VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Alcohol and Drugs

QUESTION:
I was told that my client’s recovery from TBI will be much slower because he was intoxicated at the time of the injury. I know that alcohol consumption after the injury can compromise recovery, but I had never heard that alcohol at the time of injury could delay recovery. Is this accurate?

ANSWER
Yes! Research has repeatedly demonstrated that 1/3 to 1/2 of individuals who sustained traumatic brain injuries were intoxicated (at least the legal limit) at the time of injury. These individuals were more likely to be intubated and have respiratory distress, have greater severity of injury, greater incidence of death, lower cognitive status at time of discharge, and suffer greater lengths of post-traumatic amnesia.

QUESTION:
As a drug and alcohol counselor at an inpatient program, I do not usually work with people with brain injuries. However, I have been assigned a patient with traumatic brain injury and cognitive deficits, and I need some advice on how to help him. Our facility uses a 12-step approach to rehabilitation with individual counseling and educational groups. Is this traditional approach appropriate for someone experiencing the effects of traumatic brain injury? Are there special provisions we should make for this patient?

ANSWER
The typical traditional approach of substance abuse treatment for survivors of traumatic brain injury has not successfully addressed all the issues for this population. Typically, survivors leave these settings because of their inability to successfully work with a counselor or work within the rules imposed. They end up back in the same situations and cycle back into substance abuse treatment programs. Recently a novel team approach was tried in five states to help the survivor achieve better life outcomes. ICON Community Services located in Northern Virginia was one of the sites. The special provisions made for individuals with traumatic brain injury were designed and implemented within an innovative framework which stressed teamwork.

The approach started with an educational component for survivors about substance abuse issues and rehabilitation, etc. The survivors of traumatic brain injury then helped to set up a team of people who supported them. These teams were as varied as the consumers’ needs for ongoing services and support. The teams met on a monthly or bimonthly basis to discuss all aspects of the survivor’s life. A standard agenda was used to review progress or issues in ten key life areas. This kept the meetings to an acceptable time frame for all of the professionals and nonprofessionals who were involved.

Furthermore, team meetings reduced the potential for fragmentation of efforts. It helped the substance abuse counselors to receive education about traumatic brain injury. The other professionals could, in turn, assist the substance abuse counselor by positively influencing the survivor to achieve a clean and sober approach to life. This ongoing team meeting reduced conflict and manipulation by the survivors across service providers. The substance abuse counselor could then make a determination for the best course of action.

A survivor can benefit from all of the services of an inpatient substance abuse setting. He or she can benefit from individual or group therapies, educational groups and 12-step approach when the substance abuse counselor is not alone to figure out all of the dynamics and issues. What makes the critical difference for success in these very complex instances is a coordinated team effort. It helps the survivor to address cognitive, physical rehabilitation, psychological, employment, housing, legal and many other issues with professional and nonprofessional guidance.

QUESTION:
My doctor strictly advised me not to consume alcohol (or any other non-prescription drugs) since my brain injury. He said the negative effects of alcohol and drugs would be magnified several times in my case, since my brain sustained permanent damage. What exactly does this mean? Would a few beers cause further brain damage?

ANSWER
Permanent brain injury typically results in fewer resources to deal with the additional impairing effects of alcohol. Alcohol can impair judgment which may already be clouded by the brain impairment (in other words, the poor judgment which may be a result of brain injury may be magnified by the dulling effects of alcohol). If alcohol impairs judgment, cognitive abilities and sensory-motor functions, which already may be negatively affected by the brain injury, it can increase the probability of additional traumatic brain injury. In such a case, the brain is more vulnerable to additional impairment.

Alcohol has a direct impairing effect on brain tissue in the following ways:


  • It decreases the flow of oxygenated blood to the brain .
  • It destroys important vitamin B complexes.
  • It disrupts electrolyte balances.
  • It has a direct toxic effect on brain tissue (as well as other physiological impacts).

  • Use of alcohol, typically over long periods of time, can actually destroy brain cells (neurons). It also can directly affect the potency and effectiveness of medications and lower seizure thresholds. For all of these reasons, it is not advisable for anyone with a brain injury to drink alcohol or use other non-prescribed drugs.



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