By Derek Price, CEO of Desert Hope Treatment Center
There is ample evidence that traumatic brain injury (TBI) and substance use disorders (SUDs) are linked: The rate of substance use disorders among those who have experienced a TBI is estimated to be up to 6 times that of the general population. However, astonishingly little about the science surrounding this connection is well understood.
With TBI affecting nearly 1.5 million Americans each year and 40.3 million suffering from past-year SUD in 2020, the connection between TBI and addiction is not one we can afford to ignore.
A traumatic brain injury can happen to anyone, for any number of reasons: the leading causes of TBI in the United States are falls, motor vehicle accidents, firearm-related injuries, and assaults.
That said, certain demographics are at greater risk, including:
- Military service members and veterans. Between 2000 and 2019, around 414,000 service members experienced a TBI. More than 185,000 veterans that rely on Veteran’s Affairs (VA) benefits have had one or more TBI in their lifetime.
- Athletes. Sports-related injuries account for approximately 10% of all TBIs in the United States.
- People experiencing homelessness. A 2020 review published in The Lancet found that the lifetime prevalence of TBI among unsheltered individuals was 53%, which is between 2.5 and 4 times higher than the general population.
- People that drink alcohol. People that drink are 4 times more likely to experience a TBI in their lifetime than teetotalers. Approximately 30-50% of people that suffered a TBI were intoxicated at the time of injury.
Nearly 75% of people seeking treatment for co-occurring mental health and substance use disorders have been impacted by brain injury. Despite the staggering prevalence of substance use and traumatic brain injuries, experts are only beginning to understand the complex connection between the two.
Derek Price, CEO of Desert Hope.
However, we do know that substance use and TBIs share a two-way relationship. In other words, drug and alcohol use increases the likelihood of experiencing a TBI, and people who experience a TBI are at greater risk of developing a substance use disorder.
Biological and psychological factors are believed to play a role in the development or worsening of an addiction following a TBI. For one, there is evidence that injury-related disruptions to the brain’s dopamine pathways and orbitofrontal cortical processing could help explain TBI survivors’ vulnerability to addiction. Additionally, the emotional trauma or chronic pain that results from sustaining a TBI could lead to self-medicating with drugs and alcohol, which could increase the risk of addiction development.
On the other hand, drug and alcohol use impairs a person’s judgment, which may lead to putting oneself in situations that could increase the chances of experiencing a TBI, such as driving under the influence.
TBIs can also occur during a drug overdose. Opioid overdoses often deprive the brain of oxygen. If a person survives an overdose, they may continue to struggle with persistent issues related to anoxic brain injury. Overdose survivors who have brain injuries are at higher risk for future overdoses.
Unfortunately, treating addiction among people who have experienced a TBI poses challenges. For one, TBIs often go undiagnosed. Without a diagnosis of a TBI, many patients and health providers may be unaware of how the injury affects them and of necessary special treatment considerations. Many addiction treatment programs fail to screen for TBIs, even though evidence-based screening tools are available.
TBIs are also linked to co-occurring mental health conditions like depression, anxiety disorders, and PTSD, which are associated with poorer adherence to treatment programs and higher dropout rates. Research shows that treating comorbid conditions together is more effective than treating any condition alone. Treatment for substance use disorders among people who have experienced TBI should therefore address their addiction, brain injury, and any mental health issues simultaneously.
As a state, Nevadans can work together to do more to support people who have been impacted by TBI and substance use disorders. We can fund research on TBI and substance use disorders to better understand this relationship and determine the most effective treatments. Legislators in our state can pass laws that support treatment, rather than punishment, for those with addictions.
Treatment facilities and providers can incorporate screening for TBI into their admissions process and provide comprehensive, individualized treatment. Desert Hope Treatment Center in Las Vegas, for example, offers a range of addiction treatment services that are tailored to the individual, including a specialized program that addresses the unique needs of veterans and first responders, a population at risk of experiencing traumatic brain injury.
As a society, we can work to end the stigma surrounding addiction by learning about it and encouraging our loved ones to get the help that they need. We can be careful to avoid judgmental or stigmatizing language when we talk about addiction, understanding that substance use disorder is a disease, not a choice. Taking steps to reduce stigma can encourage more people to seek help with less fear of judgment.
All of us must work together to help evoke change. Whether you are a treatment provider, legislator, or citizen, we can all do our part to help understand and support those suffering from TBI and substance use disorders.
