Substance Abuse, Mental Illness, and TBI

Janelle Forsgren, SN

Many researchers have concluded an association between traumatic brain injury (TBI) and mental illness. However, some studies suggest that substance misuse could also strongly contribute to the development of mental illness after TBI. Sami, Piggott, Coysh, and Fialho (2015) reported the case of a gentleman who sustained a TBI at age 34 due to a motorcycle accident collision with a bus in 1991. The gentleman had previously been happily married with three children, with no substantial use of substances. After the accident, he experienced a change in personality, with increased impulsivity and aggression. In 1994, he got a divorce and had a period of untreated depression. His substance use increased to up to a bottle of wine plus 10 cigars per day. After about 15 years he began to experiment with recreational substances, including cannabis, ketamine, Salvia Divinorum, DMT (N,N-Dimethyltryptamine), cocaine, and LSD. The gentleman was taken in for assessment and treatment due to increased aggression and chaos in public. He was assessed to be grandiose. He had multiple discharges and readmissions due to inability to care for himself outside of the hospital.

One of the reasons why the researchers questioned if this man’s development of psychosis was due to the head injury alone was because the psychosis developed 19 years after his TBI. The researchers noted that cannabis and other recreational substances are risk factors for psychotic disorders, including schizophrenia. However, the researchers acknowledged that psychosis development after TBI can have a long latency period. Additionally, the researchers acknowledged that the TBI was severe and there were deficits in neuropsychological testing after TBI. Thus, the researchers concluded that both the TBI and substance abuse likely contributed together to the development of psychosis in this gentleman. Future research could focus on the effects of substance abuse after TBI on the development of mental illness.

Sami, M., Piggott, K., Coysh, C., & Fialho, A. (2015). Psychosis, psychedelic substance misuse and head injury: A case report and 23 year follow-up. Brain Injury, 29(11), 1383-1386. Retrieved from

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