 63% of 243 clients screened in 13 publicly funded programs in upstate NY had TBIs; 48% of 404 screened in 12 facilities in NYC.
  • At OSU, 119 clients in residential treatment, intensive outpatient or ambulatory detoxification at a publicly funded substance abuse facility:

68% 1 TBI with loc 5 minutes, or required ER visit or hospitalization;
35% 1 TBI with loc 1 hour or requiring hospitalization;
60% 1 TBI with early effects that did not persist at time of interview;
53% 1 TBI with early effects that persisted at time of interview.

How does substance abuse affect a person who has had a traumatic brain injury?

There are multiple reasons why alcohol and other drug use after traumatic brain injury is not recommended. The substance abuse education series "User's Manual for Faster, More Reliable Operation of a Brain after Injury" (Ohio Valley Center, 1994) enumerates eight reasons:

  1. People who use alcohol or other drugs after they have a brain injury don’t recover as much
  2. Brain injuries cause problems in balance, walking or talking that get worse when a person uses alcohol or other drugs.
  3. 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. Brain injuries cause problems with thinking, like concentration or memory, and using alcohol or other drugs makes these problems worse.
  5. After brain injury, alcohol and other drugs have a more powerful effect.
  6. 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. After a brain injury, drinking alcohol or using other drugs can cause a seizure.
  8. People who drink alcohol or use other drugs after a brain injury are more likely to have another brain injury.

How is the brain affected?

There is mounting evidence about the adverse effects of alcohol and other drug use after traumatic brain injury. Several studies have observed an association between use and such unwanted outcomes as unemployment, living alone and feeling isolated, criminal activity and lower life satisfaction (Sherer et al., 1999; Corrigan et al., 1997; Kreutzer et al., 1996; Kreutzer et al., 1991; Corrigan et al., 2003). While these studies have observed associations, the causal links or processes have not been fully explained.

There are also studies suggesting an "additive effect" on brain structure and function for substance abuse and traumatic brain injury (Barker et al., 1999; Baguley et al., 1997; Bigler et al., 1996). One example is the study by Ian Baguley and colleagues from Australia (see graph below). Their 1997 study of event-related evoked potentials (an indication of how fast the brain detects new stimuli) showed a clear additive effect of heavy social drinking and traumatic brain injury requiring hospitalization. Those subjects who had either of these conditions were slower responding then people with neither; and those with both were slower still.

Are there treatment approaches that have been proven effective for people with traumatic brain injury?

Clinicians and researchers have repeatedly observed that cognitive and emotional impairments caused by brain injury present unique problems when addressing co-existing substance use disorders (Langley, 1991; Center for Substance Abuse Treatment, 1998; Corrigan, Bogner et al., 1999). While several models of how substance abuse treatment can be adapted to traumatic brain injury rehabilitation were proposed in the past (Blackerby & Baumgartnen, 1990; Langley, 1991), most presumed protracted inpatient or residential treatment that is no longer available to most persons with traumatic brain injury. Bombardier and colleagues have recommended brief interventions based on motivational interviewing techniques for use during acute rehabilitation (Bombardier, Ehde & Kilmer, 1997; Bombardier & Rimmele. 1999). Cox, Heinemann, et al. (2003) found some support for Structured Motivational Counseling in a study using a non-random comparison group.

A community-based model for treatment of substance abuse and traumatic brain injury was proposed by Corrigan and colleagues (Corrigan, Lamb-Hart & Rust, 1995; Bogner, Corrigan, Spafford & Lamb-Hart, 1997; Heinemann, Corrigan & Moore, 2004). The model uses consumer and professional education, intensive case management, and inter-professional consultation to address substance use disorders in adults with traumatic brain injury. Program evaluation data suggest significant differences in outcomes depending on whether discharge occurred before an eligible client could be engaged in treatment (eligible but untreated), after initiation of treatment but before treatment goals were met (premature termination) or upon mutual agreement with staff that goals had been met (treated). The Network’s three programmatic outcomes (abstinence, return to work or school, and subjective well-being) assessed three months post-discharge are shown below. The median length of stay for those discharged successfully is 2 years. As might be expected, drop-out is a significant problem in this model. Retrospective analysis of 1,000 consecutive referrals indicated that 66% of those eligible for treatment either are not engaged initially or drop out prematurely.

How can existing substance abuse services be adapted for people with traumatic brain injury?

There should be a very high priority placed on doing research about the effectiveness of current substance abuse treatments for persons with traumatic brain injury. However, until more is known, current treatments and services need to be adapted to accommodate disability arising from traumatic brain injury. The Ohio Valley Center for Brain Injury Prevention and Rehabilitation have made a number of suggestions for substance abuse treatment providers., shown below.

Suggestions for Substance Abuse Treatment Providers Working with Persons Who Have Limitations in Cognitive Abilities

The substance abuse provider should determine a person’s unique communication and learning styles.

  • Ask how well the person reads and writes; or evaluate via samples.
  • Evaluate whether the individual is able to comprehend both written and spoken language.
  • If someone is not able to speak (or speak easily), inquire as to alternate methods of expression (e.g., writing or gestures).
  • Both ask about and observe a person’s attention span; be attuned to whether attention seems to change in busy versus quiet environments.
  • Both ask about and observe a person’s capacity for new learning; inquire as to strengths and weaknesses or seek consultation to determine optimum approaches.

The substance abuse provider should assist the individual to compensate for a unique learning style.

  • Modify written material to make it concise and to the point.
  • Paraphrase concepts, use concrete examples, incorporate visual aids, or otherwise present an idea in more than one way.
  • If it helps, allow the individual to take notes or at least write down key points for later review and recall.
  • Encourage the use of a calendar or planner; if the treatment program includes a daily schedule, make sure a "pocket version" is kept for easy reference.
  • Make sure homework assignments are written down.
  • After group sessions, meet individually to review main points.
  • Provide assistance with homework or worksheets; allow more time and take into account reading or writing abilities.
  • Enlist family, friends or other service providers to reinforce goals.
  • Do not take for granted that something learned in one situation will be generalized to another.
  • Repeat, review, rehearse, repeat, review, rehearse.

The substance abuse provider should provide direct feedback regarding inappropriate behaviors.

  • Let a person know a behavior is inappropriate; do not assume the individual knows and is choosing to do so anyway.
  • Provide straightforward feedback about when and where behaviors are appropriate.
  • Redirect tangential or excessive speech, including a predetermined method of signals for use in groups.

The substance abuse provider should be cautious when making inferences about motivation based on observed behaviors.

  • Do not presume that non-compliance arises from lack of motivation or resistance, check it out.
  • Be aware that unawareness of deficits can arise as a result of specific damage to the brain and may not always be due to denial.
  • Confrontation shuts down thinking and elicits rigidity; roll with resistance.
  • Do not just discharge for non-compliance; follow-up and find out why someone has no-showed or otherwise not followed through.


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Bogner, J. A., Corrigan, J. D., Spafford, D. E., & Lamb-Hart, G. L. (1997). Integrating substance abuse treatment and vocational rehabilitation following traumatic brain injury. Journal of Head Trauma Rehabilitation, 12 (5), 57-71.

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Posted on BrainLine March 31, 2009. Reviewed July 27, 2018.

From the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. Reprinted with permission.

Comments (30)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

My nephew is an alcoholic. Was in a n accident with his brother. His brother was alright after accident. But other nephew hit head a couple few times against a tree. Was flighted and in med coma. He did his therapy ("that they gave him") but he wasn't the same. Starting drinking and weed. When he did it I WAS intensified and he acts like a dramatic late teenager.. he wants treatment for all what do we do

AH.. Where do I start..


Looking for help, Im a 28 year old female currently in western Wisconsin. I suffer from Bipolar 1 disorder (diagnosed 2016). I was in a 2 year extremely emotionally and physically abusive relationship and also suffer from severe PTSD.

I am a recovering meth addict of two years (until a month ago) but sober now for almost 2 weeks, but currently addicted to prescribed Xanax, and marajuana (also sober for almost 2 weeks off marajuana of 15 years).

Starting in 2019 I was in a very scary domestic violence situation, to the point I had to hide in a domestic violence shelter (sober) for over a year, hiding from my ex.. . until he was killed by police last March 2021. Shortly after his death, I finally felt like things might be okay for me. Unfortunately, not even a month had passed, and in April 2021 I was assaulted with a crowbar to my head at least 10 times by a girl from Minnesota, who I found out later after she was caught, that it was a crazy ex girlfriend of a guy I went on one date with a few months prior.

ANYWAYS, back to my point, It took until January 2022 to finally get into the correct doctors because I "looked normal" now that I was not having to be wearing wigs. I worked full time since I finished College in 2013. Until the beginning of this year 2022, I lived and recovered completely alone for about 8 months. I was sober until a month ago. I relapsed on meth. I was so alone to the point I didn't know how long I had been in my apartment that I made the mistake of inviting an old friend over, and relapsed. A week later my house was raided (still no idea why) by police while I was just at home alone sleeping. I was arrested for possession of meth, possession of the, and possession of drug paraphernalia. I sat 4 days in county jail because I was arrested on a Friday, and it was this Labor Day, holiday weekend. I am now facing a felony. I have never been in trouble with the law, ever.

Because of my TBI I have problems with memory, word finding, frustration, etc. My prior diagnosis's had my prescribed meds to very high doses. I finally am at 4mg of Xanax a day, I was at 8mg a day prior to my TBI. I suffer from EXTREME anxiety. Im half way off of tampering down my Xanax because of my TBI, but got very sick in jail without it, I was so scared of having a seizure, I got lucky. I also used weed to help with my horrible anxiety. But since I got out of jail, my bond requires complete sobriety. I honestly don't think that I need treatment for meth, it couldn't hurt, but I am scared that I will break my sobriety with weed. Im in WI, so weed is still 100% illegal. I feel like I was only able to function this far from whining of of my Xanax because I used weed to help. I know can't smoke weed, fearing going to jail or prison and cannot physically quit cold turkey from my Xanax. I have tried in the past and get seizures. I honestly don't think I will ever completely be able to go without a Benz, at least just to have like an epee pen/ security blanket, but that might not now even have a choice now. I got out of jail the day ofter Labor Day, and today was the first day I left my house. My mom came to pick me up because I told her I was so lonely I didn't feel safe. I honestly thought I lost her when I went to jail, but im so grateful she picked up the phone and came and got me. Right before she got to my apartment I got a 10 day eviction letter from my landlord because I got in trouble for drugs.

My mom said I will be going to treatment probably Monday. We are trying to find inpatient treatment centers that my insurance will take. Im totally on board with treatment. My concerns are,

Am I going to loss everything in my apartment now?

Am I going to be able to take my medications (Xanax/vraylar/pregablin/prosin?)

Will I be able to leave treatment to go to my court date in a month?

What do I pack?

Do I need money to bring for things?

Can I have my disposable nicotine vape? Im four months off cigs after 15 years, I read that you can sometimes have cigs, but I don't want to have to go back to smoking because I can't have my vape.

How will I keep in contact with things I need to take care of legally without a phone?

Do I have to stop my therapies? Speech therapy, occupational therapy, Neurology appointments, eye therapy? ect ...

I Know its a lot, but any suggestions/ feedback would be greatly appreciated.<3

My husband has a TBI which occurred August 2020. He has made remarkable recovery. The only think he struggles with is short term memory and speech. He is an alcoholic and I need to find a place that will treat his addiction along with medical supervision fit his medications. Please advice.

Does anyone know of a facility my friend could get in-house treatment? He lives in Albany but would be willing to relocate

I was wondering where to search for supportive information on how to care for my father. He is an alcoholic and suffered a TBI back in Dec 2019 as he was 3x normal limit and fell and i injured his head twice down an entire flight of stairs. He has made a significant recovery as he was thought not to have made it out of the ICU/Coma for 30 days. He has been in rehab facilities for his TBI, but they have not still addressed his addiction of 40+ years. He has forgotten the last 20 years and jokes about not falling down. He is now an egomaniac and very different from the man I've known.
I'm not sure how to feel, how to care for him. I fear that he is now being ridiculed for being "different" and it makes me sad. He was/is a great father despite his addiction.
I have so many angry feelings towards him for doing this to himself and our family.
Has anyone else felt like this and how do you get past it? I dont know who he is anymore.
Thank you.

I am a Brain Injured Alcololic. I go to AA on a weekly basis. I still shake. I need some sorta normal help.

First, has he ever been evaluated for depressive symptoms? Addressing the egomaniac part that could be because his “condition “continues to severely affect his life and that is a defense mechanism. He may think he is ok yet, everyone around feels as you do. His insight and perception are not clear. Denial?
I was involved in a Vehicle hit-and-run 11-17-92. I was the pedestrian. My injuries included a Tbi.
I have a question for you I don’t understand you asking why your father would do this to himself? ( Falling down stairs?) To make these decisions?
What has really been unbelievably helpful is a working relationship with a Lcsw. They can help him adjust and all of you affected as well. It can be very difficult at times but to have support is key. There are many groups out there to help he and the family with issues. It’s a hard road but Having a belief in the present is based on having Faith in the Future.

I have a question about TBI and drug use. If a person was struck by a blunt object and suffered a closed head injury with severe symptoms AND went to drug use after the injury, how could anyone tell apart where the symptoms are from?

I am seeing symptoms for heavy drugs like Meth, are very similar to a Traumatic Brain Injury.

So how could the doctors diagnose that patient? Because if you do not know the source of your problems, how would you treat them?

My best friend crashed his motorcycle two and a half months ago. He had substance abuse problems prior but was not under the influence at the time. He was severely affected and they thought he would have to stay in an institutional setting for the rest of his life. However he suddenly recovered almost completely, very quickly. Everyone at the hospital was amazed. We volunteered to have him stay w us afterwards. It turned out to be very difficult though. He non stop tried to get us to help him get drugs. When we refused, he went out and got them himself. I am not sure what we could have done differently. His leg is almost totally paralyzed yet he refused to use a wheelchair and insisted on using a walker and wanted a cane even though sometimes his legs buckled under him. My timew him was spent constantly arguing. He now went to visit his parents in another state, i am not sure if he will be back but if he is, what can i do differently? He was not receiving any drug treatment after his release from the hospital, before he went to a methadone clinic daily. He was in the hospital for 2 months.

I am many years post injury. Although am still in rehab at Success rehab. I would like to offer any help, that I can provide, to the injured. If I feel I could help, Maybe we can talk about employment down the road? I am offering a start to by getting first hand experiance. So I could tell them what to expect, in the years following the initial trauma. Thanks for reading.

My accident was twelve years ago. I divorced my wife with two children and have isolated myself without thought. No longer associate with anyone. I need help and would do anything to be my old self. I have wrecked the last three vehicles and extremely compulsive.I now have nothing but a ssdi check each month. Thoughts of suicide are daily. I drove my fiancé off with always needing more or not getting enough love. This is a visciouse road to travel. Good luck to all you with TBI.

I just want u to know that you are not alone dude. I had brain surgery in 2008 and my life has just been down hill ever since. I shut out everyone and it's killing the family that I do have

I am an adult with a Tbi and addiction issues. Where can I get Help in the Lehigh Valley, PA area? Thank you

If you have any type of insure you can contact them and see if they have contracts with local recovery establishments. You also should consider the level of care needed. You can look into inpatient, halfway, three-quarter houses, recovery houses, or outpatient substance use counseling. Treatment Trends, Inc., Pyramid, and White Deer Run are local options to explore. Mid Atlantic Rehabilitation Services (MARS) may be another option as well. Hope this helps!

I cannot stand how ignorant most people are towards T.B.I injuries. I had a severe case where I was carjacked and my head was beaten into the concrete with the people kicking my head against it.

That was 4 years ago and I still only have maintained about 15% of my total memory. What is even worse, is I used to be a college graduate intellectual with almost 9 years of higher level education and graduate school degrees. Yet I can not remember most of what I have learned & had to reteach myself high school education in order to help my daughter through her high school career. I can only remember what degrees I had gotten and the things that I have been through by close friends, family, and documents telling me.

I have to rely on what is told to me, as my past memories or by relearning it by myself & hope that I'm not being lied to about who I am. Yet people get angry with me and call me a child because I cannot remember even the most common of knowledge, and I will forget that my short-term memory will kick in from time to time.

I am 37 years old, have 6 college degrees, 3 of which are graduate level. It is a nightmare to live inside myself, knowing that I should know the questions I'm being asked, yet pretending to know what I'm talking about.

I will take substances to escape the reality of who I am, compared to who I used to be or who I should be. Some people might call that abuse, and I cannot disagree with it. But it is also my way of dealing with the severe emotional distress and depression that I constantly feel. So I call it medication for my illness. Because without the occasional substance to help me cope with escaping from myself, I would have gone insane awhile ago or be dead.

I have to take medicine to sleep, or I cannot sleep and will go days before my body will finally give out on myself. I have to take medicine to help me concentrate, or I can not learn or reteach myself things & will forget them. Then I have to take medication to control my emotions, or I become irrational and hard to deal with and become suicidally depressed or have outbursts of rage.

Being me is like being stuck in your own personal hell that you cannot escape from except with the occasional substance. ....

I'm going to have to go back and reread what I have just wrote, not because I am high, but because I literally have forgotten everything already because I am out of my medicine.


I just got done reading everything I wrote and fixed a lot of mistakes in my words. I will add this to my comment as well, because it is important for everyone to know these things!

With a brain injury like mine, it is extremely hard to keep a relationship with a significant other. As they tend to get upset and frustrated with you for things like repeating yourself or not remembering how to react to certain situations.... I used to be a people person and used to be extremely good with women and dating. Now, I fear that my life will end in loneliness because of my T.B.I..... Which again feels like I'm in my own personal hell, because when I'm dealing with life on my own, I tend to f*ck things up pretty badly. Yet when I have someone I love by my side, life tends to feel a lot more manageable. But having someone that will put up with you and deal with all the problems that come with this type of brain injury, is like finding a miracle in the ocean. Highly unlikely, yet highly sought after & very much needed!

I hope this helps someone/anyone understand what we deal with on a daily basis.

Btw.... I used to have a PhD in geriatrics to give you an understanding of what we go through on a daily basis, and yet I still constantly wonder who I am.

My brother had a closed head injury at the age of 13 in 1987. It was a traumatic closed head injury. He had a very devoted family. My parents made sure he got to his rehab and many types of outpatient therapies. After one month in a coma and two more months in the hospital, he finally came home in a wheelchair. Today he walks and he seems normal but still has symptoms and problems from the brain damage. If this happened today, I don't know if he could have recovered as fully. There is a lack of help for those who suffer head injuries today. Later, in his early 20s, he had a failed marriage — not his fault by the way. Due to poor decision-making skills from his head injury, he married a bad apple. We all knew she wasn't an earnest person, but he would not see this. I think this had a part in the present. He had two children and is a wonderful parent but has not been able to have a relationship with them after the divorce due to his ex causing so many problems. He just had to retreat from them to protect himself from her. Today he has addiction problems and it seems like he isn't going forward. He wrecks every car due to driving while drinking. He needs help. I know he is also struggling with a drug addiction now. If he goes into rehab, it doesn't work because the program isn't tailored for patients with head injuries. Part of his problem is he refuses to accept his deficits and the fact he is a head injury survivor. He has a degree but can't work. He has no family of his own and lives with my mother. She is to afraid to make him move out and learn responsibility. "Tough love" so to speak, she cannot do. I don't even know if that would help him face the fact that he is out of control. She worries he will be homeless someday. I wish there were a special place to help him get his life back on track and overcome this affliction of drug use and alcohol that could help him get over this. He's been to one place but about a year later he started drinking again. Now it's not just alcohol use. I know from experience and from raising my children that things don't work the same when reasoning and teaching someone with a head injury. So surely recovery from addiction wouldn't be approached the same for TBI sufferers. My children do not, thank the Lord, have addictions and neither do I, but I know how much easier it was to get them to understand things even in their teenage years than it has been for my brother. He is very strong willed and it takes a lot more to deter him from things, even bad things. Is there a place to find help for people like my brother? He Is such a good person and has so much to offer the world. I wish nothing more for him to get help and be strong again. I'd love for my mother not to have to feel she has to watch over him for the last little bit of her life. She also took care of my dad who suffered from a severe form of MS until he passed away from cancer at home 2 yrs ago.

The pain specialist treating me for 10 years prescribed Fentanyl patches 8 of those years. The highest dose was 300mcg/hr. The patches didn't stick very well to me, he had me change them every 24 hours. He also told me to cut the used patches in half, slide my tongue between it to take orally for break through pain. December 25, 2012 I knew I was in trouble. I flew to Arizona the next day to be detoxed. I've now learned stopping it cold turkey, and being told I was done with withdrawing in less than 5 days was wrong. I flew home to MN mid January 2013. Got very sick, immediately lost all memories from the past 25 years, was admitted into ICU and put on life support. I suffered, always will, a TBI as a result of being detoxed too quickly. It's been almost 4 years. I do not remember the years when I was was so drugged. My brain is healed as much as it can be. I now suffer from anxiety, severe panic attacks, and I'm stuck with a brain that is so damaged it is not compatible with my mind. Right now I have to take meds to tell it when to let me sleep, to think, to actually WORK for me. I know this is too long. But if it convinces ONE person to question their dr, it's worth it. Not all of us choose to this.

I had a brain injury 3 yrs ago and after the taste of alcohol made me sick. It just tasted bad. I have not had a drink in 3yrs and I tried everything to get sober nothing took. So since nothing else changed after my injuries but my drinking, I wonder if maybe I was able to stop because of the brain injury

I was in a car accident a month a go and they said I cant drink for a year but what would it do if I drank before that year was over?

It has been 10 yrs since my accident that caused a TBI, so my question is does drinking now effect my brain still?

I bashed my head into a tree when I fell off a galloping horse. I woke up about an hour later splayed like a human X on a wooded trial. The depression that followed led me to feeling suicidal. I turned to drugs and alcohol to numb out the dark feelings. Can one get tested for cognitive impairment decades later from TBI? If so, how? There's no alcohol or drug use in my life and hasn't been for many years. 

Our brains are far more malleable than we previously believed. It is never to late to learn and implement healthy ways to cope with stress ( following my tbi impulse control and irrational emotional reactions were devastating) . Changing your believes , and how you respond to your thoughts and emotions is difficult however I believe it is a worthwhile endeavor.

If you are seeking information about cognitive functioning (e.g., concentration, problem-solving, working memory), you would request a neuropsychological evaluation from a qualified neuropsychologist. It is a point in time assessment (usually several hours of tests and tasks plus interview) that can address strengths and challenges in cognitive functioning. If you had individualized or standardized testing of ability and/or achievement before the accident, that would give the neuropsychologist something to which to compare. Otherwise, there is some degree of inference, since individuals usually have some variability across their cognitive abilities and skills pre-injury, and some changes may have happened in the intervening decades as a result of normal aging and the drug and alcohol use (although, with years of being clean and sober, some of the latter may have been mitigated). Board certified neurologists can be located through the American Board of Professional Psychology (ABPP). Sometimes there are experienced neuropsychologists associated to hospitals and rehab centers. If someone instead were seeking treatment for depression, a neuropsychological evaluation would not be the best starting point, instead an appointment with a psychiatrist or neuropsychiatrist.

I was in a car accident in May... I was ejected from a can that was flipping. The injuries I received... crushed sturnum, 8 broken ribs, crushed collerbone, cracked my forehead, most of my nose bone was ripped off, almost ripped my liver in half, and my spleen, fractured 5 vertebrae, factured my ankle, plus a few other bones, and had tramatic brain injury. I was in a coma for two and a half weeks. I now have titanium in my forehead, nose, sturnum, collarbone, shoulder. The total of 5 plates and 20 something screws. When I left the hospital 30 days later with 7 pain pills... that was it. I never asked for more. Went back to work a little over a month later... it hurts from time to time.. but over the counter pain med work fine. Maybe I am just different. I get headaches from time to time... Excedrin works great for that.

I too just am reading about this topic.  My son one year and nine days ago received a severe brain injury call Diffuse Axonal Injury or DAI.  He has severe and I mean severe headaches to the frontal and occipital regions and severe pain to his hips especially the right hip/leg.  He has blurred vision along with the headaches and with pains in his body and cannot walk straight.  He moans in pain, takes numerous hot baths to try and decrease the pain, he is unable to sleep at night and I can hear him in the hall going up and down the stairwell continuously.  He now is a heavy smoker.  Has gone to the ER numerous  times between pain meds that are ordered for him.  He takes double the amount of pain med so he can have some relief and then runs out of medication and his pain is absolutely hard for me to see my son like this.  Neuro Md not any help, his pain management doctor is just horrible and the primary clinic he visits doesn't seem too educated regarding brain injuries.  He is on medicaid so he is unable to see the more educated and professional doctors he needs. He has severe short-term memory, impatient and if directed by me too many times, he becomes loud to the point of aggression, fowl language and appears to be going into a rage.  He is depressed and wants the pain to stop and I have no idea who to take him to to help him out.  I don't feel that he will live too long if his pains do not subside.  When you write about addiction the blame needs to be on the doctors who just shell out narcotics to the point the patient is dependent on them.  A DAI patient is always suspected of drug abuse and that is a simple solution for these doctors to do absolutely nothing.  So where does a TBI with DAI go next for treatment?  We don't have enough caring doctors who can treat these people.   And, there are many families who think the same way I do. Thank you for taking the time to read this.  From a caring mom.

I hope your son was able to get rehabilitation and is doing much better by now. Anyone with brain injury who is troubled by headaches, dizziness, blurred vision, nausea, light and/or noise sensitivity needs expert vestibular therapy by a Doctor of Physical Therapy with a further certification in Neurological Rehab. For orthopedic pain, physical therapy is needed. For cognitive issues, a speech therapist; and for almost everything else an occupational therapist. Rehabilitation therapists almost always take Medicaid. The purpose of primary care providers after brain injury is to provide referrals to rehabilitation therapists and specialists.

There are some physical rehab centers and brain injury rehab centers that take Medicaid. It sounds as though your son needs more comprehensive physical and brain injury rehab than he has had. I will not tell you there is a simple solution or that a good center will be able to solve all of his problems. However, you describe very clearly that the services he has now are insufficient. Here is an example of a more comprehensive program's services. Not sure what is available in your area.

wow thats deep sorry for takeing a long time to read this but i am doing good going to church finding that i need to lean on god i want to go back to school i think it will help me.

Cpuld it be they are seeking pain/headache relief? Sorry but if I had stayed in counseling with a neruopsych...that labeled me something else.....doesn't have the skill do be the primary healthcare provider of tbi......I figured out on my own that I might need Vestibular rehab....finally an ent ordered a vestibular test...right on....dysfunction of cental origin...I also finally got a good neurologist that ordered topamax for the headaches. Oh and I got my last untreated missed injury fixed with surgery. If poly trauma existed...then these individuals may need a better medical workup and less therapy.....Firing my neuropsyches(4) was a step in the right direction each time.
Thank you for this excellent article!! I have had visual hallucinations and periods where time seemed to disappear since a moderate TBI 7 years ago. A couple of years ago, a friend was present during one of the "time loss" episodes and described to me and doctor what it looked like: seizure. Through my recovery I continued to have a glass of wine or a beer with a meal and friends once in awhile, thinking it would not hurt. During the past year, my one-drink habit increased to almost daily - self-medicating. My seizure-like episodes also increased. A neuro-psychologist finally told me a month ago that even a small amount of alcohol might be triggering seizures. I immediately stopped drinking alcohol completely and have not had a seizure since.