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There’s a difference between manly and macho. Arguably serving your country in the armed services or on the nation’s police forces is manly while engaging in frivolous extreme sports—American football, Brazilian jiu-jitsu, mixed martial arts—is macho.
That’s a little simplistic. Motivations can be mixed. Regardless, whether manly or macho, the risks of concussion, traumatic brain injury, and post-traumatic stress disorder are well-known. Less well-known dangers, such as substance abuse, dependence, and addiction, can be both a precursor and a consequence of such injuries.
Are people with a current or past substance abuse problem more likely to suffer a traumatic brain injury? Are traumatic brain injuries caused by substance abuse? And are people more likely to have a new substance abuse problem following a traumatic brain injury?
The answer to all three questions appears to be “Yes,” but more research is needed.
According to the Centers for Disease Control and Prevention (CDC) website, a traumatic brain injury is a disruption of the normal functioning of the brain caused by caused by “a bump, blow, or jolt to the head or a penetrating head injury.” A concussion is a form of TBI, milder but not harmless.
The CDC considers TBI to be “a major cause of death and disability in the United States, contributing to the deaths of 153 people every day, or about 30 percent of all injury deaths.” And TBI survivors also can experience disabilities that last from a few days to the rest of their lives, including problems seeing, hearing, moving and even thinking, as well as chronic pain and mental issues. And maybe substance abuse.
“Substance Abuse and Brain Injury often go hand in hand,” according to the pamphlet, Brain Injury and Substance Abuse: The Cross-Training Advantage, which cites three pertinent factoids:
- Approximately one-third of traumatic brain injury survivors have a history of substance abuse prior to their injury.
- Alcohol or other drugs are directly involved in more than one-third of incidents that cause brain injury.
- Twenty percent of people who do not have a substance abuse problem becomes vulnerable to substance abuse after a brain injury.
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That makes many cases of TBI a dual diagnosis, meaning there are two conditions that need to be treated: the brain injury and the substance abuse. Not every substance abuse rehab center can effectively treat both problems at the same time, but there are dozens of dual diagnosis treatment centers in California.
While some research equivocated over which came first, the TBI or the substance abuse, in a press release about a 2014 study of Ontario high school students (grades 9 to 12), Canadian neurosurgeon Michael D. Cusimano seemed more certain. Cusimano said that the study, published in the Journal of Head Trauma Rehabilitation, found that “Overall, a teen with a history of TBI is at least twice as likely as a classmate who hasn’t suffered a brain injury to drink alcohol, use cannabis or abuse other drugs” in the previous 12 months. Some drugs were even more likely to be used and abused:
- Crystal meth and non-prescribed tranquilizers or sedatives, 3.8 times more likely
- Ecstasy, 2.8 times more likely
- Non-prescribed opioid pain relievers, 2.7 times more likely
- Hallucinogens, 2.6 times more likely
- Cocaine, LSD or smoked one or more cigarettes daily, 2.5 times more likely
- Non-prescribed ADHD drugs, 2.1 times more likely
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They also were nearly twice as likely to have engaged in binge drinking—five or more drinks in one sitting—in the previous four weeks. “And using some of these substances may also impair recovery after injury,” Cusimano said.
After a TBI, the same quantity of alcohol and drugs will have a stronger effect, as well as possibly preventing damaged nerve endings from reconnecting, increasing emotional and mental problems such as depression, causing seizures and leading to another—likely more severe—TBI.
For teens who hadn’t already experienced a TBI, Cusimano added, “substance abuse increases the odds of suffering an injury that could result in a TBI” due to a lack of coordination and impulse control.
But Cusimano’s colleague and fellow investigator for the study Dr. Robert Mann seemed less certain about cause and effect, saying the study didn’t specify which came first. “These data show us that there are important links between adolescent TBI and substance use,” Mann said but called for more research and better prevention of TBI in the first place.
Prevention involves wearing seat belts in the car, installing handrails throughout the house and wearing helmets for most sports, especially ones like soccer which involve hitting the ball with your head.
Curiously, BJJ also may help the symptoms associated with brain injury. On another BJJ site, Monica Perez wrote that the training and drilling help her with her brain injury by easing her PTSD and anxiety, and improving her impaired short-term memory.
Some of the same symptoms associated with TBI also apply to PTSD, but they are not the same thing. It’s possible to have both.
PTSD and substance abuse also have a “strong relationship”, according to the Department of Veterans Affairs, among both veterans and civilians, but like TBI, its as much causal as consequential. “People with PTSD have more problems with drugs and alcohol both before and after getting PTSD”.
Information from the Society for Neuroscience found that more than half of patients with PTSD also have a substance use disorder. This may be because “recalling traumatic memories enhances the rewarding effects of morphine” and other opioids.
PTSD is not strictly limited to combat veterans but to many types of “upsetting memories” or events, including assault and accidents. Although men are often told to shake it off, PTSD is not a sign of weakness. Trying to be stoic and not acknowledging the trauma—or self-medicating with drugs or alcohol—can actually make it worse. Social support, psychotherapy, and prescribed medications—particularly some reuptake inhibitors, but not stimulants—may make it better.
Dennis James of Toronto’s Centre for Addiction and Mental Health just wishes brain injury specialists and substance abuse specialists would work together on the problems.
In the pamphlet, which James co-wrote, it states that, despite the well-documented links between between brain injury and substance abuse, it’s hard to get “appropriate care” because “Substance Abuse providers aren’t trained to identify or manage the cognitive and behavioral problems that clients with Brain Injuries present,” and “Brain Injury providers aren’t trained to identify or manage Substance Abuse problems.”
“My fantasy?”James writes, is “That providers from both fields pick up their phones, and say to each other ‘can you help me?’”
Cooperation, consultation, and working together also is manly.
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