Sustaining A Traumatic Brain Injury Can Often lead To Substance Misuse. What Can Be Done About It?

June 25, 2024. By Robin

2023-24 Schweitzer Fellow Robin Bilodeau

In early March 2023, I received an unpresumptuous early morning text message from a friend asking if I had time for a quick telephone call. My ears heard What he told me, but my mind and body refused. He simply stated, “They found Jess, Robin”, and I immediately knew she was no longer with us. My vivacious thirty-one-year-old friend was found on the cold bathroom floor unresponsive. Her unborn 8-month-old daughter and Jess had both passed away due to a fatal overdose of synthetic opioids.

I have a transparent awareness that I am not alone in my grief as the ongoing opioid epidemic continues to ravage communities across the United States. The Substance Abuse and Mental Health Services Administration reported 115,355 Americans fatally overdosing from April 2022 to April 2023. Despite record-high federal funding for prevention and treatment, distribution of a multi-billion dollar opioid settlement funding, an increase in medically assisted treatment centers and harm reduction collectives, and a significant rise in community awareness of the epidemic- the number of fatal overdoses across the United States continues to rise. Identification of early indicators for addiction development can improve prevention strategies and harm reduction in clinical practice.

 Research has demonstrated a strong correlation between substance use and an increased probability of sustaining a traumatic brain injury including concussion. A quarter of individuals entering brain injury inpatient rehabilitation enter as a direct result of accidents that occured while the individual was under the influence of substances according to the Brain Injury Association of America. Once a head injury occurs individuals may experience a plethora of symptoms and develop comorbid behavioral, physical, and mental health conditions. The symptoms presented following a traumatic brain injury are often identical twins to the factors typically noted in addiction development.

The region of the brain impacted directly correlates to the manifestation of symptoms following injury. For example, the frontal lobes of the brain are responsible for directing higher executive functions like problem-solving, attention, problem recognition, memory, and solution identification. Following a head trauma the limbic system, which is responsible for emotional response, activates, which can lead to increased sensitivity to negative stimuli. Sustaining a brain injury increases the probability of developing an anxiety-based disorder such as obsessive-compulsive disorder, panic disorders, and phobias, which have previous association with substance use disorders as co-occurring mental health diagnoses.

The significance of analyzing the relationship between post-traumatic brain injury, and the development of substance use disorder, becomes paramount considering approximately 1.7 million people, of all ages across the lifespan, sustain a traumatic brain injury annually, in the United States. A startling statistic reported by the Brain Injury Association of America described the remarkably high rate of people who are currently incarcerated with a previous diagnosis of mild or traumatic brain injury. Currently, of the 2 million people who are experiencing incarceration in the nation, 60 percent reported sustaining a previous traumatic brain injury. A 2020 longitudinal research study of over 3 million youth found that children living with TBI are at higher risk of developing psychiatric disorders and substance use disorders simultaneously. Individuals like Jessica, who had previously experienced a concussion, face an array of symptoms that create challenges with coping and emotional regulation. As the opioid epidemic continues to rage on, understanding the medically complex variables that contribute to misuse can assist in harm reduction, prevention, and the addition of best practice protocols to address future preventable substance use.

Rehabilitation teams must adequately offer support and resources on the viability of addiction development and other mental health challenges. Families and caregivers need education on the necessary prevention techniques that clarify their increased risk of addiction, becoming unhoused, and incarceration. I urge rehabilitation professionals to address the highly stigmatized topics that pose a definitive risk to patients who exhibit a decreased ability to recognize hazards. Together we must work to promote the inclusion of social workers, occupational therapists, peer support specialists, and addiction specialists in the treatment, management, and prevention of all concurrent conditions. Healthcare professionals hold the responsibility to dismantle the societal misperception of substance misuse to ensure stigma-free comprehensive clinical treatment following brain injury.

Robin Bilodeau

2023-24 NC Albert Schweitzer Fellow

WSSU Occupational Therapy, Class of 2024