Substance use 

Substance use can lead to a brain injury, particularly in the case of opioids or impairment from alcohol and other drugs. It can also occur after a brain injury, creating multiple problems for the survivor.

Topics in this section include:

Substance use before a brain injury

It is estimated that approximately one in five Canadians aged 15 years and older experience substance use in their lifetime [1]. Substances include:

  • Alcohol
  • Opioids and other prescription drugs
  • Tobacco
  • Cannabis
  • Methamphetamines
  • Cocaine
  • Heroin
  • Ecstasy

Problematic substance use is when any substances are used in a manner, frequency, situation, or amount that is harmful to a person or those around them [2]. Examples of situations of problematic substance use that can lead to a brain injury include:

  • Excessive consumption causing impaired faculties (i.e. loss of balance or reduced vision)
  • Impaired driving
  • Opioid overdose
  • Lowered inhibition and an increase in risk-taking behaviour

What to do in an overdose situation

Overdoses occur when a person has taken more drugs or consumed more alcohol than their body can handle. Overdoses, particularly of opioids, lead to brain injury or death. There are a few ways to identify whether someone may be overdosing [3].

For opioids and other central nervous system depressants, some of the warning signs include:

  • Unresponsiveness or unconsciousness
  • Passing out or a “slumped over” posture
  • Shallow or irregular breathing, or no breathing at all
  • Slowed heart rate or absence of a pulse
  • Choking or gurgling sounds
  • Purple lips and fingernails
  • Clammy skin
  • Low body temperature
  • Vomiting
  • Seizures
  • Loss of coordination

For amphetamines and other central nervous system stimulants, some of the warning signs include:

  • Tremors and muscle twitches
  • Hot, flushed, or sweaty skin
  • Headaches
  • Chest pain
  • Difficulty breathing
  • Hostile or violent disposition
  • Uncontrolled movements or seizures
  • Panic
  • Paranoia and other symptoms of psychosis
  • Confusion or disorientation

If you suspect someone is having an opioid overdose:

  • Shake their shoulders or call their name
  • Call 9-1-1 if unresponsive
  • Perform chest compressions and rescue breathing
  • Administer nasal spray naloxone or injectable naloxone
  • If the person resumes breathing, place them in the recovery position

If you suspect someone is having an overdose caused by cocaine, amphetamines, (MDMA) ecstasy or another stimulant:

  • Call 9-1-1
  • Move the person to a quiet, safe room away from bystanders, noise, excessive light, heat and other stimulation
  • If confused or panicking, try to reassure them
  • If overheating, try to cool them down by loosening outer clothing or putting a wet towel on the back of their neck or under their arms
  • If you can’t get a response or the person is unconscious, put them in the recovery position
  • Remove anything from the immediate environment that might cause injury in case muscle spasms or seizures occur

Substance use after a brain injury

About 20% of people who survive a traumatic brain injury will develop a new problem with substance use [4]. Brain injuries that have an impact on emotional regulation or risk-taking may increase the risk of substance use disorders. Boredom, pain and stress can also cause a person to use drugs for relief. People who used drugs and alcohol before their injury may wonder if it is safe to return to use.

In general, research suggests that it is best to avoid using alcohol or other substances after brain injury to allow the brain to heal and avoid more serious problems. There are several effects that alcohol and substance use can have on someone after their brain injury. This includes:

  • Impulsivity or poor judgement
  • Increased risk of seizures
  • Increased risk of another brain injury
  • Slowing down or limiting recovery
  • Problems with balance and walking
  • Problems with concentrating and memory
  • Feeling increased effects from alcohol and drugs
  • Increased feelings of depression
  • Negative interactions with prescribed medications [5]

Drinking alcohol after a brain injury

The brain may be more susceptible to the effects of alcohol, which can impact balance, coordination, mood and cognitive processing. Alcohol is also incredibly dangerous to mix with prescription medications. If the survivor drinks regularly, the alcohol may also be having a negative effect on their recovery [6]. It is widely recommended that alcohol be limited as much as possible after a brain injury.

Abstaining from alcohol is always the best option, but if the survivor wants to have a drink at home or at a social occasion, they should always speak to their doctor first.

Substance use rehabilitation and brain injury

One of the existing challenges with treatment for substance use and brain injury at the same time is that current facilities/programs are not equipped to handle both. The majority of brain injury rehabilitation, community, and support programs require participants to be sober. Similarly, centres and programs that specialize in addiction support are not able to handle the needs of someone with a brain injury. While there are more and more resources being developed to help service providers, there is still a need for programs and facilities to develop working knowledge of the diverse needs of individuals seeking treatment for problematic substance use. The people with the most knowledge of services in your area will be members of the medical team.

If the person is using drugs or alcohol, it is important they work with professionals to ensure they are not using at the time of appointments. Developing an open and honest dialog with the treatment team is the best way to make sure rehabilitation will be able to continue.

Ways to find help for survivors with problematic substance use

Ultimately, it is up to the individual to take steps to get help. It needs to be their choice to participate. While you can offer help and support, it is not your responsibility to make them go to rehabilitation or follow a program.

Here are a few ways a person with problematic substance use can begin the recovery process.

Meeting with a counsellor
Counselling is a positive step towards overcoming problematic substance use. They can provide one-on-one help and give concrete advice and practical tips towards change.
Help groups
Many organizations with self-help groups, like Alcoholics or Narcotics Anonymous and Smart Recovery, operate in multiple locations in Canada. These groups are designed to offer a supportive environment for people with living experience of substance use.

Local healthcare professionals should be able to provide more information about support in your specific area. Self-help groups work best when a person is ready to consider making a change in their use. Large open meetings can often be more difficult for a person with brain injury to navigate. Contacting the local chapter and finding smaller, closed meetings is helpful. You may also consider attending a meeting or group with your friend or family member to help them get started.

Residential rehabilitation specifically for substance use
For those who need a different environment, residential rehabilitation centres are available.   This treatment is voluntary, usually group-based and most appropriate for people who are motivated to make a change in their substance use. Programs that are designed to accommodate concurrent disorders are most likely to be flexible in their approach and adapt to the needs of people with brain injury.  There are both private and public addiction centres in Canada. While public centres are free, they have long wait times. Private centres involve out-of-pocket expenses.

Substance use in caregivers

The risk of problematic substance use can also increase for caregivers. Everyone is affected when a loved one experiences a brain injury. Caregivers want to help but often don’t know how best to do it. This leads to feelings of guilt, grief, anxiety, and even resentment. This can be damaging to the caregiver’s mental health and their relationship with the survivor. It is the emotional and mental burden of caregiving that can lead to an increased risk of problematic substance use .

It’s important to have your own support system as a caregiver no matter what. It’s an important but tough job, and your well-being must be prioritized.

Resources and supports for people with substance use disorders

There are no quick and easy answers to substance use problems, but there are resources for individuals looking for help.

The Centre for Addiction and Mental Health has published a guide on addiction that includes chapters on addiction and caregivers/families. These chapters cover tips for helping your loved one, taking care of your own health and well-being, and maintaining your relationship.

See sources

Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:

  • The product or service promises a quick fix
  • Sound too good to be true
  • Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
  • Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
  • The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
  • Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based 

Always proceed with caution and with the advice of your medical team.