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Abstracts
 

1. PRE-INJURY ABUSE

Alcohol is often a contributing factor in motor vehicle accidents, pedestrian acidents, assaults, and falls; hence, it contributes to the occurrence of TBI. According to the National Highway Safety Administration, the drivers involved in more than one third of all traffic accidents that result in fatality have blood alcohol levels above the legal limit of 0.10 grams per deciliter.

Rimel (1981) reported that, among persons admitted for emergency room treatment because of TBIs sustained during motor vehicles accidents, blood alcohol levels of 0.10 g/dl or greater were present in 55% of cases. Furthermore, 17% of TBI survivors interviewd by Rimel and her colleagues (1982) reported having previously received some sort of treatment for alcohol abuse.

Alcohol use, driving while intoxicated, and engaging in risky behaviors are likely to cause an accident that results in serious head injury.

Risky behaviors include:

• fighting
• encounters with police
• heavy drinking
• arrests by police
• impulsive behavior
• disorderly conduct
• drug abuse
• public drunkeness

2.  INJURY

The causes of the traumatic brain injury varies among the following:

Image taken from K. Hux 2003 Traumatic Brain Injury class lecture notes

Teenagers and young adults between 15 and 24 years of age sustain TBIs more frequently than any other age group (Centers for Disease Control and Prevention, 1997; NIH Consensus Development Panel, 1999). Additionally, teenage and young adult males are 2 to 3 times more likely than females to sustain TBIs (Cohadon et al., 1991; Jagger et al., 1984; Jennet & MacMillan, 1981; Kraus, 1980; Kraus et al., 1984; NIH Consensus Development Panel, 1999; Whitman et al., 1984) The reason for this is the tendency for males to engage in risky behaviors more often than females.
 

3.   POST-INJURY ABUSE

The cycle continues after the accident as the risk of post-injury alcohol abuse increases due to:

• greater amount of time in daily schedule
• boredom
• uncertainty about returning to work 
• emotional distress
• worries about effectively functioning at work 
• physical limitations
• post-traumatic mood change
• peer acceptance
• independence

Head injury causes severe cognitive impairments that are exaggerated by alcohol, which is a brain-interfering substance itself.  The combination of cognitive impairments and alcohol has potential to lead to repeated injury.

After returning to alcohol or substance abuse, the survivor is likely to sustain a second injury, which is much worse.  The affects accumulate and combine with alcohol-related cogitive deficits, compounding the residual effects. 

The cycle of abuse-injury-abuse is common.  Between 30-40% of patients admitted to substance abuse facilities in the U.S. have had 1-3 mild head injuries in their lives.

"A second head injury is much worse.  One head injury plus one head injury does not equal two head injuries; the cumulative factor is more like three or four head injuries.

- Jeffrey Kreutzer, PhD

***Visit the Brain Injury Association of Minnesota for additional information regarding the cycle of head injury and substance abuse