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Substance Abuse and TBI

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For many, drinking in moderation doesn't pose a problem. But for those with traumatic brain injury (TBI), using drugs or alcohol to cope can be dangerous. Providers need to be aware that failure to treat substance abuse problems following TBI may be counterproductive to a successful recovery, and lead to added medical, psychiatric or behavioral problems, unemployment and family troubles for patients.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) addressed these concerns during the January webinar, “Substance Abuse and Traumatic Brain Injury: Magnitude, Manifestations, Myths and Management.” Dr. Charles H. Bombardier, professor of rehabilitation medicine at the University of Washington School of Medicine, discussed key messages for health professionals to consider when working with patients with both substance abuse and TBI, which included:

  • Substance use and abuse frequently co-occurs with TBI and can have negative outcomes for the individual
  • Unfounded myths associated with treatment of substance abuse can pose barriers to care
  • There are many brief, sensitive, no-cost screening methods
  • Different treatments are available, and multiple sessions are recommended
  • Intervention techniques can be used by non-specialists, and alcohol screenings and interventions can be integrated with clinical treatment

According to Bombardier, 38 percent of people with a TBI report that alcohol affects them easily. Harmful effects associated with alcohol use after a TBI include insomnia, fatigue, cognitive issues (attention deficit, lack of memory and processing speed), sexual inactivity, and impaired balance and coordination.

Myths, especially ones related to clinical care, can deter individuals from seeking the help they need. Bombardier noted the following myths associated with substance abuse interventions in a clinical setting: 

  • Individuals must admit they're an alcoholic
  • Not accepting help is denial
  • Denial is an alcoholic personality trait
  • Denial must be confronted
  • Formal treatment is always necessary
  • Goal must be lifetime abstinence

People seeking help for substance abuse problems and TBI should know that they don't necessarily have to enter a formal alcoholic rehabilitation program, admit that they're an alcoholic, or be questioned about being in denial, according to Bombardier. For example, goal setting, enhancing social support and reviewing ways to cope with the triggers that lead to drinking have shown to be effective intervention methods.

Bombardier also highlighted substance use screening as a valuable tool for providers. Because past problems are predictive of future problems, says Bombardier, alcohol abuse screening methods such as CAGE -- concern/cut down, anger, guilt and eye opener -- help providers identify individuals who don't require assistance, allowing them to focus on those with a defined substance abuse problem.

Substance abuse is a risk factor for those with a TBI, and TBI is a risk factor for developing a substance abuse problem. It may serve providers well to be aware of this connection, the issues involved and treatment options. Bombardier's presentation and audio from this webinar are available on the DCoE website.  

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