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Addictions and Brain Injury Completing the Picture. Ruth Wilcock Executive Director. Mission of OBIA. To enhance the lives of Ontarians living with the effects of ABI through education, awareness and support. Education – In collaboration with Brock University.

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Ruth Wilcock Executive Director

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Ruth wilcock executive director

Addictions and Brain Injury

Completing the Picture

Ruth Wilcock

Executive Director

Mission of obia

Mission of OBIA

  • To enhance the lives of Ontarians living with the effects of ABI through education, awareness and support

Education in collaboration with brock university

Education – In collaboration with Brock University

  • 6 continuing education courses

  • Over 6000professionals have completed our courses

Brain basics

Brain Basics

Obia support services

OBIA Support Services


Obia services personal advocacy

OBIA Services - Personal Advocacy

  • Income Support Programs

  • ODSP (Ontario Disability Support Program)

  • CPP (Canada Pension Plan)

  • WSIB (Workers Safety Insurance Board)

  • Disability Tax Credits

Personal advocacy con t

Personal Advocacy (Con’t)

  • Access to Services

  • Quality of Care and Services

  • General Information

Provincial network

Provincial Network

  • 21 Affiliated Community Associations across the Province

  • Provide:

  • Information

  • Support

  • Prevention

Addictions and brain injury completing the picture

Addictions and Brain InjuryCompleting the Picture



  • 1. What is Brain Injury

  • 2. Addiction and Substance Abuse

  • 3. Relationship Between Brain Injury and Substance Use/Abuse

  • 4. What You Can Do

A fragmented view

A Fragmented View

Complex issues

Complex Issues


Brain Injury

What is acquired brain injury

What is Acquired Brain Injury?

  • Definition:

  • “Damage to the brain that occurs after birth and is not related to a congenital disorder or a degenerative disease such as Cerebral Palsy Alzheimer’s disease or Parkinson’s disease”.

Traumatic and non traumatic

Traumatic and Non Traumatic

  • A brain injury can occur from:

  • A traumatic event

  • Non traumatic event



  • All brain injuries are traumatic to the person who sustained the injury

  • Trauma is often experienced:

  • Physically

  • Mentally

  • Emotionally

Prevalence of brain injury

Prevalence of Brain Injury

  • There are almost a half a million people living in Ontario with a brain injury

Incidence of brain injury

Incidence of Brain Injury


Ruth wilcock executive director

Brain injury is the number one cause of death and disability for Canadians under the age of 45.


Ruth wilcock executive director

Cost of ABI

The cost of ABI is measured in the hundreds of millions of dollars for medical care, rehabilitation and life long supports.


The cost in terms of human suffering and lost potential is immeasurable

The cost in terms of human suffering and lost potential is immeasurable.


Abi facts and fiction

ABI Facts and Fiction

  • Fiction

  • All brain injuries are alike

  • Fact – No two brain injuries are alike

Abi facts and fiction1

ABI Facts and Fiction

  • Fiction

  • All brain injuries heal with time

  • Fact

  • Many times the damage to the brain is permanent

Abi facts and fiction2

ABI Facts and Fiction

  • Fiction

  • When one physically recovers the brain has healed itself

  • Fact

  • Person may look fine but cognitive dysfunctions are compromised

Abi the invisible disability

ABI – The Invisible Disability

  • In many cases the injuries are invisible and the person suffers in silence

Brain injuries often go

Brain Injuries Often Go:

  • Undiagnosed

  • Misdiagnosed

  • Misunderstood

Brain injury and homelessness

Brain Injury and Homelessness

  • 53% of homeless people in Toronto have a history of brain injury.

  • Of the 53% of people who have a history of brain injury 70% sustained a brain injury prior to becoming homeless

Source: S.W. Hwang, A. Colantonio, S. Chiu, G. Tolomiczenko, A. Kiss, L. Cowan, D.A. Redelmeier,

& W. Levinson

Brain injury and mental health

Brain Injury and Mental Health

  • It is estimated that the prevalence rates for co-morbid psychiatric disorders in ABI may be as high as 44%.

Arrests and brain injury

Arrests and Brain Injury

  • US study found that 2% of general population arrested annually

  • 31% of brain injury survivors (5 years post injury)had one or more arrests

Brain injury and prison population

Brain Injury and Prison Population

  • 44% of people in our Ontario prison system have a history of brain injury

  • 86% of prison inmates in New Zealand

  • 87% of county jail inmates in Washington

  • In a sample of 15 convicted murderers sentenced to death, Lewis and colleagues (1986) found that 100% of this death row sample had a history of severe head injury.

The brain controls everything

The Brain Controls Everything

  • The brain controls virtually everything humans experience, including:

    • Movement

    • Sensing our environment

    • Regulating our involuntary body processes such as breathing

Lobes of the cerebral cortex

Lobes of the Cerebral Cortex

Frontal lobe executive

Frontal Lobe – (Executive)

Function of the Lobes

  • Takes information from other parts of the brain

  • Formulates responses

Frontal lobe

Frontal Lobe

  • Cognition and memory

  • Ability to concentrate

  • “Gatekeeper” on behaviour (judgment and inhibition)

  • Personality and emotional traits

  • Movement

  • Sense of smell

  • Taste

  • Planning, sequencing and organizing

  • Self-awareness

  • Word formation

The stigma and tragedy of addiction

The Stigma and Tragedy of Addiction

Definition of addiction

Definition of Addiction

  • Any repeated behaviours, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on her/his life and the lives of others"

Addiction involves

Addiction Involves:

  • Compulsive engagement with the behaviour and a preoccupation with it

  • Impaired control over the behaviour

  • Persistence or relapse, despite evidence of harm

  • Dissatisfaction, irritability or intense craving when the object- drug or other activity is not immediately available

Substance abuse and brain injury

Substance Abuse and Brain Injury

  • One-third of ABI survivors have a history of substance abuse prior to their injury

  • One third of incidents that cause brain injury are drug or alcohol related

  • 20% of survivors who do not have a history of substance abuse problem become vulnerable to an abuse problem

Quick facts

Quick Facts

  • As much as 43% of people with brain injuries can be classified as moderate to heavy drinkers

  • Substance abuse is reduces immediately following injury but often returns to pre-injury levels within two to five years post-discharge

  • Half of people with ABI and substance use problems have parents with substance use problems

Drugs of choice include

Drugs of Choice Include:

  • Alcohol 72%

  • Cannabis 13%

  • Crack and Cocaine 10%

  • Sedatives 2%

  • Heroin 1%

  • Other 2% *Ohio Valley Center for Brain Injury

Existing problem with substance abuse

Existing Problem with Substance Abuse

  • Withdrawal:

  • Physical withdrawal

  • Psychological withdrawal

  • Issues pre-injury not addressed

The role of dopamine

The Role of Dopamine

  • Nearly all addictive drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine

  • Cocaine reduces dopamine receptors

  • Can take months/years for receptor numbers in the brain to return to pre-drug use figures

Relationship of substance use to brain injury

Relationship of Substance Use to Brain Injury

  • Alcohol or illicit drugs were used before the injury

  • Drug and alcohol use can develop after a brain injury

  • Tolerance levels of substances are decreased

  • Social groups change

A vulnerable population

A Vulnerable Population

  • Some reasons for substance misuse and abuse can be:

  • A result of chronic pain

  • Cognitive problems

  • Reduced ability to cope with life's new challenges.

  • Impaired insight

  • Lack of self awareness

  • Not understanding the consequences

The brain on drugs

The Brain on Drugs

  • Diminished volume of grey matter

  • Show impaired functions of the pre-frontal cortex

Why substance use after brain injury is a bad idea

Why Substance Use After Brain Injury is a Bad Idea

  • Impedes recovery

  • Exacerbates problems with balance, walking and talking

  • Increased disinhibition

  • Interferes with cognitive skills and processing

Other considerations

Other Considerations

  • Alcohol increases depression because it is a depressant drug

  • Interaction with prescribed medications

  • Increased risk of another injury*Ohio Valley Center for Brain Injury Prevention and Rehabilitation

Why substance users fall through the cracks

Why Substance Users Fall Through the Cracks

  • Service Providers are trained to identify and treat either brain injury or substance abuse, not both

  • Lack of insight by the survivor to the seriousness of the problem

  • Many substance abuse programs do not take clients who are identified as having a brain injury

  • Symptoms of brain injury and substance abuse can present

    in similar ways and include:

Symptoms common to brain injury and substance abuse

Symptoms Common to Brain Injury and Substance Abuse

  • Memory problems

  • Difficulty concentrating

  • Balance and co-ordination

  • Impulsivity

  • Mood swings (diminished emotional control)

  • Personality changes

  • Diminished judgement

  • Fatigue

  • Anxiety and or Depression

  • Sleep problems

  • Decreased frustration tolerance

Why substance users fall through the cracks1

Why Substance Users Fall Through the Cracks

  • Many addiction programs are based on behaviour modification which will not work with a survivor with certain impairments

  • Lack of motivation

What you can do ask questions

What You Can Do – Ask Questions

  • Have you ever had a concussions? Multiple concussions? (sports related or other)

  • Have you ever been involved in a motor vehicle collisions

  • Have you ever had a stroke?

  • Have you ever had fall and hit your head?

  • Have you ever had a blow to the head?

  • Have you ever had periods of unconsciousness?

  • Have you ever been hospitalized? Be specific. When? How many times?

What you can do educate yourself about brain injury

What You Can Do – Educate Yourself About Brain Injury

  • Know what brain injury is and the consequences of brain injury

  • Knowledge and understanding of brain injury will change your approach and how you work with and problem solve with your client who has a brain injury

What you can do

What You Can Do

  • Educate the client early and often about the problems of alcohol and other drugs after brain injury

  • Provide information and support

  • Educate the family about the risks of clients with brain injuries using substances

What you can do con t

What You Can Do (con’t)

  • Engage family/social network in actively supporting the client to address the issue.

  • Take a history of client’s prior and current use

  • Ask what effect use is having on client’s life

  • Ask about the social context of use

  • Ask about family’s history of use and/or abuse

  • Help client find meaningful substance-free activities.

  • Establish ongoing contact with professionals in substance abuse programs

Five stages of change in substance use

Five Stages of Change In Substance Use

  • Stage One – Denial

  • Unaware problem exists

  • No intention of changing

  • Resistant to any type of intervention

Five stages of change in substance use1

Five Stages of Change in Substance Use

  • Stage Two – Contemplation

  • Beginning to become aware

  • Weigh’s pro’s and con’s

  • Still ambivalent

Five stages of change in substance use2

Five Stages of Change In Substance Use

  • Stage Three – Preparing for Change

  • Major turning point

  • Begins to recognize potential losses

  • Reduce amount they are using

Five stages of change in substance use3

Five Stages of Change In Substance Use

  • Stage Four – Action

  • Make significant changes

  • Alter their environment

Five stages of change in substance use4

Five Stages of Change In Substance Use

  • Stage Five – Maintenance

  • Successful at avoiding triggers

  • Has coping skills in place

  • Has a solid support system

Tips to give professionals

Tips to Give Professionals

  • Make the substance abuse provider aware of:

  • The survivors person's unique communication and learning styles and deficits

  • Known and specific triggers such as over stimulation, fatigue, noise, bright lights

  • Disinhibition problems due to a frontal lobe injury and encourage specific feedback regarding inappropriate behaviour

  • Lack of motivation may be due to cognitive impairments.

Further interventions

Further Interventions

  • Referral to treatment settings include:

  • Detoxification programs

  • Residential treatment

  • Intensive Outpatient Care

  • Counselling

  • Self-help groups

  • 12 step programs

  • Psychotherapy

  • Substance Use Brain Injury Bridging Project


Harm reduction

Harm Reduction

  • Dealing with the client where they are at

  • Reduce risks associated with substance use

  • Increase’s persons sense of control and personal choice

  • Opens up options

  • Move out of a state of chaos into control

Psychotherapeutic interventions

Psychotherapeutic Interventions

  • Assists in dealing with root issues of the addiction

  • Need to embrace the person as a whole including pre-injury

Thank you

Thank You!


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