My 24-year-old daughter who sustained a TBI more than a year ago wants to rejoin her social circle. I am worried that this means she will use alcohol and possibly other substances. How should I handle this?
This is a difficult question to answer without more information. Your first thought, of course, is to protect your daughter. But on a general level, what we do know is that alcohol often has an exaggerated effect on an injured brain; one beer may have the effect of three beers and can further compromise cognitive issues such as judgment, impulsivity, problem-solving, decision-making, and disinhibition. Illegal substances are not only harmful but they can increase the risk of a second brain injury as well as problems with the law. Alcohol and recreational drugs are dangerous when used in conjunction with prescription medications commonly used after brain injury for the treatment of seizures or psychological disorders.
The steps you take next depend on many factors including your daughter's level of functioning, the services she is currently receiving, your mother/daughter relationship, and the willingness and ability of her friends to provide support.
For people with significant challenges, there is a wonderful model you may want to look at called the Circle of Friends. This is a step-by-step process for building a social support network.
If your daughter has a treatment team, counselor, or coach, talk with them about how to handle this complex issue. If you do not have professional support, you might want to consult a mental health professional with expertise in this area. Ideally, your daughter would be aware of her own limits and would talk with her friends to enlist their help in keeping her safe.
If possible, work with your daughter and her friends to develop a plan for gradually reentering her social circle — starting with brief daytime outings and progressing to longer activities with less supervision. For all of these suggestions, open, nonjudgmental communication is crucial.