Brain injury and substance use are closely linked. The Ohio Valley Center for Brain Injury Prevention and Rehabilitation notes that many people who have a traumatic brain injury had a substance use problem before the injury, and that others develop problems after it. People hospitalized for brain injury tend to drink more heavily than their peers. SAMHSA's advisory adds that people with brain injury, fetal alcohol spectrum disorder, intellectual disability, autism and other conditions that affect thinking make up a significant share of people in substance use treatment, even when their disability is not documented.
That matters because standard treatment asks a lot of memory, attention, reading and abstract thinking. SAMHSA lists adaptations that help: appointment and activity reminders by phone call, alarm or app; simplified handouts and forms; adjusted group and individual counseling; and staff who understand that a person may say they understand more than they do. It recommends that programs offer voluntary brief cognitive screening at intake when cognitive impairment is not already documented, and explain that the purpose is to make sure treatment fits the person. The screening is a clinical task for trained providers, not something disability services staff administer.
SAMHSA also flags medication interactions. Some medications used for seizures, which people with brain injury or developmental disabilities may take, can interact with methadone. That is a question for prescribers and pharmacists, but case managers can help by making sure each provider has an accurate, current medication list, with the person's consent.
Case managers and waiver teams can do a great deal to make treatment workable. With the person's agreement, you might help set up reminders, arrange transportation that matches appointment times, share a one-page summary of how the person learns best, or connect independent living skills support with recovery goals. Keep the person in charge: ask what has helped them in the past, what has not, and who they want involved. A person with a brain injury who drops out of a program that never adapted to them has not failed treatment. The fit failed.
