About TBI and SA
Substance Abuse Issues after Traumatic Brain Injury
John D. Corrigan, PhD, and Gary L. Lamb-Hart, MDiv
The Ohio Valley Center for Brain Injury Prevention and Rehabilitation
Department of Physical Medicine and Rehabilitation
The Ohio State University
How much alcohol or other drugs is safe after brain injury?
The answer to this question is complicated because some drugs are illegal and others are not; some drugs may be prescribed by a physician.
Alcohol - because it is a legal substance for adults and is not prescribed by a physician - presents a more complex question. Our starting point is that certainly no one should consume more alcohol after brain injury than would be considered safe for an adult who had not had an injury. Many people do not realize that adult men under age 65 should not have more than two alcoholic drinks each day. For men over age 65 and for adult women, the recommended maximum is one drink per day.
So the question becomes after brain injury should an individual drink even these amounts? Based on information about how alcohol and brain injury add together to affect the brain and how it works, we have concluded that there is no safe amount to drink. We suspect that especially during the early period of recovery - the first several years when the brain is attempting to spontaneously heal and otherwise accommodate the injury - alcohol can inhibit these natural processes.
There are many reasons why it is not safe to consume drugs that are illegal. There is a great risk for illegal drugs to interact with prescribed medications to create additional medical problems. Illegal drugs may cause complications of other medical conditions. There is also the potential for being arrested, and greater vulnerability to injury by being the victim of violence. And last (but certainly not least) there is the potential for additional brain damage from use of these uncontrolled substances.
Taking prescription drugs in greater quantities than they are prescribed is another form of drug abuse, and it too is not advisable. Prescribed medications can be as dangerous as illegal drugs when a person takes more than the prescribed amount, or takes the prescribed amount more frequently than indicated. Medical complications and additional brain damage can result from this kind of substance abuse.
If you have had a brain injury you should not drink alcohol,you should not use illegal drugs, and you should not take prescription medications in greater quantity than prescribed.
How does alcohol or other drugs affect a person who has had a brain injury?
There are multiple reasons why alcohol and other drug use after brain injury is not recommended. The "User's Manual for Faster, More Reliable Operation of a Brain after Injury" (Ohio Valley Center, 1994; <www.ohiovalley.org>) describes 8 reasons:
1. People who use alcohol or other drugs after they have a brain injury don't recover as much.
Some brain cells (neurons) are killed and others are disconnected at the time of a brain injury. Recovery means re-learning by making new connections between neurons. Using alcohol and other drugs after brain injury gets in the way of your recovery by interfering with new connections between neurons.
2. Brain injuries cause problems in balance, walking or talking that get worse when a person uses alcohol or other drugs.
For people whose brain injury caused problems with balance, walking, or talking, alcohol and other drugs make the problems even worse. Without brain injury, alcohol and other drugs can make people lose their balance or fall down. People who have been drinking or using other drugs may slur their speech. Problems walking and talking caused by your brain injury will be increased by alcohol and other drugs.
3. People who have had a brain injury often say or do things without thinking first, a problem that is made worse by using alcohol and other drugs.
Every brain has a program called, “Good Idea/Bad Idea.” The program tells us what is appropriate and what is not. For example, we may think to ourselves that someone’s sweater is really ugly, but “Good Idea/Bad Idea” keeps us from saying this out loud. For some people, a brain injury takes away the fine line between good ideas and bad ideas and “lets it all hang out.” Alcohol can also cause a person to say whatever comes to mind, no matter who it hurts. Alcohol together with a brain injury shuts off the “Good Idea/Bad Idea” program, and that’s a bad idea.
4. Brain injuries cause problems with thinking, like concentration or memory, and using alcohol or other drugs makes these problems worse.
Many people have to learn new skills, or re-learn old ones, following a brain injury. People have trouble with concentration, memory, word finding, problem-solving and other thinking skills, depending on where the brain is injured. Alcohol and other drugs also interfere with the ability to think and learn new things. Adding alcohol and other drugs with your brain injury just makes thinking that much harder.
5. After brain injury, alcohol and other drugs have a more powerful effect.
The brain is more sensitive to alcohol and other drugs after an injury. There are not as many neurons to absorb the alcohol or other drugs. No matter how much alcohol or other drugs a person was able to use before, it’s less now. Also, alcohol interferes with prescribed medications. You get drunk faster and lose the good effect of the medicine.
6. People who have had a brain injury are more likely to have times that they feel low or depressed and drinking alcohol and getting high on other drugs makes this worse.
Being depressed is fairly common after a brain injury. Sometimes it is the injury to the brain that causes depression. It is also the change in a person’s life that leads to depression. Everything is different–there are financial worries, and there is boredom. Many people turn to using alcohol and other drugs to try to make this depression go away. They say it makes them less worried, more relaxed and happier. That may be true, for a while, but it quickly makes things worse. Alcohol depresses the brain and that depresses you.
7. After a brain injury, drinking alcohol or using other drugs can cause a seizure.
Seizures are a problem for about 5% of people who have a brain injury. Even though that is a low number, seizures are serious and steps need to be taken to avoid them. Some people require anti-seizure medication. Mixing alcohol and other drugs with these medications is very dangerous and can INCREASE the chance of seizure. Taking yourself off medications to drink is DANGEROUS. Doubling up on anti-seizure medications to drink is DANGEROUS. Get the facts from your doctor, and then use your brain.
8. People who drink alcohol or use other drugs after a brain injury are more likely to have another brain injury.
Among people who have had one brain injury, the chance of a second injury is three times greater. Brain injuries may cause problems with balance, coordination, vision and judgment that lead to other injuries. By drinking alcohol or using other drugs after a brain injury, you are more likely to have another injury. Also, with each brain injury it takes less force to cause greater harm.