Substance Abuse

Unfortunately, brain injury and drugs and alcohol often go hand in hand. People who abuse drugs and alcohol have a higher incidence of sustaining a brain injury -- from falling or driving while intoxicated, for example. And the effects of alcohol and drugs only get worse for people after a brain injury.

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Getting Help for a Loved One with TBI and Substance Abuse Issues

TBI and Substance Abuse: Getting Help for a Loved One
Dr. Corrigan, how can family members get a loved one with TBI help with substance abuse, if he doesn't fully understand what the problem is? Well, that is one of the toughest issues we often face is when someone just doesn't see it themselves. For some folks after brain injury, it may be even harder for them to see it, so what's real important is that one, that the message that a person is getting, they're getting consistently, so they're hearing it from their doctor, they're hearing it from any of the professionals they may be working with, they're hearing it from their family. But the way it's being said is also important. One of the things we counsel against is confrontation that the minute somebody's emotional state goes up particularly for a person with a brain injury, then what they're hearing and learning goes down. So we really don't advise confrontation. It's about giving it in a nonjudgemental, loving way--giving a consistent message that we've got something here we need to deal with, and be willing to do it with them, not a you go get fixed, but let's go work on this.

TBI and Substance Abuse Often Go Hand-in-Hand

TBI and Substance Abuse Often Go Hand-in-Hand
How many people with TBI actually have a history of substance abuse before their TBI? Among individuals who receive rehabilitation-- these are adolescents and adults--[John D Corrigan, Ph.D.] [Ohio State University] as many as half have prior histories of problems with alcohol or other drugs. What percentage of people who did not have a problem with addiction before their TBI became vulnerable to drugs and alcohol after their injury? We're not quite as certain about that number, but we think about 10 percent of everyone we treat in rehabilitation-- all the adults--about 10 percent will not have had any problem before, but will develop one at some point after their injury. So there's a window of time for vulnerability? There is both a window of time for vulnerability, but there's also--for those who've not had one before-- that, as they are facing the stressors of going home from the hospital with this injury, and the changes it's incurred, for some, the coping strategy--and not a good one-- may be to turn to drugs and alcohol. For others, it might be due to pain or other complications they have after their injury-- and it might include, actually, abuse of a prescription medication. So there is a definite vulnerability that we see immediately. But it's more than just immediate--it's also lifelong, we have to be vigilant.

Pain Management After TBI and Substance Abuse

TBI and Substance Abuse: Pain Management
Let's talk about the obvious challenge when you've got pain management after a brain injury. How do you prescribe medication if problems with drugs and alcohol are already involved? Well, pain management is absolutely critical-- particularly when dealing with a substance abuse problem. [Naval Center for Combat & Operational Stress Control] Again, you go back to the collaborative process of treating these things. And the collaboration, in that case, also includes the patient. You have to be very upfront and very honest with the patient about addressing that. The first thing, though, is to make sure that you are identifying what is causing the pain and make sure you get that treated and taken care of. And then, in managing the pain medication situation or the pain treatment, close follow up, frequent follow up; small prescriptions so that they don't have large supplies, making sure that the providers are coordinating with each other so that they aren't doctor shopping to get a little bit from here, a little bit from there, and collecting a bunch--that's part of that collaborative approach that we have to take. Female Interviewer: I see Jan is over there saying, "Yep, that's right." Jan: Yes, absolutely. I would've been the doctor shopper, [brainline.org] and so yes, it is really, really important to be able to have that level of accountability.

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