Traumatic Brain Injury A to Z - Alcohol and Drug Use

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Moving Forward

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Once the family member with TBI is home, the journey continues. Join the group as they discuss some of the challenges that occur, such as keeping the family member safe and dealing with inappropriate behaviors.
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Moving Forward

Tracy
Welcome back everybody. Listen I’d like to start by asking how things are going. So Julie, Carl - - how’s Sam doing?

Julie
He’s doing really well. He seems to get a little bit better each day now. According to him, he’s ready to start driving and go back to work. So I think he’s having a little trouble recognizing his limitations. But I believe that in time, he will be able to do all of those things.

Carl
Like I’ve always said, he’s an amazing kid. He may never get back to 100%, but we’re not ready to rule that out yet.

Tracy
Oh you guys are doing a great job. You’ve definitely got the right attitude. Michelle, how are things going with Tom?

Michelle
Well, as you all know, Tom came home this week. It’s been a bit more challenging than we expected, but still a special time. All in all, he’s doing okay. We’re working on getting him on a schedule. It seems the more structure he has, the better he does.

One good thing is that lots of people have offered to help us.

Tracy
And you are you taking them up on that offer, right?

Michelle
Well, not quite yet. At this point, we’re doing almost everything ourselves, but I’m keeping a list of people who want to help, and my sister is starting to organize our home caregiving team.

Tracy
That’s great. Great. Congratulations to your family. I do know though moving back home can be so stressful at times. So Travis, how’re you holding up?

Travis
It’s better now that Dad’s home, but I just didn’t know how hard it would be. There’s lots to do, but Emily and I are both doing all that we can to help Mom. I’m glad that Aunt Dee is there.

Carl
You know, you’re right, Travis. There’s a lot to do. We thought that we were totally prepared for Sam’s return home, but we kept finding things that we’d missed in our planning.

Tracy
Yeah that’s fairly common, Carl. Try as you might, there’s just really no way to prepare yourself completely for what lies ahead. But the good news is that in most cases, things do settle down and everyone adjusts in time.

Michelle
My biggest concern is that, in some areas, Tom’s not doing as well at home as he was at the hospital. He just seems to be more confused, and less able to focus.

Travis
Yeah, and he’s not talking as well as he was. I mean, it’s still better than before his crani... cranio…

Michelle
Cranioplasty.

Travis
Right. Cranioplasty…but he was talking better before he came home.

Tracy
Well again, you know that’s not unusual. I’ve had many families tell me that during those first few days, even weeks at home, their family member actually seemed to have taken a step or two backwards. Tom may just need a little bit more time to adapt to a new environment, even though it is a familiar one. But having said that, it is important that you be aware of any medical changes in his condition, and be sure to let the doctors know.

So in a minute we’re going to talk more about what to expect when a family member with TBI comes home, but before we get started, Megan we haven’t heard about Clay.

Megan
Well, the doctors say that Clay’s making really great progress. He’s been moved to a different floor, and he’s understanding more and more everyday. It’s still really hard for him to talk…just a few words so far. And after listening to everyone here, I’m trying to imagine what it will be like when Clay comes home. And at this point, that’s pretty hard to do… but I’m trying to stay hopeful until things get back to normal.

Tracy
You know that hope is so important, Megan. We talked about that before. Hold on to it, for yourself, and for Clayton. And keep in mind that that meaning of “normal” may change. You know for most of us, a “normal” and fulfilling life usually includes things like living independently, spending time alone, driving, working…things like that. But for a person with TBI, some... maybe all of those things might not be possible right away. But the hope is always there that, over time, some or even most of those things will be possible.

Like Michelle mentioned just a few minutes ago, people with TBI adjust better when there is some routine, good predictability in their schedule. And over time, that need for so much structure may lessen and more flexibility might be possible.

You know another thing that you may find is that your family member might have a hard time interacting with other people. You may worry a little bit about how he’ll behave. He may be impulsive or act inappropriately. 

Julie
Sam has a lot of problems with impulsivity, so one of our therapists had us act out some everyday social situations with Sam. I think this helped take some of the stress off of meeting new people.

Carl
And we’ll keep doing the role-plays as new situations come up.

Tracy
That’s excellent. Another concern that caregivers sometimes have that relates to bringing the loved one home is how to keep them safe. In your Guide to Caregivers you’ll find a home safety checklist that you can use to determine just how safe your home actually is.

And along that same line, one thing that comes up frequently when TBI patients come home is driving. Now depending on your loved one’s condition, he may be eager to drive. But before that can happen, he should be evaluated. In some situations driving might not be possible. And you may want to prepare him for that possibility in advance.

Let’s take a short break. And then we’ll continue in a few minutes. Okay.

Alcohol and Drug Use

Some people with TBI turn to alcohol and/or drugs to help them cope with the effects of their injury. This coping strategy for a person with TBI can be very harmful and is never a good idea.

After a TBI, the brain is more vulnerable to the effects of alcohol and drugs so the person will feel these effects much more quickly.

Alcohol and other non-prescription drugs can slow down the recovery of your service member/veteran with TBI in the following ways:

  • make it harder for the brain to heal 
  • interfere with thinking processes that are already slowed down 
  • interact negatively with prescription medications 
  • increase aggressive and socially inappropriate behaviors 
  • increase balance problems 
  • promote other risky behaviors 
  • create greater risk for seizures
  • increase problems with the law for public drinking 
  • cause addiction 
  • cause problems with friends and family 
  • worsen feelings of depression and anxiety
  • put your family member and others at risk for falls, car crashes, and other accidents that can lead to another TBI or worse

Cognitive difficulties and decreased awareness make it more difficult for your family member with TBI to recognize that alcohol and drugs have a negative effect on him or her.

Take an active role in helping your service member/veteran with TBI avoid alcohol and drugs.

You might:
  • Talk with him or her about readiness to change drinking or drug use. Help your family member make a list of pros and cons of using substances.
  • Spend time with those family and friends who are supportive of your service member/veteran not using substances. Minimize spending time with those who are not supportive.
  • Avoid high-risk situations, such as people or places that your service member/veteran associates with drinking or using drugs.
  • Develop a plan to help your service member/veteran cope with tempting situations, such as leaving the situation or calling a supportive friend.
  • Explore new social circles or environments that do not involve drinking.
  • Encourage learning of new ways to deal with stress.
  • Remove alcohol and other dangerous substances from the home.
  • If depression or boredom or loneliness are reasons for use, seek counseling and other services.
  • If your service member/veteran has recently quit using substances, talk openly with him or her about the possibility of using again in the future and stress that one “slip” does not need to mean a return to regular use. Encourage use of support systems to help avoid a full relapse.
  • Locate a local AA group or treatment program if advised by your health care team.
  • Use of alcohol should be discussed with the health care team before leaving the rehabilitation facility.
"It had been 15 months and he had slowly improved. But he couldn’t talk. He’d kind of start trying to mouth words, but he just couldn’t talk. And so, on October 21st, 2005, I’ll never forget that morning. I came in to the bedroom and I said, Fred, how are you doing?’ And he said, ‘Fine.’ Okay. I think he just talked to me. So I just turned around and went back into the kitchen, got his breakfast, came back in and thought, okay, let me try this again. I said, ‘Fred, how are you doing?’ And he said, ‘Fine.’ It wasn’t a lot at first, but he could talk." -  Denise G.

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