Hidden Danger: TBI and Addiction (Traumatic Brain Injury)

By P. Casey Arrillaga, LCSW, LCDC

There is a clear connection between Traumatic Brain Injury [TBI] and addiction, yet the nature of this connection is not as well-understood as we would like. Nonetheless, we can say with certainty that both are life-altering and even life-threatening conditions on their own, and they too often are combined to pose even greater danger. To make matters worse, TBI is not easily visible without specialized screening, so many people are at high risk and neither they nor their families know it. This post explores what we know so far and what we can do to help.

As a note, there is so much to be said about TBI and other mental health conditions, that this is just the first of our blog posts on such topics.

What We Know So Far

Traumatic Brain Injury [TBI] and addiction are closely linked, with each condition seeming to make the other more likely. In other words, someone with an addiction is more likely to sustain a TBI, and someone with a TBI is more likely to engage in behavior that leads to an addiction, such as risky substance use. One reason for this is that a TBI can lead to changes in brain function that affect impulse control, decision-making, and emotional regulation, making individuals more susceptible to substance abuse and potentially other addictions, such as gambling disorder. Additionally, people with already have an addiction are more likely to engage in risky behaviors that increase their chances of sustaining a TBI, such as driving under the influence or engaging in violent altercations.

Notably, such things are often thought of as greater risks for boys and men, but girls and women are disproportionately at risk for TBI from intimate-partner violence, and research suggests that once they have a TBI, females are more vulnerable to excessive substance use. We also know that while more men become addicted to alcohol and other drugs, women who use substances such as alcohol excessively progress more quickly into addiction than men. In addition, while there is not enough research done in these areas, there is good reason to believe that women are more vulnerable to some process addictions such as food addiction or love addiction. Both can be serious threats to health and life. To make matter worse, women often do not report domestic violence, which means that many TBI victims are never screened or treated, so they are walking around at high risk of addiction and further injury, and no one knows it.

After a TBI, individuals may experience memory problems, impaired judgment, mood swings, and increased anxiety or depression. Some people turn to alcohol and other drugs as a form of self-medication. This puts them at chronic risk of addiction unless the TBI effects can be sufficiently addressed, something that is all too rare.

Conversely, chronic substance use can increase the likelihood of experiencing a TBI. Alcohol and other drug use put people at high risk of accidents, falls, and other activities that result in brain injury. A significant percentage of TBI cases are linked to intoxication at the time of injury. In these cases, recovery from TBI may be more complicated due to the neurological effects of ongoing substance abuse, which can hinder the healing process and exacerbate cognitive deficits. While most of the research on this has been done on the influence of alcohol on the frequency of TBI, there is every reason to believe that many other substances can put users at similar risk.

Researchers have pointed out that there may be other variables in the interplay between addiction and TBI, such as personality factors that put people at greater risk for both conditions. For instance, some people are more likely to take risks even as young children, and there is reason to believe childhood TBI puts people at higher risk for addiction, but this poses a “chicken and egg” problem, because a more impulsive or higher risk-taking personality leaves a person more likely to have a TBI, but a TBI can lead to more impulsivity. It may be less important to know which came first than to realize that either one is a sign of danger that must be heeded.

Higher Risk

There are some times and circumstances that put people at higher risk for TBI and thus addiction. We’ll look at two that are particularly dangerous.

A particularly risky time for TBI is during adolescence. This is in part because adolescents, especially males, are more likely to engage in risky behavior that can lead to TBI, including substance use or other compulsive activities that can become addictive. It’s also important to know that some of the strongest evidence of a pathway from TBI to addiction is in research showing that a TBI in adolescence leaves a person significantly more likely to engage in excessive substance use later. While this risk has traditionally been more associated with boys and men since they are more likely to engage in high-impact sports, the military, and risk-taking behavior, the gap between males and females has been closing in recent years. Unfortunately, this is not because males are at lower risk, but because females are more likely than ever to join high-impact sports and enlist in the military.

In fact, the risk of TBI is so much higher for military personnel due to the high likelihood of exposure to blasts, gunfire, and vehicle accidents, that it is rightly considered a job hazard. The nature of military operations also increases the risk of repeated TBIs, which can lead to cumulative neurological damage. This can result in cognitive impairments, emotional difficulties, and an increased risk of developing mental health issues such as PTSD and addiction. Due to the nature of combat and some aspects of military culture, TBI may not be recognized or treated right away, or perhaps ever, leaving those who served their county faithfully at high risk of addiction and other TBI effects. There is so much to be said about this that we will continue exploring this theme in future blog posts.

The coexistence of TBI and addiction poses unique challenges for treatment and recovery. Individuals dealing with both conditions often require integrated care that addresses the cognitive impairments from TBI and the compulsive behaviors associated with addiction. Traditional substance abuse treatments may be less effective for TBI survivors due to memory issues and decreased executive function. Unfortunately, many treatment centers don’t have any effective way to even screen for TBI beyond asking the person during intake, and many people are not good at giving accurate information about such things. This is partly because they may not have clear recollections about potentially traumatic injuries, especially if they were using substances at the time, and partly because they may not have ever gotten assessed, so they have no idea that they have been affected. In many cases, even if someone reports TBI during treatment intake, there is little that can be done to address it.

How Do We Use This Knowledge to Help People?

At Windmill, we not only screen every client for TBI as part of our thorough assessments, every client is also given an EEG shortly after arrival, which allows us to directly see if there are effects of concussion and TBI. Through this process, our clients, team, and family members can then move forward armed with objectively accurate information. When we find evidence that someone has had TBI, we have cutting-edge tools including validated psychometric tools and individualized Transcranial Magnetic Stimulation [TMS], to help people not only manage their lives, but also directly reduce the effects of TBI, thus giving them a much greater chance of recovery from both the TBI and any addiction.

In addition, we offer specialized services for active-duty military, military veterans, and first responders. We have what it takes to overcome combat trauma, other military trauma, and first-responder trauma, both physical and psychological, including any TBI effects.

The Bottom Line

The relationship between TBI and addiction is complex and goes in both directions, and it is often undetected. TBI can increase vulnerability to addiction due to neurological and psychological changes, while substance use can elevate the risk of sustaining a TBI through risky behaviors and accidents. Effective treatment requires a comprehensive, integrated approach that addresses both the cognitive impacts of TBI and any addiction. If you or anyone you love has been affected by TBI and/or addiction, reach out for help now.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.