Читать книгу Concussion - Kester J Nedd DO - Страница 16
ОглавлениеIt’s About Time we pay attention!
UNTIL RECENTLY, TBI/CONCUSSION received relatively little attention in the field of neuroscience. Nevertheless, due to increased consumerism, this subject has now become one of the most popular matters of concern in our society.
I recently learned that the American Academy of Neurology receives more inquiries about concussion and TBI than other neurological disorders. For those of us who attend meetings in the field, we can see it has become a very popular subject of discussion. It is clearly a sign that greater action on these issues is necessary. What the public fails to understand about TBI/concussion is that it is a significant cause of disruption in our social order and is responsible for disruption in families, causing divorces, child and spouse abuse, loss of wages and jobs, criminal and antisocial behavior, and substance abuse. In fact, whenever I evaluate a patient with history of anger management, violence, panic attacks, motion sickness, headaches, panic disorder, autism, severe anxiety, phobias, OCD, attention deficit, bipolar disorders, and even schizophrenia; I ask them or their family members if they recall even the most insignificant incident of trauma to the head. An individual may have hit their head as a child, infant, or adult on the cupboard, on the side of the pool, during a sporting event, while navigating the monkey bar, or even in a car or bicycle accident. These individuals may not have thought much of the fact that they were dizzy, experienced vertigo, faced trouble concentrating, or had a headache and that these symptoms lasted for days or weeks. I can recall that, in the not too distant past, physicians such as emergency room doctors, neurologists, neurosurgeons, physical medicine and rehabilitation specialists, pediatricians, primary care physicians, and psychiatrists would say to patients that they have not suffered a TBI or concussion, as they did not experience loss of consciousness, despite hitting their head and having symptoms. In my practice, I see patients having suffered major disruption in their lives, who despite being evaluated and treated by competent health care providers, failed to receive appropriate treatments due to this issue of determining whether they have had a concussion. This often arises from the fact that they themselves or their healthcare providers entirely missed that they had a TBI or concussion sometime in the past, since many of these injuries occurred during childhood. When clinicians do not explore the issue of concussion and TBI, they can miss important facts in the diagnosis and treatment of patients. Many of these patients may report dizziness and vertigo while on elevators, driving, or on a boat and plane, but they were not able to see the link to a past traumatic event. From my work in the field and from reviewing medical literature and media stories, I have seen that the issue of TBI/concussion, its impact, and its effects are very complex and at times not well understood. Raising these issues has been long overdue.
The Penal System and TBI/concussion
Considering the tremendous impact that concussion and TBI have on our society, let us look at the penal system.
| Image # 3 – Penal System |
“Within five years following injury, nearly one-third of individuals with TBI report some involvement with the criminal justice system,” said Farrer et al. (Farrer 2011). An article published in the American Psychological Association Newsletter stated, “Since 1980, the number of prisoners has more than tripled to 743 per 100,000 people, an increase brought on in part by mandatory minimum sentences and the war on drugs” (Brian 2014).
This explosion in the number of individuals behind bars is due to the significant legislation passed by Congress and pressure from society to lock up persons with antisocial, substance-abusing, and criminal behavior. For decades now, the issue of African American males in America being imprisoned at a much higher rate than Whites has been talked about. We know that substance abuse has been at the center of the discussion. Substance abusers with low income, usually minorities (African Americans and Hispanics in the USA) tend to abuse crack cocaine (synthetic form), as it is cheaper and relatively easy to acquire. The wealthier tend to abuse actual cocaine made from the cocoa plant that is more expensive. Due to the minimum mandatory laws passed by the US congress for persons consuming crack cocaine, judges and courts administer rougher sentencing to those on crack. Therefore, American prisons have a disproportionate representation of individuals from lower socioeconomic class, and they are generally African Americans and Hispanics. By now, you should be asking the question, what does this have to do with TBI?
The USA has the highest incarceration rates in the world, at a much higher rate for minorities than for the whites (Kruger 2009). So, there you have it: a large number of incarcerated minorities. We also know that a high percentage of those incarcerated have TBI, along with also having drug and alcohol-related issues.
A study by Walker et al., in which prisoners self-reported, indicated that those with one or more head injuries have significantly higher levels of alcohol and/or drug use in the year preceding their current incarceration (Walker 2003). In another study where interviews were conducted with inmates in South Carolina between 2009 and 2010, it was noted that “early TBI predicted greater severity and earlier onset of drug use and an earlier use predicted greater aggression regardless of the age of TBI” (Fishbein 2016). So, if there’s a link to higher rates of incarnation for minorities and higher drug use among inmates and higher rates of TBI in inmates, what then is the conclusion?
Kreutzer et al. demonstrated the interrelationship between crime, substance abuse, aggressive behavior, and TBI (Krutzer 1995).
Just about every article written on the subject calls for further study of this issue. Our understanding of the links between TBI/concussion, illicit substance use and alcohol abuse, low socioeconomic situations, race, and those more severely impacted can significantly change the way societies are impacted.
The issue of punishment and isolation over treatment takes the centerstage when we link incarceration and the factors influencing incarceration to TBI and concussion. This is not a pretty subject, and very little research and few dollars are spent on this issue.
According to a Newsweek report by Erika Hayasaki on June 29, 2016, “convincing the general public to care about the mental health of society’s cast-offs is no easy task. But in the past decade, the interplay of brain disorders and criminal behavior has started to become a topic of popular discussion, partly because some athletes and soldiers—society’s heroes—have turned criminal, suicidal, emotionally volatile, or violent, and a common denominator may be traumatic brain injury” (Hayasaki 2016).
A Scientific America article published in February 2012 by Katherine Harmon pointed out that brain injury rates are 7 times higher in the prison population (Harmon 2012).
A review of several studies indicates that the prisoners surveyed and evaluated in various prison systems have a prevalence of TBI/concussion between 65% and 92%. Most of them experienced moderate to severe injuries in which there was associated LOC. In those studies, most injuries occurred prior to being imprisoned (Farrer 2013, Farrer 2011, Shiroma 2010). Other studies on the jail and prison population reveal that between 25% and 87% of inmates reported a head injury, (Schofield 2006, Slaughter 2003, Morrell 1998) compared to the general non-incarcerated population, with 8.5% reported TBI (Silver 2001). Bill Slaughter conducted an analysis of county jail populations and found that 87% reported TBI over a lifetime (Slaugher 2003).
Alcohol and substance abuse in TBI/concussion
“Substance abuse is a risk factor for having a traumatic brain injury and traumatic brain injury is a risk factor for developing a substance abuse problem,” says Dr. John Corrigan, a well known neuroscientist involved in the evaluation and treatment of TBI (Corrigan 1995). It is estimated that 37–66% of TBI patients have alcohol use disorders and 10–44% of TBI patients abuse illicit drugs (Parry-Jones 2006).
Between 50% and 66% of persons admitted to a hospital with a TBI diagnosis have a history of heavy alcohol use or abuse and between 10% and 20% of persons with TBI develop a substance use problem for the first time after their injury (Corrigan 1995, Kreutzer 1996). Alcohol use gradually worsens 2 to 5 years after the injury, and many patients resume their prior levels of alcohol and other drug abuse (Kreutzer 1996). Thirty-one percent of patients undergoing substance abuse treatment reported one or more TBI with LOC, and the ones with two or more TBIs with LOC are more likely to have depression, anxiety, hallucinations, suicidal thoughts and attempts, violent behavior, trouble concentrating and remembering, and more months of illicit substance use (John 2008).
TBI patients who consume illicit drugs and alcohol can recover slower and to a lesser degree. In addition, they may have trouble with balance and coordination, thus facing a greater risk of falls and the increased likelihood of another TBI. They may have great trouble with memory and concentration, anger management and impulsive behavior, depression, anxiety, and increased chance of a seizure following TBI (Unsworth 2017).
If you are personally dealing with this issue of substance abuse and alcoholism or you have a family member or colleague who is, you know how difficult it can be to recover from this condition and how much it affects your world. With the backdrop of TBI and concussion, this issue is magnified since 60% of the persons seeking treatment drop out. Treatment programs are usually only 30 days long and may require up to 1 year of staying clean in the longer term (Corrigan 1995, Corrigan 1999, Bogner 1997). A significant number of patients in substance abuse treatment programs have TBI, and most of them are undiagnosed. Not diagnosing TBI in this setting can impact the future of a person in a catastrophic manner with the dual diagnosis of TBI and substance abuse/alcoholism.
