This is part 4 of a series on holiday adjustments. As mentioned in the previous blog posts in this series, deficits suffered in the wake of a brain injury may impact brain injury survivors’ ability to participate in holiday celebrations to the degree that they had in previous years so adjustments may need to be made in order to provide a greater likelihood of those survivors enjoying a successful holiday. Part 4 will be focusing on issues related to drinking alcohol during holiday celebrations.
Alcohol consumption is associated with several holidays. A champagne toast is often at the center of New Year’s Eve celebrations. Eggnog with an alcohol such as rum or brandy added is featured at many Christmas parties. However, alcohol can be highly problematic for a brain injury survivor. Anyone who has suffered a brain injury should always consult with a physician prior to drinking alcohol.
There are a number of reasons why a brain injury survivor should avoid alcohol absent a physician’s approval. First, for many survivors alcohol played an integral role in the circumstance that led to the survivor sustaining a brain injury in the first place. For instance, if a survivor suffered a motorcycle accident because he or she was driving drunk home from a bar, clearly he or she faced difficulty managing alcohol safely prior to the injury. There may be any number of issues underlying such a problem that need to be addressed with a substance abuse counselor, a psychiatrist or a psychotherapist. Suffering a brain injury does nothing to remove or address a pre-existing problem with alcohol or life issues that may have set the stage for the injury. Far too often a brain injury survivor will return in his or her post-injury life to old habits with regards to alcohol and consequently suffer yet another injury.
Second, alcohol chemically alters functioning in certain parts of the brain responsible for controlling skills with which survivors often already face substantial struggles. For instance, alcohol depresses functionality in the prefrontal cortex, the part of the brain involved in decision-making and planning. It also affects the cerebellum, which coordinates muscle movements for skills like walking. If you think of a stereotypical drunk individual, the image that usually comes to mind is that of a person who has trouble walking, talking, coordinating body parts and effectively remembering activities in which they are engaged. In many cases, these are precisely the areas that the survivor is working to improve following his or her injury. Alcohol is ostensibly a voluntarily induced temporary chemical brain injury and the last thing a brain injury survivor needs is that voluntary chemical brain injury on top of the current brain injury which was most certainly not chosen.
Third, alcohol interacts poorly with medication. One compelling illustration of this dynamic can be found in brain injury survivors who take Dilantin (Generic name: Phenytoin) to prevent post-injury seizures. Alcohol can change Dilantin levels in the blood, which then leads to an increased risk of seizures. Other brain injury survivors, particularly stroke survivors, may take the blood thinner Coumadin (Generic name: Warfarin). Alcohol can magnify the effect of Coumadin, which then leaves those survivors at risk of excessive bleeding. Anti-anxiety medications such as Ativan (Generic name: Lorazepam) and Xanax (Generic name: Alprazolam) may have interaction effects with alcohol that can range from increased dizziness to serious respiratory problems. These are just a few of the many medications that when mixed with alcohol can threaten terribly dangerous consequences. The National Institute of Alcohol Abuse and Alcoholism has a more complete list of medications and the negative effects of mixing those medications with alcohol:
Fourth, alcohol often affects the survivor far more strongly post-injury than experiences prior to the injury would tend to indicate. As example, a patient at TLC once tried a beer while with his family when out on pass. He reported to staff that he had not even finished drinking enough beer to empty the neck of the bottle before feeling potent symptoms of inebriation. This scared him so much that he handed the bottle back to his family and swore off drinking then and there.
Now that the risks associated with drinking alcohol after a brain injury have been made more clear, here are a few suggestions as to how survivors and their families can make maintaining sobriety easier during the holidays. First, survivors, families and friends can simply have a party without alcohol. If no one is drinking alcohol because there is none available, then there is obviously no risk that the survivor will drink. Holiday celebrations are ultimately about spending valued time together and celebrating as a community, not drinking. Second, sparkling juices and imitation non-alcoholic beers can easily be substituted for alcoholic beverages. Sparkling juices look like champagne or wine but are non-alcoholic. TLC has a “Sparkling Juice Taster” twice a year and patients often find brands and flavors that they enjoy as a substitute for alcohol. Sparkling juices and imitation beers can be purchased at low cost at most supermarkets. Third, most people understand that someone on medication cannot consume alcohol. In many cases, survivors need only point out that they are taking medication and other party-goers will understand why the survivors are not drinking (and then refrain from offering alcohol and/or insisting that those survivors partake).
Hopefully this post has been helpful in its elucidation of the specific and substantial risks to brain injury survivors contemplating alcohol consumption and has offered a few effective ways to approach managing those risks during holiday celebrations.
Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org
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