Traumatic brain injury and substance use among offenders

Although research has long demonstrated the link between substance abuse and criminal behaviour, the connections between Traumatic Brain Injury (TBI), substance abuse and criminality, the prevalence of TBI within correctional settings, and the specific needs of offenders with a TBI are complex and poorly understood. We explore what is currently known about TBI and substance abuse among offenders in this brief literature review.

There is a strong association between TBI and substance abuse.¹ The relationship between brain injury and substance abuse is a considerable public health problem given that substance abuse increases severity of injury. The coexistence of both substance abuse and TBI has been well documented in the correctional setting.² Yet, we know little about how TBI and substance abuse interact and the extent to which these interactions might affect criminal behaviour.³

Prevalence studies suggest that occurrence of TBI among offenders is significantly higher than in the general population. American jail and prison studies indicate that 25-87% of inmates reported experiencing a TBI.⁴ Twenty-three percent of admissions to a forensic treatment program in Ontario had a well documented history of TBI.¹ Eighty-two percent of Australian prison inmates reported a history of TBI; loss of consciousness occurred in 79% of cases. Recurrent TBI was also high with 43% of inmates reporting four or more occurrences.²

Evidence suggests that deficits like reduced impulse control and aggressive tendencies among those with a TBI play a role in violent and disruptive behaviour⁵ and have the potential to increase risk of involvement in criminal activities.¹

Once incarcerated, the behavioural difficulties associated with TBI such as attention and memory deficits, irritability, anger control, and various difficulties with inhibition or impulsivity can significantly impact an offender’s ability to engage in rehabilitation and programming.⁶ With such emotional and behavioural difficulties, adjustment to the institutional environment will be extremely challenging for these individuals.

Research demonstrates the need for TBI prevalence studies within correctional systems. Identifying TBI among offenders, and further study around the complex interactions between TBI, substance abuse and criminality, are critical to advancing the understanding of the rehabilitative needs of this population and ensuring programming for those with a TBI is appropriately targeted to reduce recidivism.

(1) Colantonio A, Stamenova V, Abramowitz C, Clarke D, Christensen B. Brain injury in a forensic psychiatry population. Brain Injury 2007 December;21(13/14):1353-60.

(2) Schofield PW, Butler TG, Hollis SJ, Smith NE, Lee SJ, Kelso WM. Neuropsychiatric correlates of traumatic brain injury (TBI) among Australian prison entrants. Brain Injury: [BI] 2006 December;20(13-14):1409-18.

(3) Kolakowsky-Hayner SA, Kreutzer JS. Pre-injury crime, substance abuse, and neurobehavioural functioning after traumatic brain injury. Brain Injury: [BI] 2001 January;15(1):53-63.

(4) Centers for Disease Control and Prevention (CDC). Traumatic Brain Injury in Prisons and Jails. 2009.

(5) Magaletta PR, Diamond PM. The Brain Behind Bars: Perspectives on Injury and Aggression. Corrections Today 2007 October;69(5):135-6.

(6) Slaughter B, Fann JR, Ehde D. Traumatic brain injury in a county jail population: prevalence, neuropsychological functioning and psychiatric disorders. Brain Injury 2003 September;17(9):731.

Prepared by: Pamela Forrester & Flora I. Matheson

Addictions Research Centre
Research Branch
(902) 838-5900
addictions.research@csc-scc.gc.ca