By Suzanne G. Martin PsyD, MPH, Intrepid Spirit Concussion Recovery Center, Camp Lejeune, N.C.
A concussion – also known as a mild Traumatic Brain Injury (mTBI) – is a disruption of normal brain function that occurs when the skull is hit, suddenly thrust out of position, penetrated, or struck by an external force. According to the North Carolina Department of Health and Human Service (NCDHHS), individuals from age 0-4 years, 15-19 years and 65+ years have the highest risk of having a brain injury. However, members of the military, especially veterans of the Iraq and Afghanistan war, are at particularly high risk because of their exposure to explosive devices in combat.
The Brain Injury Association of North Carolina estimates that approximately 43,000 North Carolina residents currently live with the effects of TBI based on population data for the year 2000. The severity of a TBI may range from mild, a brief change in mental state or consciousness, to severe, an extended period of unconsciousness after the injury. Fortunately, about 75 percent of all brain injuries are mild.
A TBI is often the result of alcohol abuse (for example a fall as a result of intoxication). According to the Centers for Disease Control and Prevention (CDC), up to two-thirds of civilians with TBI have a history of alcohol abuse. Between 30-50 percent of people with TBI were injured while they were intoxicated. Up to two-thirds of people with TBI have a history of alcohol abuse or high-risk drinking
There is an increasing amount of research to suggest the negative effects of alcohol (and other drug use) after brain injury. Alcohol is a neurotoxin – in other words, it kills brain cells – compounding the negative effects of a TBI. There is no recommended safe amount of alcohol after a brain injury – especially early in recovery when the brain is healing. Even moderate amounts of alcohol for people with mTBI have been associated for poor outcomes on memory, attention, balance, and behavior. Heavy alcohol use pre-injury is associated with poorer health outcomes and substance abuse post injury. Many TBI patients report that they are more sensitive to the effects of alcohol after injury. Just a little alcohol after a TBI can impair judgment and increase the risk of a fall and subsequent head injury.
Another consideration is depression. In the first year after injury, TBI survivors are eight times more likely to be diagnosed with depression. Since alcohol itself is a depressant, drinking alcohol after a TBI can increase the risk of developing depression. Alcohol can also reduce the effectiveness of many medications – including those for treatment of depression – and can dangerously amplify the effects of other medications such as painkillers. In some cases, the interactions of alcohol with prescribed medications can be fatal. Regardless of TBI history, many people have died as a result of alcohol related drug interactions. Finally, because a TBI increases the risk of a seizure and alcohol lowers the seizure threshold, drinking alcohol further magnifies the risk of a seizure.
The bottom line is that there is no safe level of alcohol use following a TBI. Recognizing that however, if you or someone you know chooses to drink after a TBI, consider a risk reduction approach and:
- Have food and water before drinking.
- Switch to low level alcohol drinks (e.g. beer)
- Sip slowly and have no more than one drink every hour or two drinks every day.
- Use water rather than soda as a mixer to reduce the blood alcohol level (carbonated drinks can increase the speed at which the body absorbs alcohol).
- Take vitamins B1 (thiamine), B2 (riboflavin), or B9 (folate).
- Never drink and drive.
- Take drinking “holidays”
The safest approach of course is to eliminate alcohol from your choice of beverages.