Giving Providers Knowledge and Skills


Although the links between traumatic brain injury (TBI) and substance abuse are well documented, significant barriers to appropriate care continue to exist in our health care system for individuals living with this co-occurring condition.

Current data indicate that approximately one-third of traumatic brain injury survivors have a history of substance abuse prior to their injury, while one in five people who do not have a substance abuse problem become vulnerable to substance abuse after a traumatic brain injury. And alcohol and other drugs are directly involved in more than one-third of incidents that cause brain injury.

One of the primary challenges to addressing this complex issue, according to Dennis James, Clinical Director of Assessment and General Treatment at The Centre for Addiction and Mental Health in Toronto, is the need for increased cross-training and communication between providers working in the areas of substance abuse and TBI.

“Because substance abuse providers are not trained to identify or manage conditions that individuals with brain injury present, and brain injury providers are not trained to identify or manage substance abuse problems, individuals with this concurring condition often fall between the cracks,” says Mr. James. “They may receive not only inappropriate treatment, but their recovery in general may be jeopardized.”

To address this critical issue, a multi-disciplinary team of providers from The Centre for Addiction and Mental Health, Toronto Community Care Access Centre, St. Michael’s Hospital and the Toronto Acquired Brain Injury Network received funding from the Ontario Neurotrauma Foundation (ONF) last year to develop a resource tool to deliver skill-based training to providers in both TBI and addictions.

Their objective was to improve the identification, assessment and service planning of clients with this dual condition, enhance understanding of the functional relationships between TBI and substance abuse and present the systemic problems that exist in providing services to clients with a concurrent condition and what typically happens to them.

The result is an educational manual and video package, “Brain Injury and Substance Abuse: The Cross-Training Advantage.” Part of the ONF grant is being used to disseminate the package to a number of substance abuse and TBI providers across Ontario, to obtain their feedback for an evaluation of the resource tool.

While this approach has been explored in some treatment centres in the United States, it has not yet been tried in Canada, according to Mr. James. “There have been initiatives in the addictions area to look at specific populations who may be at risk,” he says. “But this generally did not include survivors living with the devastating effects of traumatic brain injury.

“We wanted to provide enough information to demystify traumatic brain injury for providers working in the substance abuse area, and vice versa,” adds Mr. James. “No one is hopeless and helpless. We, as providers, in what are generally regarded as two distinct fields, have to communicate better with each other in order to promote ways of intervening with persons who have traumatic brain injury and a substance abuse problem. We must explore new and more effective ways of helping clients to more successfully re-integrate into the community.”

For copies of the cross-training manual and to participate in the evaluation of this tool, please contact Dennis James at (416) 535-8501, or e-mail: The manual will also be available for downloading from the ONF website,

“Brain injury providers feel helpless when their clients are using. We have to give providers knowledge and skills.”
— Charissa Courtney, Assistant Executive Director, Toronto Acquired Brain Injury Network


– TBI is the leading cause of death and disability among children.*
– Each year, over 6,000 Canadians become permanently disabled after a brain injury.*
– It is estimated that the direct and indirect costs associated with TBI are $3-billion annually in Canada ($1-billion in Ontario).*
– Alcohol and drugs have a more intense effect after a brain injury.
– Alcohol and drugs are neurotoxins that negatively affect recovery after a brain injury by interfering with the ability of nerve endings to reconnect.
– Substance abuse can lead to another brain injury.

* Obtained from the Ontario Brain Injury Association.

(With funding from the Ontario Ministry of Health and Long-Term Care, Ontario Neurotrauma Foundation is strategically investing in research, advancements and knowledge transfer in spinal cord and traumatic brain injury. For more information on our funding program in neurotrauma injury prevention, rehabilitation and biomedical research, call (416) 422-2228 or e-mail:


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