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Substance Misuse Can Lead to Stroke Even in Young People
By: Jean Carl
Mar 16 2021

Dr. Ning Cao standing next to rehab robots

Headlines about 28-year-old singer Demi Lovato recently shone a light on the risk of brain injuries resulting from substance misuse, regardless of age. Lovato revealed that she has brain damage caused by strokes suffered due to a 2018 drug overdose.

In honor of National Brain Injury Awareness Month, we talked to MossRehab Stroke Rehabilitation Program Co-Director, Ning Cao, MD, a specialist in stroke rehabilitation and brain injury management, about stroke and brain damage related to substance abuse in young people.

What are the current statistics regarding substance-related stroke and brain injury in young people?

The Centers for Disease Control (CDC) 2019 Surveillance Report of Substance-related Risks and Outcomes reveals that nearly 20% of people age 12 and older reported illicit substance use in 2018. Data from MossRehab Elkins Park indicates that approximately 12% to 13% of patients with a stroke have a history of substance misuse in the previous six months. And substances are a common factor for stroke among patients under the age of 35. People between the ages of 15 and 44 who abuse substances are 6.5 times more likely to experience a stroke than others in their age group. That’s a significant number that young people must realize as a risk factor for a stroke that can lead to brain damage.

What risk factors are contributing to this trend?

Certain factors are causing an uptick in substance abuse. The coronavirus and its disruptions to daily life are causing fear and worries associated with losing family members, jobs, and outside connections. These stress factors can cause adverse mental health and amplify chronic pain, depression, anxiety, and other pre-existing psychological conditions. The CDC reported that 40% of adults struggle with an anxiety disorder during the COVID pandemic, with 13% starting or increasing substance use. That’s three times higher than numbers from 2019. Depressive disorder was approximately four times higher than reported in the second quarter of 2019. Young people misuse substances, including prescription medications, as a coping mechanism. On the other hand, restricted access to resources because of isolation, loss of a community support system, and limited medical management can cause more mental health issues and substance misuse. Increased substance dosage can lead to an overdose that causes a person to have a stroke, respiratory problems, heart attack, or even die.

Which substances most commonly cause brain damage?

The illicit substances more frequently correlated with a stroke are cocaine, amphetamine, and heroin/opiates. Individuals taking these substances don’t know about their risk in producing sudden and dramatic effects on the body that causes serious health consequences including neurological conditions or damage. For example, cocaine and amphetamines are neuro-stimulants that can narrow or spasm the blood vessels in the brain that may result in a stroke. An intravenous form of crack cocaine increases the risk of serious infection in heart valves that can lead to stroke. Unfortunately for cocaine users, an intracranial hemorrhage has worse short-term functional outcomes compared to patients who hemorrhage while not using cocaine. They also are three times more likely to die than those who do not use cocaine. Similar risks are related to amphetamine. These two substances closely correlate to stroke in young adults who do not have other health risk factors.

Other substances such as heroin/opiates can cause another type of brain injury called anoxic brain injury that causes oxygen deficiency, preventing enough oxygen from reaching the body. During a period of low oxygen, a person can suffer from irreversible oxygen deprivation in the brain. Further research can provide better evidence on other substances. For example, while marijuana is legalized in many states, there might be an impact on the younger population based on usage.

Once suffering from brain damage, what difficulties would someone experience?

If a person suffered a stroke or has brain damage, they might experience loss or impairment of walking/balance, vision, motor, sensory, and even cognitive functions. In addition, they could have speech and swallowing problems impacting every aspect of function in daily life. Young stroke survivors must learn to cope with these challenges while readjusting to their roles working, raising children, driving, and meeting family expectations. These issues create an emotional or financial toll on the family as well as society.

What does recovery look like for a young person who suffered a brain injury or stroke?

The younger population has a better prognosis for recovery from a cerebrovascular event than someone older with chronic conditions. But, in general, recovering from a stroke caused by substance use is similar to the process of recovering from a stroke caused by other diseases. Recovery depends on the initial brain damage from the cerebral vascular event and resulting body impairment. Early access to medical management and intensive rehabilitation can help reverse some of the brain damage. The first three to six months following a brain injury are very critical to receive treatment. However, even after six months, we still see progress made by patients.

Patient recovery typically follows an individualized path based on the severity and location of the brain injury. Treatment timing and intensity can lead to variable outcomes. Some people with a milder brain injury get back to their life in just a couple of months of rehabilitation, while someone who experienced a severe stroke or brain injury may struggle for years. Those with less access to mental health providers and multidisciplinary rehabilitation treatment potentially can have greater challenges reaching their expected level of functioning in society. A person with very severe or non-reversible damage can experience long-term effects. But I have seen very determined patients go through many cycles of rehabilitation treatment and progress. We need to educate individuals about what they can still do to recover from their brain injury and provide adaptive intervention to maximize their independence.

How important is early treatment?

Stroke is not a diagnosis considered by young people when they don’t feel well or experience neurological symptoms. As a result, we have seen many cases that don’t seek medical help in time and delay evaluation and treatment. However, if they go to the hospital within four to five hours, certain medications or interventions can help prevent or reduce brain damage. Young people must become aware of how substance abuse is related to cerebral vascular disease regardless of age. If symptoms are present, they must get to the hospital to get early treatment to reduce non-reversible brain damage.

What treatments does MossRehab offer stroke/brain injury patients?

MossRehab offers inpatient rehabilitation at our specialized stroke rehabilitation program and brain injury program in the Drucker Brain Injury Center as well as outpatient therapies at various locations throughout the Philadelphia region including Tabor Road, Elkins Park, Jenkintown, and other satellite locations in different counties. Our facilities have excellent outcomes for stroke/brain injury patients and are ranked among the top rehab centers in the nation by U.S. News and World Report. We are very proud of our dedicated team of clinicians in physical therapy, occupational therapy, speech therapy, and recreational therapy as well as our neuropsychologists, social workers and rehabilitation nurses. A multidisciplinary treatment team is key for patients recovering from brain injury. All patients at MossRehab have access to one of the largest collections of rehab robotics in the country and benefit from our specialized expertise.

Our inpatient services focus on medical management that prevent complications while maximizing patients’ functional recoveries. We also address psychosocial behavior issues as patients go through substance withdrawal and emotional adjustment and follow them during community reintegration to help them return to work and other social roles. A case manager assists them in applying for support through different state programs. MossRehab also offers driving, vocational and recreational programs to help patients relearn skills and get them back to their lives.

What support groups exist for patients with substance-related brain injuries?

In addition to rehabilitation, patients with brain injury need community and social support to get better. For example, MossRehab offers a young stroke support group to help this population transition into their role in society. This group provides an opportunity for patients with similar conditions to share stories about how they’ve overcome difficulties. Therapy teams also provide guidance and facilitate connections to other services. Typically, the group meets monthly but has been virtual during the COVID pandemic. We also operate a Caregiver Support Group that helps families and caregivers of young stroke victims. Members of the community can join to get guidance on how to provide care for loved ones with a brain injury due to stroke.

Other young adult substance addiction rehab resources include:

  • Livengrin Foundation offers a network of Pennsylvania substance and alcohol treatment centers that help patients and families struggling with addiction. 800-245-4746.
  • Wedge Recovery Centers offer mental health and substance use treatment in seven locations in Philadelphia. 215-276-3922.
  • NetCenters offers mental health, addiction treatment, foster care, residential group care among other services through 15 sites located throughout Greater Philadelphia, the Lehigh Valley, and Delaware. 215-831-6024.

What research is being conducted in substance-related stroke?

We need to get more data on substance-related stroke or brain injury from a public health standpoint and develop more revolutionary treatment for those patients who have incomplete recoveries. While there is a lot of technology and advanced treatment for stroke patients, we need to tailor them to the individual. We need more therapies or options that potentially treat chronic pain or psychological disorders such as neuromodulation or non-invasive brain stimulation.

While we understand the treatment and outcome of certain patient groups, we need to know more about those with pre-existing conditions and the effects of rehabilitation treatment. From findings like these, we can better predict recovery for those patients and what kind of intervention is best geared to them. We also need to understand why certain patients have addiction problems, psychological disorders, or a greater tendency to suffer a brain injury or stroke. We still have a lot to learn about the brain.

Learn about how The Drucker Brain Injury Center and MossRehab outpatient stroke rehabilitation program that treats patients with stroke/brain injury.

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