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 person living with a brain injury.
Topics in this section include:
- Substance use before a brain injury
- Substance use after brain injury
- Substance use and rehabilitation
- Ways to find help for problematic use
- Resources for substance use
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 . Substances include:
- Opioids and other prescription drugs
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 . 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
About 20% of people who survive a traumatic brain injury will develop a new problem with substance use . 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 your brain to heal and avoid more serious problems. Understanding how drugs affect recovery after brain injury can help you to make a better decision. There are several effects that substance use can have on someone after their brain injury, including:
- 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 
Drinking alcohol after a brain injury
Your brain may be more susceptible to the effects of alcohol, which can impact your balance, coordination, mood and cognitive processing. Alcohol is also incredibly dangerous to mix with prescription medications you may be taking after your acquired brain injury. If you drink regularly, alcohol may also be having a negative effect on your recovery .
While abstaining from alcohol is your safest option it is always best to speak with your doctor about alcohol use and your 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.
If you are using drugs or alcohol, it is important to work with professionals to ensure that you are not using at the time of appointments. Developing an open and honest dialog with your treatment team is the best way to ensure that you will be able to continue your rehabilitation.
The people with the most knowledge of services in your area will be members of the rehabilitation team and local mental health and addictions programs.
Individuals seeking help with substance use have several options available to them.
- 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. Simple adaptations to counselling often make it possible for people with brain injury to benefit more from the care they receive. It may help to introduce your addictions counselor to other members of your rehabilitation team so that everyone can work together to support you.
- 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 your local chapter and finding smaller, closed meetings is helpful. Often arranging someone to attend with the brain injury survivor is a good strategy to get involved.
- 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.
There are no quick and easy answers to substance use problems, but there are resources for individuals looking for help.
- Alcoholics Anonymous branches in Canada
- Find a Narcotics Anonymous meeting
- The Smart Recovery Program
- From Canada.ca: a complete list of substance use support services available by province/territory
- How to discuss substance use - a guide by Canada.ca
- The Acquired Brain Injury Partnership Project has an informative video on substance use and brain injury.
- Addiction - An Information Guide provided by the Centre for Addiction and Mental Health for people with substance use problems and their families/friends.
- Canada’s Low-Risk Drinking Guidelines
- Find a branch of the Canada Mental Health Association
- HelpGuide.org’s practical tips for overcoming addiction
- You and Substance Use Workbook by HeretoHelp BC
- Opioid Overdose Prevention Toolkit Please note this is Ontario specific, but the information is applicable Canada-wide
- Brain injury and substance use workbook
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.