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Alcohol abuse and traumatic brain injury

Alcohol Health & Research World, Spring, 1989 by Gregory A. Jones

Alcohol Abuse and Traumatic Brain Injury

The role of alcohol and other drug abuse in traumatic brain injury is well documented, with an incidence of intoxication at injury of approximately 50 percent. Because of cognitive, behavioral, and functional deficits, brain injury survivors pose unique challenges to the alcoholism treatment field.

Head Injury and Alcohol Abuse

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Alcohol consumption is a strong predisposing factor in traumatic brain injury (Kerr et al. 1971; Field 1976; Parkinson et al. 1985). In studies addressing head injury and alcohol use specifically, elevated blood alcohol levels were present in more than 40 percent of the patients seen in emergency rooms or admitted to hospitals because of traumatic head injury (Galbraith et al. 1976; Rutherford 1977; Brismar et al. 1983; Parkinson et al. 1985). In the most recent study of head-injured patients at a North American trauma center, 67 percent of those tested for blood alcohol levels showed evidence of alcohol use and more than one-half (51 percent) were intoxicated, using a definition of 100 mg/100 ml (100 mg/dl) (Sparadeo and Gill, in press). This is consistent with a Swedish study showing a 58-percent rate of intoxication among those tested (Brismar et al. 1983).

In a study of neuropsychological deficits in alcoholics, psychometric test performance was significantly lower among head-injured alcoholics than among those who had not experienced head injuries (Hillbom and Holm 1986). Both groups scored lower than the general population on most test items. Results of the study also suggest that the incidence of head injury in alcoholics is two to four times higher than in the general population.

Other studies have documented the role of alcohol and other drug abuse in traumatic brain injury. Alterman and Tarter (1985) found the risk for head injury in patients with familial alcoholism to be almost twice that of patients without such history. In a study of 75 severely brain-injured patients (Tobis et al. 1982), 51 had histories of alcohol abuse and 29 had histories of illicit drug use. The number of patients using both alcohol and other drugs was not specified. Sparadeo and Gill (in press) found that 25 percent of their sample had alcohol histories documented in their medical records. A recent survey of brain injury rehabilitation programs around the country reported that approximately 55 percent of patients had some alcohol or other drug abuse problems before the brain injury and 40 percent had abuse problems described as moderate to severe (NHIF 1988).

Psychosocial Consequences of

Head Injury

Traumatic brain injury can mean many long-term psychological and behavioral difficulties. Because every head injury is different, it is impossible to predict the exact outcome for the survivor. While generalizations can be made, it is important that treatment professionals and other concerned persons note that individuals may present few problems or a combination of several problems. Some deficits following head injury are painfully obvious; others are extremely subtle and become evident only during intensive clinical evaluation (Lezak 1978b). Alcohol and other drug abuse professionals working with head injury survivors commonly deal with clients who appear to function normally in most settings but who are unable to understand the concepts of alcohol or other drug addiction or to benefit from traditional treatment modalities.

To work effectively with survivors of traumatic brain injury, it is vital that alcohol and other drug abuse professionals acquaint themselves with the unique problems these clients present. The following discussion of the more common consequences of head injury is drawn from general knowledge in the field of brain injury rehabilitation. For more detailed information, the reader is directed to Levin and colleagues (1982), Edelstein and Couture (1984), Lezak (1978a, 1978b, 1983), and Brooks (1984).

Impairment of memory-Post-traumatic amnesia is one of the most common consequences of head injury. For many survivors, memory for events and conditions prior to their injury is generally intact while short-term memory for recent events is disrupted. In practical terms, this means that brain injury survivors might remember the events of their high school prom in great detail but forget what was served for breakfast this morning. Some survivors may try to fill in the gaps with confabulation, a usually sincere attempt to mask memory deficits that is sometimes misinterpreted as dishonesty. Impairment of recent memory makes it difficult for many survivors to retain information and generalize new learning from one setting to another.

Decreased self-awareness and insight - Many survivors of traumatic brain injury experience a reduced capacity for insight, self-monitoring, and awareness. They may have difficulty seeing the relationship between their behavior and the resulting consequences and may experience confusion or frustration in their attempt to understand situations.

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Alcohol abuse and traumatic brain injury

Alcohol Health & Research World, Spring, 1989 by Gregory A. Jones

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