More than half of all traumatic brain injuries are directly or indirectly caused by alcohol with a large number of patients having elevated blood alcohol levels at the time of the injury. Specifically, binge drinking, defined as having 5 or more drinks on one occasion, is associated with TBI more than chronic drinking and is a risk factor for sustaining such injury.
Traumatic brain injuries linked to alcohol are primarily due to falls, moving vehicle crashes, and assaults. Among all trauma patients, high blood alcohol is more common in patients presenting with head injuries.
Following a TBI, alcohol consumption usually drops due to factors such as:
1) Lack of access to alcohol in the care facilities
2) Physical disabilities associated with TBI
3) Advice to abstain from drinking from health care providers
4) Possible side effects with medications
The use and misuse of alcohol during the recovery period can reduce the efficacy of rehabilitation. It increases the likelihood of developing seizures, mood and anxiety disorders, and subsequent TBIs. Drinking after sustaining a TBI can produce adverse consequences in the psychosocial, health, and employment domains. Studies on patients who have endured brain injuries have shown that alcohol use produces impairment in executive function beyond what is experienced as a result of the injury or alcohol use alone.
When it comes to chronic drinking or repeated binge drinking, patterns of neuroinflammation, loss of neurons, demyelination, and significant cognitive impairments have been observed. Additional neurodegeneration linked to alcohol use disorder occurs in frontal and limbic structures responsible for regulating emotions, memory, impulses and executive functioning. Therefore, alcohol abuse exacerbates TBI symptoms, lengthens the recovery period, and impairs the ability to fully recover. Alcohol misuse generally leads to poorer TBI outcomes and worsened compliance to rehabilitation protocol.
Mood disorders following TBI are significantly more frequent among patients with a history of alcohol abuse or disorder than among normal drinkers or nondrinkers. Studies have also reported that drinking in excess after TBI increases the likelihood of meeting diagnostic criteria for mood disorders compared to those who abstain from drinking or drink in moderation.
So why do some patients continue drinking or suffer from substance abuse following their injury?
Some patients believe that drinking will have positive effects on them or reduce negative outcomes such as improving mood and reducing social anxiety or peer pressure. Some also use alcohol as a form of self-medication to reduce negative affect and deal with post-traumatic stress disorder (PTSD) symptoms that often follow a TBI.
In athletes, alcohol may serve as a coping mechanism against sports-related stressors and performance anxieties, especially after a brain injury. Research has shown that university athletes with a history of a concussion consumed significantly more alcohol per outing compared to those with no history of concussion.
It is important to note that the majority of people refrain from using alcohol following a brain injury as recommended by health care professionals. In the months and years following injury, alcohol consumption tends to return to pre-injury levels in many patients, although many report having reduced tolerance to the effects of alcohol following TBI.
Written by Lea Farah
References
Alcock, B., Gallant, C., & Good, D. (2018). The relationship between concussion and alcohol consumption among university athletes. Addictive Behaviors Reports, 7, 58-64. https://doi.org/10.1016/j.abrep.2018.02.001
Jorge, R. E., Starkstein, S. E., Arndt, S., Moser, D., Crespo-Facorro, B., & Robinson, R. G. (2005). Alcohol misuse and mood disorders following traumatic brain injury. Archives of General Psychiatry, 62(7), 742-749. https://doi.org/10.1001/archpsyc.62.7.742
Weil, Z. M., Corrigan, J. D., & Karelina, K. (2016). Alcohol abuse after traumatic brain injury: Experimental and clinical evidence. Neuroscience and Biobehavioral Reviews, 62, 89-99. https://doi.org/10.1016/j.neubiorev.2016.01.005