TBI Survivors and Addiction Risk

Pictured above: Angela Haas, author of blog post

You have likely dealt with substance abuse before, whether it’s in your family, a friend of a friend, or someone you are working with now. If so, you know that substance abuse has an effect on everyone, but that effect is especially dangerous for those who have suffered a traumatic brain injury.

For brain injury survivors, alcohol and drugs can increase the likelihood of seizures, and can also have dangerous interactions with individuals’ prescribed medications. In addition, alcohol and drugs affect our brains differently, and can have a much more powerful effect on someone with a brain injury.

Just as importantly, alcohol and drug use may increase the likelihood of re-injury, as survivors under the influence are more likely to engage in behaviors such as impaired driving, or suffer difficulties with balance or impulsive decision making.

Some of the most bothersome cognitive impacts of TBI include issues with decision-making (mentioned above), as well as problem solving, short-term memory, low inhibition, and decreased awareness. Alcohol and drugs can exacerbate all of these symptoms, unquestionably impacting recovery -- which is why complete abstinence from alcohol and drugs is the healthiest and safest choice to aid in brain injury recovery and sustainability.

Risk Factors for Addiction

  • Alcohol/Drug use or dependence prior to obtaining their brain injury
  • History of mood disorders
  • Current depressive disorder or symptoms of depression
  • Addiction to tobacco
  • Family history of addiction
  • Poor social skills
  • Poverty
  • Early use in adolescence
  • Stress at home
  • Unhelpful support group or lack of natural supports
  • Lack of health insurance or access to health care

Questions to ask if you fear that you or someone you love may have an addiction and need support

  • Do they go through withdrawals if/when they stop using?
  • Do they have to take larger amounts or over a longer time period than intended?
  • Has their use resulted in a failure to fulfill major obligations at work, school, or home?
  • Have they continued to use despite continuous problems with using?
  • Have they made unsuccessful attempts to cut down?
  • Do they have cravings, or a strong desire to use?
  • Have they given up important social, occupational, or recreational activities because of use?
  • Do they continue to use in situations where it is physically hazardous?
  • Do they continue to use despite knowledge of having physical/psychological dependence?
  • Do they spend a great deal of their time obtaining, using, or recovering from its effects?

Want help?

There are many avenues to find support, whether one has commercial insurance, Medicare, Medicaid, or no insurance at all. You can call your local Behavioral Health Authority, and talk to someone who can immediately assess your need for treatment and link you to the appropriate resources. Treatment can involve medical supervision, individual or group therapy, peer support, 12 step recovery, case management, family therapy, and psychiatric services.

Below are several links depending on your need:

If any of these apply to someone you know, show that person that you care, are concerned, and are there to support them! Understand that there are likely reasons they do what they do:

  • Self-medicate for severe/chronic pain from their injuries
  • Cope with the trauma that they have endured
  • Try to combat their symptoms of depression due to a loss they have experienced in their life
  • Escape from their new reality
  • Use due to an underlying mental health condition

You can use the resources above, or contact a professional who can help you get connected. You can also contact the BIAMI staff to help you connect with helpful resources. Stay strong, supportive, and realize that they may be doing the best they can, in this moment, to get through whatever difficulties they may be facing.

Angela M. Haas, LMSW CAADC is a licensed master’s level social worker with her certified advanced alcohol and drug counselor certification. She works with Special Tree Rehabilitation Systems in their outpatient clinic in Midland and Saginaw.

A Response to the Recent CTE Study

Written by Or, Sean Rose

A newly published research study, titled “Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football’” diagnosed CTE in 110 of 111 former NFL players, and overall in 177 of 202 former football players with varying amounts of playing exposure. This is an important study because it included the largest number of CTE cases in football players ever published. However, it’s important to put these results into the right context.

Understanding two different research principles is necessary when interpreting the results: levels of scientific evidence and selection bias. There are multiple levels of scientific evidence, from weak to strong. Opinion and anecdotal findings (for example, when a doctor notices a pattern in a few of his/her patients) are the weakest types of evidence. Randomized trials and compilations of multiple trials are the strongest. A case series: which means that the people included in the study were chosen based on their medical condition, is considered to be one of the weaker types of This study is a case series because the football players were already known or suspected to have CTE. Case series are unable to establish a cause-effect relationship or the incidence of a disease.

“Selection bias” means that the people who are included in a study are not randomly chosen, and the group chosen is not representative of the population that needs to be studied. For example, if you want to know what percentage of students at a school have strep throat, you would bias the results by only testing those students complaining of a sore throat. In this study, the player or his family chose to donate his brain to be studied for CTE, likely because he was having symptoms and other brain problems before he died. Farmer football players who do not have symptoms before dying are less likely to donate their brains to be studied for CTE.

Keeping in mind these two research principles, it becomes clear that focusing on the percentage of football players diagnosed with CTE in this study is misleading. The high frequency of CTE in this group of patients could represent the high degree of selection bias. As the authors of this study acknowledge, “Caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample.” Much more research, involving study types with stronger scientific evidence, is needed to determine the risk factors for developing CTE. Studying a random group of former football players’ brains, or following a group of youth football players through their years of participation, would provide that stronger evidence.

As we await the results of ongoing research in these areas, we should be thoughtful in the way we handle the current evidence. CTE does develop in some football players, as well as other athletes and non-athletes who are exposed to repetitive head impacts. We don’t know the degree of risk, but it is reasonable to assume that there is a dose effect (i.e. more head impacts increase your risk). Taking results from studies of NFL players and applying them to children is problematic. In the current study, CTE was not seen in any individuals who only played football in grade school, and seen at a low frequency in those who only played through high school. It is also important to note that the current study findings have not been replicated in better designed studies. For example, in a study of over 400 individuals (average age 68) who played high school football from 1946-1956, there was no increased risk of dementia or other neurodegenerative diseases compared to classmates who did not play a contact sport.1

The bottom line is that while concern about CTE in former NFL players may be an appropriate response to this study, putting it into the right context highlights the need to conduct substantially more research using different stud y designs before we make dramatic conclusions and statements about CTE and contact sports participation in general.

1. Savica R, Parisi JE, Wold LE, Josephs KA, Ahlskog JE. High school football and risk of neurodegeneration a community-based study. Mayo Clinic Proc. 2012;87:335-340.

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