The Link Between Traumatic Brain Injury and Substance Abuse

Traumatic brain injuries (TBI) and substance abuse have the potential to disrupt the lives of the individuals who grapple with them, as well as their loved ones. Each of these conditions alone can result in challenges with cognition and decision-making, the ability to perform daily tasks, and emotional health. When a person must navigate both a traumatic brain injury and a substance abuse disorder at the same time, the resulting negative impact can be greatly amplified. Recent research shows that individuals who have sustained a traumatic brain injury are more likely than others to have had issues with substance abuse before their injuries. In addition, about 1 in 5 people with a prior TBI will face substance abuse issues after their injury, and those who had substance abuse issues before their brain injury are more likely to relapse to drug or alcohol dependence afterward.

Traumatic Brain Injury Basics

The U.S. Centers for Disease Control and Prevention defines traumatic brain injury (TBI) as a disruption in brain function caused by impact to the head or a penetrating head injury. While anyone may suffer a TBI, children and older adults are at the highest risk of such injuries. Men of any age are about 1.5 times more likely to suffer a brain injury than women. About 1.7 million people suffer a traumatic brain injury in the United States each year, and more than 5 million Americans require long-term care as a result of a previous brain injury.
The leading causes of TBI in the United States are:

  • Falls
  • Motor vehicle accidents
  • Being struck by or against an object
  • Intentional self-harm

While most traumatic brain injuries are classified as mild, the injury can have a wide range of severity. People who experience a TBI may have symptoms that last for only a few days, but symptoms also can linger for the remainder of their lives. In some cases, the person who incurred the brain injury will not realize they are injured until months after the injury, when the symptoms become disruptive to their daily lives.

TBI symptoms generally fall into four categories:

  1. Cognitive, which includes difficulty concentrating, difficulty remembering new information, poor judgment and decision-making, and memory loss
  2. Physical, which includes dizziness, headaches, nausea, and vomiting shortly after the injury, fatigue, vision issues, balance issues, seizures, motor impairments, weakness, and noise or light sensitivity
  3. Emotional, which includes depression, irritability, anxiety, flat affect, impulsiveness, and mood instability
  4. Sleep, which includes difficulty falling asleep, insomnia, sleeping less than usual, or sleeping more than usual

TBI and Substance Abuse: The Compounded Risks

Studies show that substance abuse, including alcohol consumption, after a traumatic brain injury may correlate with worse outcomes regarding cognition, employment rates and satisfaction with life. Individuals who continue to use alcohol and other substances in the aftermath of a TBI are more likely to be diagnosed with psychiatric disorders, face legal charges, and are less likely to return to work following their injury.
For individuals with a traumatic brain injury, the use of substances can lead to slower recovery time, increased brain damage, seizures, a greater chance of incurring another head injury, and
exacerbated TBI symptoms. In fact, the Brain Injury Association of America has explicitly stated that there is no safe amount of alcohol one can consume after a brain injury.
Statistics from the Association for Addiction Professionals demonstrate a connection between substance abuse and TBI beginning from the time of injury:

  • 20 percent of people hospitalized for TBI were intoxicated when the injury occurred
  • 30 percent of people requiring rehab following a TBI were intoxicated when the injury
  • Up to 66 percent of people who have experienced a TBI report alcohol abuse, compared
    to about 24 percent of people with no history of TBI
  • Up to 37 percent of people who have experienced a TBI report illegal drug use,
    compared to about 15 percent of people with no history of TBI

However, limited research also indicates that people who sustain a TBI may have a higher likelihood of drug or alcohol use even if they did not have a history of significant substance abuse before the injury. One theory as to why this occurs is that the substance abuse may serve as a coping mechanism for the individual’s extreme stress and pain resulting from the brain injury. Additionally, if a TBI causes damage to the part of the brain called the orbitofrontal cortex, it can cause an organic personality disorder that could make a person more susceptible to substance abuse.

Unique Issues for Veterans

One of the populations with the highest incidence of both substance abuse and traumatic brain injury is U.S. service members returning from recent conflicts such as those in Iraq and Afghanistan. About 22 percent of those who have been deployed to these countries screen positive for a combat-acquired TBI, usually resulting from proximity to explosive blasts.

According to the Traumatic Brain Injury Center of Excellence (formerly the Defense and Veterans Brain Injury Center), members of the U.S. military sustained more than 434,000 traumatic brain injuries during the two decades from 2000 to 2020. In addition, nearly 1 in 4 recent veterans struggle with substance abuse, most commonly alcohol. One of the greatest challenges for soldiers who have both a brain injury and substance abuse disorder has been little research or coordination by the Military Health System to determine how to treat both problems concurrently and provide veterans with the mental health services
they need when the physical injuries are interrelated.

Seeking Concurrent Treatment for TBI and Substance Abuse

When choosing a provider for treatment of a substance abuse issue in the presence of a traumatic brain injury, a patient should be confident that the health professional or facility
understands how the conditions relate to one another. The complexities of both conditions are compounded by the fact that people who have TBIs are less likely to remain in treatment, in part because of issues relating to cognition, memory, and compliance. To successfully treat addiction in the context of TBI, medical professionals must consider both pieces of the puzzle in tandem.
For example, New Vitae Wellness and Recovery’s comprehensive recovery support services can be combined and developed into an optimal plan for care that best suits each individual. These
services include:

People living with behavioral health, brain injuries, and addiction can feel alone and isolated.
New Vitae understands and is ready to help. Contact us at 610.928.5200 or

If you are in crisis, call 911.