Non-Compliance with Pain Management or Substance Abuse Treatment/Programs: Could it be an Acquired Brain Injury (ABI)?

Mar 19, 2020 at 11:42 pm by pj




As we know from multiple sources published over decades, many addictive substances act in the brain to produce their euphoric effects, however, some can also cause significant brain damage due to seizures, stroke, and direct toxic effects on the brain cells themselves. Repeated drug use leads to changes in the function of multiple brain circuits that control pleasures/reward, stress, decision-making, impulse control. learning and memory, and other functions.(1) As time and study progress, we are beginning to understand the mechanisms of this cellular damage or injury to the brain itself as being commonly related to the brain’s reaction to prolonged exposure to these substances and/or the related hypoxia (deficiency in oxygen) that may occur on a cellular level.  Researchers say certain club drugs trigger a chemical chain reaction in the brain similar to what occurs during traumatic brain injury, leading to cell death, memory loss and potentially irreversible brain damage.(2)

In further discussion, definitive identification and diagnoses can be established utilizing modern imaging techniques. The central nervous system effects of these drugs include neurovascular complications, encephalopathy, atrophy, infection, changes in the corpus callosum, and other miscellaneous changes.  Imaging abnormalities indicative of these complications can be appreciated at both magnetic resonance (MR) imaging and computed tomography (CT). (3)

Although many of us are not experts in these types of injuries or able to effectively analyze the latest research, we as healthcare or compensation/benefit providers must acknowledge those individuals we serve, that for no other apparent reason, continue to be non-compliant or fail to benefit from professional pain management or substance abuse treatment programs. Considering what we are now aware of as being a result of true impaired function (cognitive, decision making, impulsivity, behavioral or physical deficits) or injury causing at least in part a non-intentional pattern of behavior leading to ineffective treatment or unsuccessful productive outcomes including the ability to return to gainful employment.

One of the most challenging questions we must address is how do we begin to determine if an individual may be experiencing the sequela of this type of acquired brain injury? Though determining the possibility of this type of brain injury is a multistep process, there are professionals that recommend the following with the guidance of an appropriately licensed healthcare provider;


  • Identify the potential ABI client – This is not a diagnosis defined term as it consists only of the client’s history relating to their past substance use and the reasons given for non-compliance or failed treatment (subjective from the client as well as what was determined by the professional provider).
  • Confirm there is an ABI – This is a medical diagnosis and may require medical imaging studies and/or supportive information such as a comprehensive evaluation by a neurologist, psychiatrist, neuropsychologist, and other members of an accredited neurorehabilitation/neurobehavioral team including a certified substance abuse licensed mental health counselor.
  • Refer for appropriate care and services – Depending on the degree and effect of the injury, as all brain injuries are “individual injuries,” the referred neurorehabilitation/neurobehavioral program must:


  • Be outcome-focused with an intensive concentration on community re-entry;
  • Have at least 24/7 neurobehavioral/substance abuse support and immediate intervention protocols;
  • A drug free secure environment;
  • A care and treatment program and team that is trained and accredited as a brain injury specialty program.


In summary, the success and final outcome of the individual with an acquired brain injury from a non-traumatic source will depend on many factors; one of the most influential being the identification of the substance induced ABI as well as the type and quality of the post-acute neurorehabilitation/neurobehavioral program the individual is referred to for care and treatment.  The CARF accredited Brain Injury Specialty Program at NeuLife Post-Acute Rehabilitation (residential or outpatient) offers comprehensive neurorehabilitation/neurobehavioral services resulting in eighty percent discharge to home or community with maximal obtainable level of function, independence and return to employment potential, if applicable.


Michael Samogala, RN, CRRN, CBIS, is Director of Education for NeuLife Rehab.




  1. National Institute on Drug Abuse
  2. University of Florida. "Club Drugs Inflict Damage Similar to Traumatic Brain Injury." ScienceDaily.
  3. Neurologic/Head and Neck Imaging Your Brain on Drugs: Imaging of Drug-related Changes in the Central Nervous System, Benita Tamrazi, Jeevak Almast