We’ve known for a long time that drug, and alcohol use, are associated with a higher risk of traumatic brain injury. That’s because excessive substance use significantly increases your risk of being involved in a serious accident, a fight, or becoming the victim of violence. Continued substance use can also make recovery from a brain injury harder. However, it’s also possible that head trauma can increase your risk of addiction too.
The question of whether head trauma can increase your risk of addiction is difficult to pin down for a number of reasons. Part of it is that researchers have to rely on self-reports of both symptoms and prior substance use. So, for example, someone gets into a car accident but doesn’t go to the hospital right away, where they might get a blood test. A few days later, they go to the doctor complaining of persistent headaches and confusion and insist they weren’t drinking at the time of the accident.
Was there a pre-existing alcohol use issue or not? It’s hard to say. Similarly, for some kinds of brain injury there is no medical test, so whether someone actually has suffered head trauma is not always easy to establish. Finally, sometimes different causes can get tangled up. For example, receiving a head injury as a result of a violent crime may also cause PTSD, another major risk factor for substance use issues.
However, there are several reasons to think that head injuries can contribute to addiction risk, even in people who don’t have the typical risk factors such as genetic predisposition, family history, abuse or neglect, or pre-existing mental health issues.
One study found that military veterans with a mild traumatic brain injury were 2.6 times more likely to be discharged for drug and alcohol use, while those with moderate traumatic brain injury were 5.4 times more likely to be discharged for the same reason. The following are some possible ways that traumatic brain injury may be connected to increased risk for substance use disorders.
First, whether a head injury affects your addiction risk depends to some extent on the injury. Brains are complex and traumatic brain injuries can sometimes cause highly specific or even bizarre changes in behavior. These changes may or may not include substance use or related behaviors. However, even a fairly specific injury might have unpredictable downstream effects.
Mood disorders are common in brain injuries for several reasons. First, mood disorders, such as major depression are often a direct result of brain injury. Experts estimate that anywhere between 25 and 50 percent of people with a traumatic brain injury develop symptoms of major depression or anxiety in the first year following the injury. There are a number of reasons this happens.
Injuries typically cause some degree of inflammation, which recent research has linked to some forms of depression. The prefrontal cortex of the brain also plays an important moderating function when it comes to mood. Since the prefrontal cortex is near the surface of the brain, it can be damaged by an impact to the head even if it doesn’t damage the skull. As a result, you may become more vulnerable to depression and anxiety.
There may be downstream effects as well. If you suffer from symptoms of traumatic brain injury, whether it’s a mood disorder, impaired cognitive function, aggression, poor social skills, and so on, you may end up losing your job or becoming socially alienated, which only makes the situation worse.
Anxiety and depression are both major risk factors for substance use disorders. About 15 percent of people who experienced an anxiety disorder–not including PTSD–in the past year also developed substance use issues. And of people with mood disorder–including major depression and bipolar disorder–about 32 percent develop a substance use disorder.
As noted above, it can be hard to tease out how much traumatic brain injuries affect your addiction risk because traumatic brain injuries and PTSD often go together. To some extent, they can’t be separated because if you are violently attacked or involved in an accident serious enough to cause brain trauma, there’s a greater likelihood of developing PTSD.
The severity of trauma is one of the most important risk factors in developing the condition. As discussed above, the physical damage caused by the injury may also make PTSD more likely, as your ability to regulate your moods might be impaired too.
PTSD is a major risk for developing a substance use issue. Research suggests that between 20 and 50 percent of people seeking help for a substance use disorder have had a lifetime diagnosis of PTSD. Most commonly, this trauma is the result of childhood abuse, sexual assault, and events that don’t involve traumatic brain injury, but they do sometimes overlap.
As discussed, one common challenge of traumatic brain injury is that it impairs emotional regulation. Depending on the injury, other faculties can be affected as well. Injury to the prefrontal cortex, which is important in emotional regulation, can also result in more impulsive behavior, lack of foresight, lack of self-control, and poor decision-making. These can all lead to increased and inappropriate substance use.
Traumatic brain injury may also lead to personality changes, for example, in the famous case of Phineas Gage. Gage was a railroad worker who suffered severe damage to the front of his brain as a result of a work accident. Before the accident, he was conscientious, polite, and a hard worker but after the accident, he became antisocial and developed an alcohol use problem.
Finally, a brain injury can lead to chronic pain such as migraines or pain felt elsewhere in the body. That can lead to increased substance use–including alcohol, prescription medication, and illicit substances–to try to manage pain. This may be compounded by some of the factors discussed above, such as impulsivity or mood disorders.
The relationship between chronic pain and addiction is complex and murky and no doubt will benefit from further research. The military and combat veterans in particular have a lot at stake in this regard, since traumatic brain injury, substance use, PTSD, and suicide are all closely interrelated issues. However, brain injuries and trauma happen to everyone, and if you struggle with substance use, it’s worth considering whether a brain injury may be part of the reason.
At Hired Power, we know that there is no one-size-fits-all in addiction recovery. Everyone has different needs and different circumstances and treatment should fit the individual. We provide services such as interventions, sober transportation, case management, sober coaching, and others, that allow you to create a recovery experience that works for you. For more information, call us today at (714) 559-3919.
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