The hidden risk to rehabilitation and civil claims
Over four decades (or so) representing personal injury claimants, I have frequently seen individuals with traumatic brain injuries (TBIs) resort to illicit drugs to cope with prolonged physical and mental suffering. While this is a direct consequence of their symptoms, illicit drug use serves as a profound intervening factor in civil claims. Defendants often use it to reduce financial liability, challenge medical causation, and restrict rehabilitation funding. Consequently, clinical case managers and legal teams must address this early by providing pathways to reduce drug use and prevent exacerbating adverse mental health and behavioural issues.
Substance use as a rehabilitation risk
Dealing with clients who desperately turn to illicit substances, whether Class A (cocaine, heroin) or Class B (cannabis, ketamine) is a major red flag in TBI rehabilitation. This can prove to be a difficult and complex challenge for the multi-disciplinary team, especially a clinical case manager, trying to achieve a balance of illegal usage against legally prescribed medications like painkillers and to manage their patient’s intake or so not to interfere with the effectiveness of prescribed medications.
Cannabis remains the most common issue, as its usage significantly compounds neurocognitive and psychiatric deficits in TBI recovery. While some patients use it to manage chronic pain or insomnia, clinical guidance warns that recreational cannabis poses severe risks to an already vulnerable neurological system. It can actively undermine other treatments within the rehabilitation package and in turn, rehab funding.
It is scientifically established that cannabis directly interferes with the brain’s natural healing mechanisms. While traumatic brain injuries develop a wide range of symptoms depending on severity, with diffuse axonal injury typically being the most debilitating, common deficits include fatigue alongside impaired memory, attention, executive planning, and processing speed. Cannabis use actively exacerbates these exact domains. This severely hinders rehabilitation outcomes and makes it exceptionally difficult to track whether ongoing deficits stem from the original trauma or continuing drug intake.
The litigation risk: funding, causation and evidence
On numerous occasions, I have observed Defendant funders, while initially supportive of funding support to address drug intake, will, after time, begin to question the validity of the whole rehabilitation package if undermined by continuing drug use. Not an unreasonable stance.
When a claimant has a history of pre-existing recreational drug use, it introduces profound cultural conflicts and biases between the claimant’s rehabilitation team and the defendant’s legal team. This challenge is further magnified if the claimant lives in an environment where illicit substances are easily accessible.
In these scenarios, the rehabilitation team must remain calm and encouraged to develop a structured management plan. Educating the claimant on these risks forms a critical part of this clinical challenge and introducing protocols for clinical case managers to implement drug-screening or harm-reduction strategies early is advisable.
This can be equally problematic when it comes to medico-legal evidence in the disciplines of neuropsychology and neuropsychiatry and the expert is left to unpick this issue. The expert can take a deep dive into how cannabis use is compromising white matter integrity, the corpus callosum, which is the main communication pathway between the left and right hemispheres of the brain is usually affected but still presents a difficult challenge on causation.
Clinical and behavioural consequences
Expert in neuropsychology and neuropsychiatry understand the aftermath of a brain injury which frequently includes mood swings, irritability, and heightened anxiety. There is no doubt that introducing cannabis can turn these symptoms into major clinical hurdle as they can became more severe and harder to stabilise.
The onset of illicit drug taking, unless established as being pre-existing, is sometimes not identified until months and months into the rehabilitation progress but can also be revealed as early as the production of the clinical case manager’s immediate needs assessment giving the opponent in a civil claim an opportunity to block or pause funding. These issues have to be addressed head-on by family, legal representatives and the treating clinicians/therapists. It should be identified to the claimant that drug usage (and alcohol for that matter) has a knock on effect on respect of;
- Physical and Mental Recovery: Actively derails neurological healing and treatment efficacy.
- Financial and future: Reduces life expectancy and diminishes future earning capacity.
- Skill Retention: Reverses cognitive and physical skills that had been successfully regained during therapy.
- Epileptic Risk: Significantly increases the chance of post-traumatic seizures, even in patients initially deemed low-risk.
- Behavioural Control: Lowers inhibitions, leading to dangerous risk-taking, heightened arguments, and socially inappropriate behaviour.
- Cognitive Function: Exacerbates deficits in concentration, memory, problem-solving, and the ability to learn new information.
- Physical Co-ordination: Increases difficulties with balance, gait, and speech.
- Psychiatric Stability: Heightens the frequency and severity of clinical depression.
Mental capacity may well be an additional factor to bear in mind as the lack of capacity may well be a valid reason for the claimant choosing a path which is in conflict with clinical advice, effectively developing an uncoordinated and destructive coping mechanism.
How Moore Barlow can help
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