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Substance Abuse and Brain Injuries
Relationship between Traumatic
Brain Injury and Substance Abuse
John D. Corrigan, PhD
Department of Physical Medicine and Rehabilitation
Ohio State University
Substance abuse is more prevalent among persons with disabilities than
society in general (Moore & Polsgrove, 1991; Moore & Li, 1994;
Center for Substance Abuse Treatment, 1998); yet, research and treatment
specific to this segment of the population has been minimal (National
Association on Alcohol Drugs and Disability, 1998). Among disability
groups
with unique issues of substance abuse are those individuals who have
experienced traumatic brain injury. There has always been acknowledgment
of the relationship
between intoxication and injury (Jernigan, 1991; Corrigan, 1995), but
only more recently has attention been given to the mediating effects
of
substance abuse on rehabilitation outcomes following traumatic brain
injury (Corrigan, 1995; Kreutzer, Witol et al., 1996; Corrigan, Bogner
et al.,
1999). Clinicians and researchers have repeatedly observed that cognitive
and emotional impairments caused by brain injury present unique problems
when addressing co-existing substance abuse problems (Langley, 1991;
Center
for Substance Abuse Treatment, 1998; Corrigan, Bogner et al., 1999).
Traumatic brain injury is widespread in society, but the
public and many treatment professionals are unaware of its prevalence
and impact. The Centers for Disease Control and Prevention (CDC) report
that each year 220,000 Americans will be hospitalized due to traumatic
brain injury and 51,600 will die (Waxweiler, Thurman et al., 1995). Each
year in the United States, over 1 million emergency department visits
are due to traumatic brain injury (Guerrero, Thurman et al., 2000). CDC
has recently estimated that 5.3 million Americans live with disability
due to these injuries (Thurman, 1998).
Young adult males are among the highest risk groups, with
most injuries occurring as the result of moving vehicle crashes (Thurman,
1998). Alcohol is a major contributor to the occurrence of injuries. Equally
troubling is the proportion of adolescents and adults hospitalized for
traumatic brain injuries who have pre-injury substance use disorders (Corrigan,
1995). Among patients receiving acute medical rehabilitation, as many
as two-thirds have evidence of premorbid substance use disorders. A longitudinal
study underway at Ohio State University found 58% of the consecutive sample
of 350 patients admitted to the Brain Injury Unit had prior histories
of substance use disorders using DSM-III-R criteria.
There is growing evidence that persons with traumatic brain
injury and substance abuse problems have significantly worse problems
than persons with traumatic brain injury alone. Among patients with the
most severe brain injuries, alcohol or other drug consumption declines
in the immediate post-injury period; however, people tend to return to
pre-injury levels of use by two years post-injury (Corrigan, Rust et al.,
1995; Kreutzer, Witol et al., 1996; Kreutzer, Witol et al., 1996; Corrigan,
Smith-Knapp et al., 1998). Approximately 20% of persons who abstained
or were light drinkers pre-injury, become high volume users after (Corrigan,
Rust et al., 1995). Persons with traumatic brain injury and substance
abuse problems are less likely to be working (Sander, Kreutzer et al.,
1996; Bogner, Corrigan et al., 1997; Corrigan, Bogner et al., 1997), and
have lower life satisfaction (Bogner, Corrigan et al., 1997).
Persons with traumatic brain injuries face several challenges
when seeking treatment from substance abuse providers (Center for Substance
Abuse Treatment, 1998). Cognitive impairments may affect a person's learning
style, making participation in didactic training and group interventions
more difficult. Misinterpretation of memory problems as resistance to
treatment can undermine a treatment relationship. Damage to the frontal
lobes affects executive thinking skills and promotes socially inappropriate
behavior. Environmental cues may not be perceived, creating consternation
for fellow clients and staff. It is easy to interpret these behaviors
as intentionally disruptive, particularly when the individual with a brain
injury shows no visible signs of disability (Center for Substance Abuse
Treatment, 1998).
Cited and related articles:
Bogner, J. A., J. D. Corrigan, et
al. (1997). "Integrating
substance abuse treatment and vocational rehabilitation following traumatic
brain injury." Journal of Head Trauma Rehabilitation 12(5): 57-71.
Center for Substance Abuse Treatment (1998). Substance Use
Disorder Treatment for People With Physical and Cognitive Disabilities.
Treatment Improvement Protocol (TIP) Series. Washington, DC, U.S. Government
Printing Office. Number 29.
Corrigan, J. D. (1995). "Substance abuse as a mediating
factor in outcome from traumatic brain injury." Archives of Physical
Medicine and Rehabilitation 76(4): 302-9.
Corrigan, J. D., J. A. Bogner, et al. (1999). Substance
abuse and brain injury. Rehabilitation of the Adult and Child with Traumatic
Brain Injury. M. Rosenthal, E. R. Griffith, J. D. Miller and J. Kreutzer.
Philadelphia, PA, F.A. Davis Co. 3rd Edition.
Corrigan, J. D., J. A. Bogner, et
al. (1997). "Systematic
bias in outcome studies of persons with traumatic brain injury." Archives
of Physical Medicine and Rehabilitation 78(2): 132-7.
Corrigan, J. D., E. Rust, et al.
(1995). "The nature
and extent of substance abuse problems among persons with traumatic brain
injuries." Journal of Head Trauma Rehabilitation 10(3): 29-45.
Corrigan, J. D., K. Smith-Knapp,
et al. (1998). "Outcomes
in the first 5 years after traumatic brain injury." Archives of
Physical Medicine and Rehabilitation 79(3): 298-305.
Guerrero, J. L., D. J. Thurman,
et al. (2000). "Emergency
department visits associated with traumatic brain injury: United States,
1995-1996." Brain Injury 14(2): 181-186.
Jernigan, D. H. (1991). "Alcohol and head trauma: Strategies
for prevention." Journal of Head Trauma Rehabilitation 6(2): 48-59.
Kolakowsky-Hayner, S. and J. S.
Kreutzer (2001). "Pre-injury
crime , substance abuse, and neurobehavioral functioning after traumatic
brain injury." Brain Injury 15(1): 53-63.
Kreutzer, J., A. Witol, et al. (1996). "Alcohol and
drug use among young persons with traumatic brain injury." Journal
of Learning Disabilities 29(6): 643-51.
Kreutzer, J. S., J. H. Marwitz,
et al. (1995). "Interrelationships
between crime, substance abuse, and aggressive behaviours among persons
with traumatic brain injury." Brain Injury 9(8): 757-68.
Kreutzer, J. S., P. H. Wehman, et
al. (1991). "Substance
abuse and crime patterns among persons with traumatic brain injury referred
for supported employment." Brain Injury 5(2): 177-87.
Kreutzer, J. S., A. D. Witol, et
al. (1996). "A prospective
longitudinal mulitcenter analysis of alcohol use patterns among persons
with traumatic brain injury." Journal of Head Trauma Rehabilitation
11(5): 58-78.
Langley, M. J. (1991). Preventing post-injury alcohol-related
problems: A behavioral approach. Work Worth Doing: Advances in Brain Injury
Rehabilitation. B. T. McMahon and L. R. Shaw. Orlando, FL, Paul M Deutsch
Press, Inc.
Moore, D. and L. Li (1994). "Substance abuse among
applicants for vocational rehabilitation services." Journal of Rehabilitation
60(4): 48-53.
Moore, D. and L. Polsgrove (1991). "Disabilities, developmental
handicaps, and substance misuse: A review." International Journal
of Addictions 26(1): 65-90.
National Association on Alcohol Drugs and Disability (1998).
Access Limited--Substance Abuse Services for People with Disabilities:
A National Perspective. San Mateo, CA, NAADD.
Sander, A. M., J. S. Kreutzer, et
al. (1996). "A multicenter
longitudinal investigation of return to work and community integration
following traumatic brain injury." Journal of Head Trauma Rehabilitation
11: 70-84.
Thurman, D. J. (1998). Traumatic Brain Injury in the United
States: An Interim Report to Congress. Atlanta, GA, Division of Acute
Care, Rehabilitation and Disability Prevention, National Center for Injury
Prevention and Control, Centers for Disease Control and Prevention.
Thurman, D. J., C. Alverson, et
al. (1999). "Traumatic
brain injury in the United State: A public health perspective." Journal
of Head Trauma Rehabilitation 14: 602-615.
Thurman, D. J., J. E. Sniezek, et al. (1995). Guidelines
for Surveillance of Central Nervous System Injury. Atlanta, GA, Centers
for Disease Control and Prevention.
Waxweiler, R. J., D. Thurman, et
al. (1995). "Monitoring
the impact of traumatic brain injury: A review and update." Journal
of Neurotrauma 12(4): 509-516.
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