Substance use risk after TBI: Recognition and response

A 34-year-old client is attending outpatient occupational therapy following a moderate traumatic brain injury (TBI). He has been missing sessions, reports difficulty maintaining employment, and describes increasing stress related to financial instability. During conversation, he casually mentions past recreational drug use and says he has mostly stopped. Nothing in the chart flags a substance use disorder, and he does not report current substance use. However, his daily routines are shifting, his follow-through is inconsistent, and his stress is escalating.