Over 450,000 cases of Traumatic Brain Injury (TBI) have been reported within the military (about the size of Miami). Although 82.2% of these are mild in severity (i.e., concussions), TBI is a significant burden to service member health and warfighter readiness [1].
Studies of veterans of the Afghanistan and Iraq wars have also shown psychiatric disorders such as Post Traumatic Stress Syndrome (PTSD), depression, and anxiety often co-occur with TBI. While many with mild to moderate cases recover on their own or with some treatment, for many others the condition has long-lasting physical and psychological effects.
Military TBI significantly affects short- and long-term health, often leading to persistent cognitive, emotional, and physical symptoms—particularly in cases of repeated or severe injury.
What Is a Military Traumatic Brain Injury?
Military TBIs can occur from a sudden blow or jolt to the head (concussion), also causing neck and back injuries, or a punctured skull such as from a gunshot. A TBI can also occur without a blow, when the brain is shaken within the skull due to whiplash, for example, causing bleeding between the brain and skull and bruises where the brain hits the skull.
A TBI is the injury or event. The symptoms that result from a TBI are called TBI-related symptoms, although they are often referred to by those affected as TBI. These affect how the brain works [2]. TBI-related symptoms vary from person to person, so they may not be the same, even for people with similar severity of TBI.
Military TBIs have been classified as follows below [3]. Note that the U.S. Department of Veteran Affairs (VA) further restricts the diagnosis of mTBI (mild TBI or concussion) to injuries with no signs of brain injury on clinical neuroimaging.
Mild traumatic brain injury
- Post-concussion syndrome
- Concussion
- Mild head injury
Moderate to severe traumatic brain injury
- Moderate traumatic brain injury
- Severe traumatic brain injury
- Moderate or severe head injury.
It is often assumed that an active duty service member sustains TBI during combat from gunshots, explosions, blast injuries, or vehicle accidents, for example. It is important to recognize that injuries also occur in different settings (i.e., during recreation, military training, deployment, or even before their military service) [1].
For many veterans, the effects of TBIs can be debilitating, leading to mental health conditions and substance abuse, making the return to civilian life difficult.
Mental Health Consequences of Traumatic Brain Injury
After moderate-severe TBI, most active duty military and veterans assume productive roles and are satisfied with life. However, widespread difficulties and functional limitations persist. Patients with all severities of TBI are at elevated risk of mental health symptoms, and in some cases clinically significant affective disorders, after injury.
Symptoms of TBIs overlap heavily with symptoms of psychiatric disorders such as PTSD, major depressive disorder (MDD), and anxiety disorders. Military service members are at increased risk of MDD, PTSD, and suicidality.
Studies following the conflicts in Iraq and Afghanistan have clearly demonstrated that TBI is actually an important risk factor for PTSD. One survey of U.S. Army soldiers after return from deployment to Iraq found PTSD rates of [4]:
- 43.9% of those reporting TBI with loss of consciousness
- 27.3% of those reporting mTBI with altered mental status
- 16.2% of those with other injuries
- 9.1% of those with no injury
A study of 108,930 male Marines assessed at basic training and followed during active duty found that TBI was associated with risk of completed suicide after controlling for other risk factors such as depression [1].
Major alterations in behavioral responses after moderate or severe TBI are often described by survivors and caregivers as “personality changes,” which are typically characterized by impulsivity, severe irritability, affective instability, apathy, and a frequent lack of awareness of these changes on the part of the affected individual.
The following table illustrates the relationship between PTSD and TBI [2].
| Common and unique symptoms of PTSD and TBI | ||
| Unique PTSD Symptoms | Symptoms Common in Both PTSD and TB | Unique TBI-Related Symptoms |
| Reliving the event | Sleep problems | Headaches |
| Nightmares | Negative thoughts and feelings | Dizziness |
| Avoiding trauma reminders | Irritability and anxiety | Nausea and vomiting |
| Easily startled or feeling “on guard” | Memory problems | Vision problems |
| Trouble concentrating | Light or noise sensitivity | |
Long-term complications of moderate-to-severe TBI may include:
- Cognitive deficits (memory, attention, executive function)
- Neurobehavioral changes (depression, anxiety, irritability)
- Physical symptoms (headaches, chronic pain)
- Increased risk of neurodegenerative diseases such as Alzheimer’s and Parkinson’s
Persistent disability occurs in about 12% of cases following mild TBI and over 50% after severe or penetrating TBI. Social and occupational consequences may persist for years, with some individuals reporting ongoing symptoms a decade after injury [5].
TBI and the Risk of Substance Abuse
Military members with TBI who experience increased physical and psychological pain tend to self-medicate with alcohol and drugs at a much greater rate than those without TBI. As a result, military TBI is strongly associated with increased risk of substance use and addiction, particularly following separation from service.
Rates of new-onset substance use disorders and alcohol dependence are significantly higher in service members with TBI than in those without.
In one study, there was a 100% increase in substance use disorders in active-duty soldiers following a TBI diagnosis while they were in the military, compared with a 14.5% increase in those without a military TBI diagnosis [6]. In another study, substance use disorders were the 3rd most common class of mental health disorders (after depression and anxiety [7].
Stigma plays a significant role in preventing members from seeking help for substance use. Accessing supportive services is key to overcoming this barrier to health.
Recovery and Support for TBI Veterans
While most recover fully from mild TBI, moderate and severe cases require staged treatment and ongoing interdisciplinary care—especially for co-occurring substance use and mental health conditions.
Stages of Military TBI Recovery
Acute Stage: Stabilization, monitoring, and rest after injury. If symptoms return during early rehabilitation, further rest and monitoring are prescribed.
Post-Acute Stage: Symptom management (headaches, dizziness, mood changes), gradual physical and cognitive activity, and screening for persistent impairments.
Rehabilitation Stage: Interdisciplinary therapy is recommended best practice. To restore function and coping, this includes physical, occupational, speech, and psychological support. The work involves managing symptoms, supporting reintegration, and monitoring for new mental health or substance use issues.
Treatment for Co-Occurring Substance Use
Programs combining TBI rehabilitation and substance use disorder (SUD) treatment are recommended. Evidence-based therapies include Motivational Interviewing, Cognitive Behavioral Therapy for SUD, medication management as needed for opioids (e.g., buprenorphine, naltrexone), and recovery coaching. Group therapy, education, and support with addiction specialists are essential for dual diagnosis recovery.
Treatment for Co-Occurring Mental Health Conditions
PTSD and mood disorders are common after TBI. Treatment blends cognitive rehabilitative therapy, trauma-focused psychotherapy (e.g., Cognitive Processing Therapy, Prolonged Exposure), and Dialectical Behavioral Therapy.
For severe depression, anxiety, or PTSD, medications may be recommended. Monitoring is necessary due to brain vulnerabilities following the onset of TBI.
Outcomes for mental health conditions are enhanced with peer support, coping skills development, and targeted group interventions.
How Miramar Health Supports Veterans Through Addiction Recovery
As a veteran-owned treatment facility focused exclusively on support for active-duty military and veterans, Miramar Health offers years of experience helping military members recover from substance abuse and co-occurring mental health conditions. We know and understand military culture. We use the trauma-informed therapy approaches referred to above and customize treatment to each member’s needs. We also provide related support to military family members.
Get in touch with our Admissions team today!
Sources
[1] Remigio-Baker R. et al. 2023. The Impact of Lifetime Traumatic Brain Injury (TBI) on Mental Health Symptoms among Service Members in Interdisciplinary TBI Programs, Military Medicine, Volume 188, Issue Supplement_6, November/December 2023, Pages 199–207.
[2] U.S. Department of Veterans Affairs. 2025. Traumatic Brain Injury and PTSD.
[3] Government of Canada. Veterans Affairs. 2025. Traumatic Brain Injury Entitlement Eligibility Guideline (EEG).
[4] Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008 Jan 31;358(5):453-63.
[5] French L and Brickell T. 2023. Chronic Effects of Traumatic Brain Injury in Military Service Members. Practical Neurology.
[6] American Psychological Association. 2024. Service members with TBI are at high risk for serious mental health problems. Vol. 55 No. 1
[7] Schulz-Heik R. et al.2016. Long-term outcomes after moderate-to-severe traumatic brain injury among military veterans: Successes and challenges. Brain Inj. 2016;30(3):271-9
Howlett, J. R., Nelson, L. D., & Stein, M. B. (2022). Mental Health Consequences of Traumatic Brain Injury. Biological psychiatry, 91(5), 413–420
Brenner LA, Forster JE, Gradus JL, et al. 2023. Associations of Military-Related Traumatic Brain Injury With New-Onset Mental Health Conditions and Suicide Risk. JAMA Netw Open. 2023;6(7)