When Acquired Brain Injury, Mental Health and/or Addictions Overlap
Although the presentation of some mental health issues can be difficult to differentiate from the effects of an ABI, the two are not addressed the in the same way. While issues relating to brain injury remain generally stable or improve over time, mental health symptoms may have a onset that post-dates the injury, or display symptoms that come and go depending on mood. Those living with an ABI are often more vulnerable than the general population to mental health disorders such as anxiety, post-traumatic stress disorder, and depression (www.abiebr.com). It should be noted that the severity of the ABI is not correlated to the likelihood of a concurrent mental illness. Many individuals who have sustained what would be deemed a mild brain injury face their first onset of depression in the days that follow.
Causes & Diagnosis
Often this is most noticeable to those closest to the person with an ABI; family, friends, and support workers. Sometimes these comorbidities pre-date the injury, at other times the brain changes may trigger issues which did not previously exist. The trauma, loss of ability, and social connection many face following an injury can also trigger symptoms of anxiety and depression. The injury often places a strain within family systems, causing stress, fear, or tension. Changes to the brain can trigger biochemical changes and difficulty with the regulations of body systems such as the endocrine system, which left untreated, can manifest themselves in mental health issues.
Complaints may include that the individual is not able to cope as they had at an earlier time, or have noticed changes in behaviour or abilities. By asking the right questions and looking to the root of the issue and not the presentation, it is often possible to distinguish with some probability whether a mental health issue should be considered.
Questions to Ask the Survivor and Family Members, If Possible:
- Were there mental health or addictions issues prior to sustaining the brain injury?
- Have you noticed changes in your ability to do things you had been able to do since the time of injury?
- Have there been any behavioural concerns or irritability? What were the triggers?
- Have you noticed changes in: grooming, appetite, sleeping habits, pain, concentration, attention, or memory? (Consider that the although these areas may be impacted as a result of the injury they are still subject to change in the event of a mental health issue)
- Have you been able to engage in activities you enjoy at home, or in the community? Assess for feelings of loss related to injury.
- Has the injury affected your family members? How well do you feel you are supported and understood?
- Have you experienced recurring thoughts of the accident or fears that something similar could occur again?
It is generally recommended that a biopsychosocial approach be taken in the treatment of mental health issues in the ABI population. Medications should be considered where appropriate, while accompanied by supports to engage the individual in the community and activities as much as possible. Counselling is advisable not only to the affected individual, but their family members as well, to enhance coping abilities within the family unit. Finally, steps should be taken to maximize the individuals’ physical health through balanced diet and regular exercise, as these factors have been demonstrated to impact positive outcomes.
Many resources are available which provide further education on brain injury for physicians and caregivers. Please visit our Research and Learning Links section or contact us directly to request a consultation.
ABI (Acquired Brain Injury) and Addiction/Mental Health Collaboratives
The ABI (Acquired Brain Injury) and Addiction/Mental Health Collaborative is a group of service providers who meet monthly to hear about people who meet specified criteria and are believed to be at risk. There is a Collaborative for each of the three regions of the SE LHIN: HPE, KFLA and LLG. The Collaboratives were established to provide a mechanism for addressing the needs of people with moderate to severe ABI and a comorbidity of mental illness and/or addiction. Collaborative members are representative of (government-funded) ABI, Addictions, and Mental Health and related services in Southeastern Ontario (SEO). The Collaborative members talk about what services they are able to offer to address and hopefully reduce risk and assist with the provision of treatment, rehabilitation and support services.
For more about the ABI (Acquired Brain Injury) and Addiction/Mental Health Collaboratives:
Heightened Risks of Substance Use Following Brain Injury
Substance use is of greater concern following a brain injury due to the impact of drugs and/or alcohol on the healing brain. Use of alcohol and illicit drugs can hamper the brain’s ability to heal, increase risk of seizures, and increase impairments. Tolerance for certain substances including alcohol is also reduced following an brain injury, causing the individual to display signs of intoxication at levels of use they might not have previously. Compounding the nature of addiction issues, the brain injury can affect the individual’s self-awareness and perceptions, reducing their ability to recognize concerns and consequences of substance misuse.
Considerations for Addictions Professionals
Individuals living with a brain injury are often more susceptible to addiction issues. According to the Substance Use/Brain Injury Bridging Project (SUBI) as many as 30% of individual are intoxicated at the time they sustained their brain injury, and even those who did not have substance use concerns prior to the injury are at increased risk of using following an injury.
There are many factors which contribute to these concerns. Individuals may be experiencing a loss of abilities or vocational pursuits, or experiencing a trauma response to the injury. Alcohol or drug use may be used by the survivor to self-medicate these emotional concerns. Additionally many individuals experience impairment in the areas of impulse regulation, decision making, and problem solving, which may allow the circumstances for substance use to become excessive.
There are many resources available which have been tailored to address the issues surrounding substance misuse in the ABI population. These include SUBI and the Ohio Valley Centre for Traumatic Brain Injury. It has been demonstrated that the best outcomes are achieved when the addictions services and brain injury rehabilitation programs occur simultaneously and maintain open contact with one another. Professionals may find it is helpful to engage others in the survivor’s life, such as family or caregivers, to provide feedback. When gathering information, questions should be specific about the amount of alcohol or substances used each day and how often in a week. The issue should be discussed in a calm, non-judgmental way to elicit most honest responses.
System Navigation can provide consultation and support to coordinate working relationships where addictions are a concern. Please contact us for further information.