Traumatic brain injury (TBI) and substance use disorder share many symptoms, and one condition may often complicate the other. Experts from the Defense and Veterans Brain Injury Center (DVBIC) discussed the problems service members can face when the two conditions intersect during a webinar hosted by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
Research shows that substance misuse is responsible for 37-50 percent of all TBIs. The majority of individuals who experience a TBI have a history of substance misuse, which often continues after the injury. In addition, a TBI itself can lead to substance misuse, said Lars Hungerford, a senior clinical research director for DVBIC.
“TBI is actually a risk factor for binge drinking, even after controlling for PTSD and demographic factors,” Hungerford said.
Substance misuse, particularly alcohol use, can complicate TBI in several ways:
- Increased likelihood of another TBI. That’s because substance misuse can impair balance, coordination and judgment.
- Lowered seizure threshold. TBI may increase the risk of seizure from drinking, and alcohol can impede anti-seizure medications.
- Delayed or halted brain recovery. Alcohol can cause inflammation of the brain, which inhibits its ability to heal.
- Increased TBI symptom severity. Issues with memory, cognition and concentration can all increase when drinking alcohol. Because some effects of TBI and substance misuse are similar, it can be difficult to tell them apart when they occur together:
- Poor memory
- Poor concentration
- Decrease in impulse control and judgment
- Impaired language and motor skills
- Increased frequency and intensity of headaches. Substance misuse can result in headaches independent of those caused by TBI. Together, they can lead to more painful and more frequent headaches.
- Worsening depression. Depression is eight times more prevalent among those with TBI. Alcohol reduces the effectiveness of anti-depression medication.
- Dangerous interactions with TBI medications. Medicine for TBI can have adverse effects when paired with alcohol or other substances.
It is important to fully disclose all incidents of TBI and any substance use to your provider. Lack of communication may lead your provider to wrongly attribute symptoms to a TBI when they are due to substance misuse, and vice versa.
Some people fear telling their doctor that they drink or use illegal substances. However, reluctance to report substance use is another obstacle to proper TBI care. Ezra Aune, a regional program manager for DVBIC, emphasized that seeking help is always a better option than keeping information from a provider.
“Most of the branches of service and the service equivalents aim to make it safe for people to step forward and self-refer, or to get a medical intervention that is not a substance-related incident,” Aune said.
He encouraged service members not only to reach out to their health care providers, but also to seek help for possible drinking or drug problems. Programs such as Alcoholics Anonymous can be powerful tools in helping service members with these challenges.
“If they surround themselves with other people that really want to say sober, and move forward, that can be a huge help,” Aune said.