Читать книгу Concussion - Kester J Nedd DO - Страница 17

Image # 4 – Substance and alcohol abuse and TBI

People often take drugs and alcohol as a means to an end and often see it as a way of relieving themselves from their TBI symptoms, despite these substances causing more destruction. If you carefully examine patients who have prior psychiatric diagnoses, you may find that they have underlying bipolar conditions caused by concussion/TBI, which were never recognized or treated. Moreover, once they discover alcohol and illicit drugs can make them feel good, they quickly become addicted. The story of marijuana as a therapeutic modality for the treatment of TBI/concussion and many other disorders is at the forefront now. While there are benefits to be derived from the use of cannabinoids and THC, we cannot turn a blind eye to the addictive nature of THC, despite the mounting evidence of its value. Furthermore, there is limited data available to measure the benefits of such substances against the risk. While there are several research studies in progress, more is needed in the coming years to better answer the questions on how efficacious drugs such as marijuana and CBD are. Other traditional prescription drugs of abuse such as the benzodiazepines (e.g., clozapine, Xanax) can impact the treatment and outcomes following concussions and TBIs.

The BHET method “From Head to Tails” is fundamentally a work that attempts to change such perception and provide practical solutions to these burning issues of TBI/concussion, substance abuse, and mental illness.

The military and TBI/concussion

The field of brain injury has been popularized due to the many stories from the sports world and in particular American Football that are only now receiving attention in the media. In addition, the stories of the returning soldiers from recent military conflicts in Iran and Iraq have raised our awareness on the impact of blast injuries in causing concussion, which greatly affects the wellbeing of the affected soldiers and those with whom they interact. Until the Iraq and Afghanistan wars, TBI was not labeled as a signature injury of war (Walter Reed 20017, Department of Defense 2008).

Image # 5 – War Injuries

The impact of war can be felt long after it ends. Of the 1.64 million servicemen and women deployed in Iraq and Afghanistan in October 2007, approximately 320,000 sustained TBIs.

Due to better equipment and access to emergency care in the field, more individuals have survived, and some are living with the effects of TBI (Okie 2005).

Between 18% and 25% of the returning veterans from modern wars have suffered a TBI/concussion, (Carson 2007, Terrio 2009) with most of them being due to the effects of a blast (Ling 2009).

The New England Journal of Medicine reported a survey of 2525 returning soldiers after a year-long deployment in Iraq. According to the study, 124 (4.9%) reported injuries with LOC, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting LOC, 43.9% met the criteria for post-traumatic stress disorder (PTSD) as compared to the 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who experienced LOC, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and post-concussive symptoms than those with other injuries (Hoge 2008).

PTSD is a condition in which a person who either experienced trauma or witnessed one develops symptoms that are physically and psychologically tied to the experience. These individuals have anniversary-type symptoms that cause them to re-live the trauma in some way, at times not realizing that this is in fact the case. This can manifest through a racing heartbeat, bad dreams, anxiety, fear, and other negative experiences that may transpire when they are reminded of the incident or are triggered by a particular experience and their internal sense, circumstance, or environment.

So, are you beginning to pay attention now?

Do you know people who have trouble staying on task and completing projects, constantly experience mood swings, have trouble with sleep, make inappropriate comments at inappropriate times, lose their temper for little to no reason, are highly narcissistic, and see themselves as the center of the universe or need attention constantly? Well, they may have suffered a concussion or a TBI sometime in their past.

Irrespective of your stand on aberrant social behavior, including criminal, antisocial, and other negative behavior in society, not recognizing the fact that TBI and concussion play important roles in the evolution of these disorders is a travesty. So, let’s think logically for a moment. If most of the prison population comprises of African American and Hispanic males, and between 25% and 87% of those incarcerated suffered a Concussion or TBI, then what other conclusions we can draw about the minority populations in prison? A significant portion of that population must have experienced TBI. We need to study this issue in a serious way. In my opinion, the legal system, our schools, religious organizations, and other institutions fail society when they do not ask questions about the role of TBI and concussion in antisocial behavioral conditions that lead to incarceration. Our society is often insensitive to the plight of others until they themselves or a person close to them is affected by such conditions that manifest abhorrent behavior. While most individuals with TBI and concussion do not engage in antisocial behavior, a significant number of individuals are negatively impacted. TBI and concussion at any age can cause dysfunction of the hierarchical brain organization that ultimately disrupts the social order. This problem is more pervasive than we once thought and affects our world in more ways than we are prepared to address as a society. Well, this is the story of the lion’s share of individuals with TBI and concussion with manifested physical, cognitive, and behavioral impairment. So, let’s give this disorder the attention it deserves!