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What You Need to Know About Substance Abuse and TBI

Service member surrounded by medications and an empty bottle
U.S. Navy photo by Seaman Tina Staffieri

For many, drinking in moderation doesn’t pose a problem. But for those with traumatic brain injury (TBI), using drugs or alcohol to cope can be dangerous. Providers need to be aware that failure to treat substance abuse problems following TBI may be counterproductive to a successful recovery, and lead to added medical, psychiatric or behavioral problems, unemployment and family troubles for patients.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) addressed these concerns during the January webinar, “Substance Abuse and Traumatic Brain Injury: Magnitude, Manifestations, Myths and Management.” Dr. Charles H. Bombardier, professor of rehabilitation medicine at the University of Washington School of Medicine, discussed key messages for health professionals to consider when working with patients with both substance abuse and TBI, which included:

  • Substance use and abuse frequently co-occurs with TBI and can have negative outcomes for the individual
  • Unfounded myths associated with treatment of substance abuse can pose barriers to care
  • There are many brief, sensitive, no-cost screening methods
  • Different treatments are available, and multiple sessions are recommended
  • Intervention techniques can be used by non-specialists, and alcohol screenings and interventions can be integrated with clinical treatment

According to Bombardier, 38 percent of people with a TBI report that alcohol affects them easily. Harmful effects associated with alcohol use after a TBI include insomnia, fatigue, cognitive issues (attention deficit, lack of memory and processing speed), sexual inactivity, and impaired balance and coordination.

Myths, especially ones related to clinical care, can deter individuals from seeking the help they need. Bombardier noted the following myths associated with substance abuse interventions in a clinical setting:

  • Individuals must admit they’re an alcoholic
  • Not accepting help is denial
  • Denial is an alcoholic personality trait
  • Denial must be confronted
  • Formal treatment is always necessary
  • Goal must be lifetime abstinence

People seeking help for substance abuse problems and TBI should know that they don’t necessarily have to enter a formal alcoholic rehabilitation program, admit that they’re an alcoholic, or be questioned about being in denial, according to Bombardier. For example, goal setting, enhancing social support and reviewing ways to cope with the triggers that lead to drinking have shown to be effective intervention methods.

Bombardier also highlighted substance use screening as a valuable tool for providers. Because past problems are predictive of future problems, says Bombardier, alcohol abuse screening methods such as CAGE — concern/cut down, anger, guilt and eye opener — help providers identify individuals who don’t require assistance, allowing them to focus on those with a defined substance abuse problem.

Substance abuse is a risk factor for those with a TBI, and TBI is a risk factor for developing a substance abuse problem. It may serve providers well to be aware of this connection, the issues involved and treatment options. Bombardier’s presentation and audio from this webinar are available on the DCoE website.

Be sure to join us for a discussion on chronic pain in the next DCoE webinar, from 1 to 2:30 p.m. (EST) Feb. 28.

Comments (6)

  • Debbie Peterson 05 Feb

    I am a LPC Mental Health provider and am interested in messages, online training and working with men and women returning home with PTSD, depression, etc.

    Thank you,
    Debbie Peterson
  • Elisendo Humillado 06 Feb

    El 28 de febrero hará 24 años que empezó esta gran lucha con mi vida. No puedo más, y encima mucha gente que me han conocido, se pensarán que yo deseó ser el Mesías (Jesucristo). ¿Por qué Creador/a?

    ¿Qué sentido tiene todo esto? ¡Tengo ganas de morir, aunque no lo volvería a intentar (el suicidio)! ¡Soy un luchador nato! Tantas cosas especiales que me han pasado, sentido, presagiado, deseado... y tanta personas que me han hundido mis ideas y sólo para ayudar a los demás. Cuanta poca fe tiene el ser humano y qué arrepentido me siento de estar en este planeta. Todo por el asqueroso dinero, poder, querer pisotear y destrozar a toda costa al que tenemos al lado. Me avergüenzo absolutamente de ser, ser humano: valga la redundancia. ¿Qué más puedo esperar del hombre? Esto cada vez va peor y el futuro de la humanidad no es Nada beneficioso para nosotros. Y encima salpicamos a la Naturaleza, demás seres vivos y a toda la Vía Láctea. Somos penosos y ruines. Que Dios/a(es) se apiaden de nuestras almas: ¡Qué así sea, que así sea por los siglos de los siglos! Siglo XXI (777) 2013. Este año lo vamos a pasar francamente mal. JJOO
  • DCoE Blog Editor 06 Feb

    @Debbie, Here are just a few sites that might be worth checking out:

    - You can search for opportunities to help veterans and military families in your area at

    - Find training information and resources in the training section of the DCoE website at

    - The Center for Deployment Psychology offers multiple educational packages geared towards behavioral health providers who treat service members, visit

    - The Military Health System offers education and training, visit

    - Lastly, Give an Hour, a nonprofit organization that provides free mental health services to military personnel and their families, has information on how providers can get involved at

  • Elaine 06 Feb

    I would like to participate in more of your great training. Could you add a feature that allows me to save this to my calendar? ICal

  • DCoE Blog Editor 06 Feb

    Thanks for your interest in our monthly webinars. Your idea will be shared with the webinar team. You can also send questions and provide feedback about the DCoE monthly webinars to

  • DCoE Blog Editor 08 Feb

    @Elisendo, ¡Muchas gracias por comunicarse con nosostros! Sepa que no está solo y, hay muchos recursos y apoyo para usted. Si usted está en medio de una crisis; o siente agonía intensa y está en medio de problemas, o dificultades; si tiene pensamientos de hacerse daño o suicidas; por favor llame a la linea nacional de prevención de suicidio, teléfono 800-273-8255, y hable con alguien. Si usted es un miembro activo en las fuerzas militares o, un veterano presione el uno (1) y sera conectado con un consejero en la linea de crisis militar.

    Si tiene preguntas relacionadas con salud mental o lesiones traumáticas del cerebro, por favor llame a la linea de comunicacion y acercamiento de los Centros de Excelencia del Departamento de la Defensa (DCoE) 866-966-1020, al correo electrónico o, comuniquese al Estos centros están disponibles 24/7 y, pueden ayudarte a encontrar recursos adecuados en tu region, distrito o area.

    Thank you for reaching out to us. You're not alone and support is out there. If you’re in a crisis, experiencing emotional distress or suicidal thoughts, please call the National Suicide Prevention Lifeline at 800-273-8255 and talk to someone. If you’re a service member or a veteran, press 1 to be directed to the Military Crisis Line counselors.

    If you have questions related to psychological health or traumatic brain injury, please call the DCoE Outreach Center at 866-966-1020, email or live chat with someone. The center is available 24/7 and can assist you in finding resources in your area if needed.

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