Contact Sports, Traumatic Brain Injuries, and Addiction

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Traumatic brain injuries (TBI) impact many individuals in the United States and, in some cases, can result in serious complications. (1) While there are multiple causes of TBIs, contact sports can often result in multiple blows to the head and subsequent brain injuries. (2)

Individuals with TBIs may be more likely to develop mental health disorders, including substance use disorders. Additionally, individuals with a substance use disorder may be more likely to develop a TBI during their use. (3, 4)

If you or a loved one has experienced a TBI and may also struggle with addiction, it is important to understand TBIs, what addiction is, the signs and symptoms of addiction, and available treatment options.

Fortunately, there are many successful treatment methods available for individuals with addictions and substance use disorders and strategies that a treatment center may use specific to the issues that result from a TBI. (5, 4)

What is a Traumatic Brain Injury?

A TBI occurs when a sudden trauma causes damage to the brain. A TBI can happen when the head hits an object suddenly and violently or when an object pierces the skull and enters the brain tissue. TBI symptoms can range from mild to severe depending on the damage. (6)

A mild TBI might affect brain cells only temporarily. A more serious TBI might result in bruising, torn tissues, bleeding, and other physical damage to the brain. More severe injuries can lead to long-term complications and even death. (1)

A TBI can impact how the brain works and is a significant cause of death and disability in the United States. While anyone can experience a TBI, some individuals have a higher risk of getting one or having worse outcomes after the TBI. (7)


  • In 2020, almost 176 Americans died from a TBI-related injury each day (7)
  • In 2019, there were over 223,000 TBI-related hospitalizations (7)
  • In 2019, nearly 15% of high-school students in America reported one or more sports or recreation-related concussions in the past year (7)


A TBI is usually caused by a traumatic head injury or a blow to the head. The degree of damage usually depends on the injury and the force of impact. Common events that can result in a TBI include: (1)

  • Falls. Falls are the most common cause of TBI, especially in older adults and young children. Falls can include those from a bed or ladder, down the stairs, in the bath, and other falls.
  • Vehicle-related collisions. Vehicle-related collisions involve cars, motorcycles, bicycles, and sometimes pedestrians. They are also a common cause of TBI.
  • Violence. Examples of violence that most commonly causes TBIs include gunshot wounds, domestic violence, child abuse, and other assaults. Shaken baby syndrome is a kind of TBI caused by violent shaking.
  • Sports injuries. Sports injuries that cause TBIs can include soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports. These are most common in younger people.
  • Explosive blasts and other combat injuries. A common cause of TBI in active-duty military personnel includes explosive blasts in combat. The damage may occur from a pressure wave passing through the brain that significantly disrupts its function, but it is not yet well understood. Penetrating wounds, severe blows to the head from shrapnel or debris, and falls or collisions with objects after a blast are other causes of TBI in combat.

Contact Sports and TBI

Contact sports can often result in strong hits to the head. Individuals who play sports are often more concerned with competition than repetitive head injury consequences. Football, hockey, and boxing are examples of sports that may result in repeated head injuries. (2)

Sports players may end up with a TBI if one of these hits to the head results in brain damage. If someone experiences repeated TBIs, they are at higher risk of developing chronic traumatic encephalopathy (CTE). CTE is characterized by long-lasting alterations to the brain’s function or structure. (2)


TBI symptoms depend on the severity of the brain damage. Mild TBI symptoms can include: (8)

  • Brief loss of consciousness; however, many people with mild TBI remain conscious
  • Headache
  • Confusion
  • Lightheadedness
  • Dizziness
  • Blurred vision or tired eyes
  • Ringing in the ears
  • Bad taste in the mouth
  • Fatigue or lethargy
  • Change in sleep patterns
  • Behavioral or mood changes
  • Challenges with memory, concentration, attention, or thinking

Moderate or severe TBI may result in the same symptoms as mild TBI but may also include additional symptoms such as (8)

  • A headache that gets worse and does not go away
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Inability to wake up from sleep
  • Larger pupils than usual in one or both eyes (dilation)
  • Slurred speech
  • Weakness or numbness in the arms and legs
  • Loss of coordination
  • Increased confusion, restlessness, or agitation

TBI and Addiction

Individuals who experience TBIs can experience several physical and cognitive symptoms, like those described above. TBIs can also create affective symptoms, including emotional dysregulation, mood, anxiety, and personality changes. (9)

Mental health issues characterized by affective symptoms can last an entire lifetime. (9) Individuals with a substance use disorder may be more likely to experience these affective symptoms and to have a TBI in the first place. (9, 4)

Over 40% of individuals with a substance use disorder have had at least one TBI with a loss of consciousness. People who have co-occurring substance use disorders and mental health disorders are even more likely to have experienced a TBI. (4)

TBIs that occur early in life can also predispose an individual to substance abuse, as structural damage in the brain alters one’s ability to control their behaviors. Individuals who have their first TBI before age 6 are three times more likely to have a drug or alcohol dependence diagnosis by age 25. Individuals who have their first TBI between ages 16 and 21 are three times more likely to be diagnosed with drug dependence. (3)

What is Addiction?

Addiction is a treatable, chronic disease that may develop due to interactions among brain circuits, genetics, the environment, and a person’s life experiences. Individuals who suffer from addiction use substances or engage in behaviors that become extremely difficult to stop despite harmful consequences. (10)

Different prevention methods and treatment approaches for addiction are usually just as successful as those for other chronic diseases. (10)

Signs and Symptoms of Addiction

If you or a loved one have experienced a TBI and you believe that you or your loved one are now struggling with an addiction, there are signs and symptoms to be aware of and to look out for. 

Signs and symptoms of addiction can vary from one person to another and depend on what substance was used, how long it was used, and the severity of the drug use. General symptoms of substance use disorder can be broken down into physical signs, psychological signs, and behavioral signs. (11)

Physical Signs

The physical signs of substance use disorder can include: (11)

  • Sudden weight loss or gain
  • Pupils that are smaller or larger than usual
  • Bloodshot eyes
  • Changes in appetite and sleeping patterns
  • Slurred speech
  • Impaired coordination or tremors
  • Deterioration of physical appearance
  • Changes in grooming practices
  • Runny nose
  • Unusual odors on breath, body, or clothes

Psychological Signs

The psychological signs of substance use disorder can include: (11)

  • Feeling paranoid, anxious, or fearful
  • Unexplained personality changes
  • Feeling “spaced out”
  • Lack of motivation
  • Feeling excessively tired
  • Periods of excessive energy, mental instability, or restlessness
  • Sudden changes in mood
  • Increased agitation or anger

Behavioral Signs

Behavioral signs of substance use disorder can include: (11)

  • Starting to act in a secretive or suspicious manner
  • Experiencing problems in relationships due to the addiction
  • Using more than initially intended
  • An inability to control substance use
  • Neglecting family and friends
  • Neglecting duties at home, school, or work
  • Getting in legal trouble, including driving under the influence, fights, or accidents
  • Sudden changes in hobbies, friends, or activities
  • Using a substance in a way that causes unsafe conditions, such as sex without a condom, driving under the influence, or using syringes that are not sterile
  • Experiencing sudden, unexplained financial problems, which can include frequently asking for money or stealing
  • Frequently trying to avoid or relieve withdrawal symptoms
  • Experiencing increased tolerance of the substance, which can cause the individual to use more and more of it
  • Noticing that life revolves around substance use and recovering from use, with constant thoughts of how to get more
  • No longer engaging in previously enjoyed activities due to substance use
  • Continuing to use drugs despite negative health consequences


There are multiple effective treatment methods for substance use disorder. Before successful treatment can occur, the individual needs to recognize that there is a problem. Interventions involving concerned friends and family can offer this awareness and lead to treatment for the individual. (12)

If you suspect that you or a loved one is experiencing an addiction, it is essential to reach out to a medical professional for a formal assessment. This assessment of symptoms can identify whether a substance use disorder is present and if it is mild, moderate, or severe. (12)

Anyone with an addiction or substance use disorder can benefit from treatment, regardless of the severity of their symptoms. Additionally, individuals who don’t quite meet the criteria for a substance use disorder might also benefit from treatment. (12)

A combination of multiple types of treatment may be necessary, especially for those with an addiction that affects many aspects of their life. This treatment often involves a combination of medication and individual or group therapy. Treatment programs can often offer this combination to individuals. (12)

The most effective treatment approaches address an individual’s specific needs, including any co-occurring medical, psychiatric, and social problems they may be diagnosed with. (12)


Medication may be used in drug addiction treatment to manage withdrawal symptoms, prevent relapse, and treat co-occurring conditions. (5)

Medications and medical devices can help suppress withdrawal symptoms that usually occur during detoxification, which is an integral part of the treatment process but is generally unsuccessful without additional treatment. (5)

Individuals may also use medications to assist in re-establishing normal brain function and decrease cravings. Medications for relapse prevention are available for opioid, tobacco, and alcohol addiction treatment. (5)

Different medications are available to treat any co-occurring mental health disorders that may contribute to an individual’s addiction, like anxiety and depression. (5)


Psychotherapy, or talk therapy, can help individuals with addictions to change their attitudes and behaviors related to their drug use, increase healthy life skills, and continue to use other forms of treatment, like medication. There are many different psychotherapy settings and approaches. Different treatment settings include: (5)

  • Outpatient treatment. This kind of treatment offers programs for individuals to meet with behavioral health counselors. Programs usually involve individual and group drug counseling. Individuals in outpatient treatment stay at home and travel to a facility.
  • Inpatient or residential treatment. This treatment occurs at a licensed residential treatment facility with 24-hour structured and intensive care. Inpatient and residential treatment centers also offer safe housing and medical attention. These centers also provide individual and group drug counseling.

Different psychotherapy approaches include: (5)

  • Cognitive-behavioral therapy. This type of therapy helps people recognize, avoid, and cope with triggering situations in which they are most likely to use drugs.
  • Multidimensional family therapy. This type of therapy is specifically for adolescents and their families. It addresses a range of influences on adolescents’ drug patterns and aims to improve family functioning.
  • Motivational interviewing. This approach encourages an individual’s readiness to alter their harmful behaviors and enter into a treatment program.
  • Motivational incentives. This approach utilized positive reinforcement to maintain abstinence from drugs and alcohol.

Treatment for Individuals with TBI

Individuals who have experienced a TBI and suffer from addiction may benefit from specific strategies that address the functioning problems associated with their TBI. For individuals who struggle with paying attention, these strategies can include: (4)

  • Presenting information in smaller chunks
  • Providing straightforward instructions
  • Offering opportunities for hands-on learning

For individuals who have difficulty processing information, these strategies can include: (4)

  • Providing extra time
  • Offering repetition
  • Simple instructions

For individuals who have problems with memory, these strategies can include: (4)

  • Offering written summaries of material covered in groups
  • Repetition of important material
  • Other forms of reminders

For individuals who have trouble initiating tasks, these strategies can include: (4)

  • Breaking tasks down into manageable portions

For impulsive individuals, these strategies can include: (4)

  • Working with the individual to anticipate impulses
  • Setting realistic goals
  • Encouraging the individual to think about the consequences of their behaviors

For individuals who struggle with planning and organization, these strategies can include: (4)

  • Working with the individual to maintain routines
  • Utilizing organization systems
  • Helping the individual to make lists

For individuals who struggle with mental flexibility, these strategies can include: (4)

  • Remembering that the individual may get stuck in one way of thinning
  • Recognizing that the individual might struggle to provide solutions to unexpected problems

For individuals who struggle with self-awareness and good decision making, these strategies can include: (4)

  • Working with the individual to plan ahead
  • Encouraging the individual to practice positive social interactions

Additionally, incorporating physical activity, anger management strategies, stress management, pain management, and medication management into the treatment plan is beneficial for individuals with TBIs. (13)