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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

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
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
  • 1. What is Brain Injury
  • 2. Addiction and Substance Abuse
  • 3. Relationship Between Brain Injury and Substance Use/Abuse
  • 4. What You Can Do
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

Cost of ABI

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


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
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
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!