Addictions and Brain Injury
Completing the Picture
Ruth Wilcock
Executive Director
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To enhance the lives of
Ontarians living with the
effects of ABI through
education, awareness and
support
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6 continuing education courses
Over 6000professionals have
completed our courses
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1-800-263-5404
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Income Support Programs
 ODSP (Ontario Disability Support Program)
 CPP (Canada Pension Plan)
 WSIB (Workers Safety Insurance Board)
 Disability Tax Credits
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Access to Services
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Quality of Care and Services
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General Information
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21 Affiliated Community Associations across
the Province
Provide:
 Information
 Support
 Prevention
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1. What is Brain Injury
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2. Addiction and Substance Abuse
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3. Relationship Between Brain Injury and
Substance Use/Abuse
4. What You Can Do
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Definition:
“Damage to the brain that occurs after birth
and is not related to a congenital disorder or
a degenerative disease such as Cerebral
Palsy Alzheimer’s disease or Parkinson’s
disease”.
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A brain injury can occur
from:
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A traumatic event
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Non traumatic event
All brain injuries are traumatic to the person
who sustained the injury
 Trauma is often experienced:
 Physically
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 Mentally
 Emotionally
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There are
almost a half a
million people
living in Ontario
with a brain
injury
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Brain injury is the number one cause of death
and disability for Canadians under the age of 45.
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Cost of ABI
The cost of ABI is
measured in the
hundreds of millions
of dollars for medical
care, rehabilitation
and life long
supports.
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Fiction
 All brain injuries are
alike
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 Fact
– No two brain
injuries are alike
Fiction
 All brain injuries heal
with time
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Fact
 Many times the damage
to the brain is
permanent
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Fiction
 When one
physically recovers
the brain has
healed itself
 Fact
 Person may look
fine but cognitive
dysfunctions are
compromised
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In many cases the
injuries are
invisible and the
person suffers in
silence
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Undiagnosed
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Misdiagnosed
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Misunderstood
 53% of homeless people in Toronto
have a history of brain injury.
 Of the 53% of people who have a
history of brain injury 70% sustained
a brain injury prior to becoming
homeless
Source: S.W. Hwang, A. Colantonio, S. Chiu, G.
Tolomiczenko, A. Kiss, L. Cowan, D.A. Redelmeier,
& W. Levinson
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It is estimated that
the prevalence rates
for co-morbid
psychiatric disorders
in ABI may be as
high as 44%.
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US study found that
2% of general
population arrested
annually
31% of brain injury
survivors (5 years post
injury)had one or
more arrests
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44% of people in our Ontario prison
system have a history of brain injury
86% of prison inmates in New Zealand
87% of county jail inmates in
Washington
In a sample of 15 convicted murderers
sentenced to death, Lewis and
colleagues (1986) found that 100% of
this death row sample had a history of
severe head injury.
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The brain controls virtually everything
humans experience, including:
Movement
Sensing our environment
Regulating our involuntary body processes such
as breathing
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Takes information
from other parts of
the brain
Formulates
responses
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Cognition and memory
Ability to concentrate
“Gatekeeper” on behaviour (judgment
and inhibition)
Personality and emotional traits
Movement
Sense of smell
Taste
Planning, sequencing and organizing
Self-awareness
Word formation
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Any repeated behaviours,
substance-related or not, in
which a person feels
compelled to persist,
regardless of its negative
impact on her/his life and the
lives of others"
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Compulsive engagement with the behaviour
and a preoccupation with it
Impaired control over the behaviour
Persistence or relapse, despite evidence of
harm
Dissatisfaction, irritability or intense craving
when the object- drug or other activity is not
immediately available
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One-third of ABI survivors have a history of
substance abuse prior to their injury
One third of incidents that cause brain injury
are drug or alcohol related
20% of survivors who do not have a history of
substance abuse problem become vulnerable
to an abuse problem
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As much as 43% of people with brain injuries
can be classified as moderate to heavy
drinkers
Substance abuse is reduces immediately
following injury but often returns to preinjury levels within two to five years postdischarge
Half of people with ABI and substance use
problems have parents with substance use
problems
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Alcohol 72%
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Cannabis 13%
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Crack and Cocaine 10%
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Sedatives 2%
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Heroin 1%
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Other 2%
*Ohio Valley Center for Brain Injury
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Withdrawal:
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Physical withdrawal
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Psychological withdrawal
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Issues pre-injury not
addressed
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Nearly all addictive drugs, directly or
indirectly, target the brain’s reward system by
flooding the circuit with dopamine
Cocaine reduces dopamine receptors
Can take months/years for receptor numbers
in the brain to return to pre-drug use figures
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Alcohol or illicit drugs were used before the
injury
Drug and alcohol use can develop after a
brain injury
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Tolerance levels of substances are decreased
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Social groups change
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Some reasons for substance misuse and
abuse can be:
 A result of chronic pain
 Cognitive problems
 Reduced ability to cope with life's new
challenges.
 Impaired insight
 Lack of self awareness
 Not understanding the consequences
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Diminished volume of
grey matter
Show impaired functions
of the pre-frontal cortex
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Impedes recovery
Exacerbates problems with
balance, walking and talking
Increased disinhibition
Interferes with cognitive skills
and processing
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Alcohol increases depression
because it is a depressant
drug
Interaction with prescribed
medications
Increased risk of another
injury
*Ohio Valley Center for Brain Injury Prevention and Rehabilitation
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Service Providers are trained to identify and treat either brain
injury or substance abuse, not both
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Lack of insight by the survivor to the seriousness of the
problem
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Many substance abuse programs do not take clients who are
identified as having a brain injury
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Symptoms of brain injury and substance abuse can present
in similar ways and include:
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Memory problems
Difficulty concentrating
Balance and co-ordination
Impulsivity
Mood swings (diminished emotional control)
Personality changes
Diminished judgement
Fatigue
Anxiety and or Depression
Sleep problems
Decreased frustration tolerance
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Many addiction
programs are based on
behaviour modification
which will not work with
a survivor with certain
impairments
Lack of motivation
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Have you ever had a concussions? Multiple
concussions? (sports related or other)
Have you ever been involved in a motor vehicle
collisions
Have you ever had a stroke?
Have you ever had fall and hit your head?
Have you ever had a blow to the head?
Have you ever had periods of unconsciousness?
Have you ever been hospitalized? Be specific. When?
How many times?
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Know what brain injury is
and the consequences of
brain injury
Knowledge and
understanding of brain
injury will change your
approach and how you work
with and problem solve with
your client who has a brain
injury
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Educate the client early and often about the
problems of alcohol and other drugs after brain
injury
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Provide information and support
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Educate the family about the risks of clients with
brain injuries using substances
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Engage family/social network in actively supporting
the client to address the issue.
Take a history of client’s prior and current use
Ask what effect use is having on client’s life
Ask about the social context of use
Ask about family’s history of use and/or abuse
Help client find meaningful substance-free
activities.
Establish ongoing contact with professionals in
substance abuse programs
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Stage One – Denial
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Unaware problem exists
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No intention of changing
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Resistant to any type of
intervention
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Stage Two –
Contemplation
Beginning to become
aware
Weigh’s pro’s and
con’s
Still ambivalent
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Stage Three – Preparing for
Change
Major turning point
Begins to recognize potential
losses
Reduce amount they are
using
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Stage Four – Action
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Make significant changes
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Alter their environment
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Stage Five – Maintenance
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Successful at avoiding triggers
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Has coping skills in place
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Has a solid support system
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Make the substance abuse provider aware of:
The survivors person's unique communication and
learning styles and deficits
Known and specific triggers such as over stimulation,
fatigue, noise, bright lights
Disinhibition problems due to a frontal lobe injury
and encourage specific feedback regarding
inappropriate behaviour
Lack of motivation may be due to cognitive
impairments.
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Referral to treatment settings include:
 Detoxification programs
 Residential treatment
 Intensive Outpatient Care
 Counselling
 Self-help groups
 12 step programs
 Psychotherapy
 Substance Use Brain Injury Bridging Project
 www.subi.ca
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Dealing with the client
where they are at
Reduce risks associated
with substance use
Increase’s persons sense
of control and personal
choice
Opens up options
Move out of a state of
chaos into control
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Assists in dealing
with root issues of
the addiction
Need to embrace
the person as a
whole including
pre-injury
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www.obia.ca
1-800-263-5404
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