Overview

Traumatic Brain Injury (TBI) and alcoholism are both major health concerns in adults with significant physiological, social, and interpersonal effects. Although TBI and alcoholism may seem like independent health issues, studies suggest a possible interrelationship between them. Research shows that alcohol intoxication greatly increases the risk of TBI, while there is less evidence regarding the influence of TBI on alcoholism. 

Understanding traumatic brain injury

Definition of TBI

TBI is a disruption in the normal function of the brain caused by a bump, blow, jolt to the head, or a penetrating head injury.¹ In England and Wales, of 200,000 annual cases of head injuries admitted to emergency departments, 40,000 are classified as TBI.² TBI is also a major cause of death among young people in the UK.³

Types of TBI

There are broadly two types of TBI: 

• Penetrating TBI (open TBI): Occurs when an object pierces the skull and enters brain tissue, typically damaging the specific region of the brain it contacts. Non-penetrating TBI (closed head injury or blunt TBI): When a strong external force moves the brain within the skull, resulting in a coup-contrecoup injury.⁴

Coup contrecoup injury

Coup contrecoup injury is associated with non-penetrating TBI. Upon initial impact of the object, a bruise forms at the site of contact due to damage to internal tissue and blood vessels. This is known as a coup lesion. A  contrecoup lesion forms when the brain hits the side opposite the initial injury. In addition to the coup and contrecoup lesions, the brain’s internal linings and blood vessels may also be damaged.⁵

Causes of TBI

• Penetrating TBI – caused by bullets, sharp weapons such as knives or pikes, or bone fragments.
• Non-penetrating TBI – caused by strong impacts in car accidents, falls, or sports injuries.

Both types of TBI can also be caused by natural disasters, explosions, or other extreme events involving impacts.⁵

Symptoms

TBI can cause a range of physical, sensory, and cognitive impairments, including the following: 

Physical symptoms

• Headache
• Nausea and vomiting
• Loss of balance
• Drowsiness

Sensory symptoms

• Blurred vision
• Ringing in the ears
• Sensitivity to light and sound 

Cognitive symptoms

• Loss of consciousness
• Confusion
• Mood changes and depression
• Memory impairment
• Insomnia
• Change in personality

These symptoms can last for a long time, depending on the severity of the injury and the quality of rehabilitation.⁶

Understanding alcoholism

Definition of alcoholism

Alcoholism is characterised by impaired control over drinking, a preoccupation with alcohol, continued use despite adverse consequences, and distortions in thinking, most notably denial.⁷

Patients exhibiting the following behaviours are generally diagnosed with alcoholism:

• Drinking for longer periods than intended. 
• Inability to reduce or control alcohol consumption despite efforts.
• Impairment of social or occupational activities due to alcohol consumption attempts to obtain alcohol, or efforts to recover from its effects.
• Persistent drinking despite awareness of the physiological and psychological problems associated with alcohol use.⁸

Risk factors of alcoholism

The following factors are thought to be  major causes of alcoholism:

• Psychological functioning
• Family environment
• Peer pressure
• Traumatic and/or stressful events⁹

Consequences of alcoholism

Alcoholism significantly increases the risk of alcohol-related diseases affecting the liver and heart, as well as pregnancy complications that can have long-term effects on the baby. The risk of cardiovascular problems is elevated due to hypertension and increased blood cholesterol. A range of neurological consequences can also occur, including alcohol-induced neuropathies such as Gayet-Wenicke syndrome, alcoholic dementia, and Marchiafava-Bignami Syndrome.¹⁰ Other consequences include a heightened risk of cancer, a weakened immune system, and pancreatitis.¹¹ Alcohol misuse also increases the likelihood of social problems such as divorce, unemployment, and domestic abuse.

The interrelationship between TBI and alcoholism

Alcoholism as a risk factor for TBI

There is sufficient evidence to highlight the relationship between alcoholism and TBI. For example, approximately 30 to 50% of TBI incidents are associated with alcohol intoxication at the time of injury, especially during vehicle accidents.¹²

Additionally, individuals who typically consume five drinks or more in a single sitting are three times more likely to suffer trauma leading to TBI.¹³ It is believed that poor decision-making and impaired spatial awareness due to intoxication increases the likelihood of TBI. Similarly, symptoms of TBI, such as loss of balance, poor coordination, and nausea, combined with alcoholism, increase the risk of a secondary TBI that can be more severe than the initial injury. 

TBI as a risk factor for alcoholism

Typically, alcohol use drops immediately after a TBI. This is due to medical advice, lack of access to alcohol during hospitalisation or household management, and personal avoidance.¹⁴ However, alcohol use tends to rise over time but eventually returns to pre-injury levels, although there is some disagreement in the literature.¹⁵ Evidence suggesting that TBI contributes to alcoholism includes the fact that 20% of individuals with low or no alcohol consumption showed a drastic increase following TBI. In military scenarios, soldiers who experienced TBI were more likely to increase alcohol consumption compared to those who were uninjured.^{16, 17}

Effect of alcoholism on recovery

Unhealthy levels of alcohol consumption hinder recovery and rehabilitation from TBI. For example, increased alcohol consumption can trigger pro-inflammatory responses at the injury site, resulting in impaired recovery and greater vulnerability to secondary damage.¹⁸ Additionally, rehabilitation is a key factor in successful recovery from TBI and in preventing the development of long-term symptoms. Patients with alcoholism are less likely to follow rehabilitation procedures, thus hindering positive outcomes.¹² Furthermore, increased alcohol consumption post-TBI makes reintegration into social and occupational environments more difficult.

Why does TBI increase alcohol consumption?

It is highly likely that TBI and Alcoholism are associated with post-traumatic stress disorder (PTSD), mainly because trauma is a common denominator between TBI and PTSD. Cognitive impairments caused by PTSD are likely to create further stress, forming a vicious cycle and increasing the likelihood of alcohol dependency. Therefore, the emotional stress triggered at the time of injury, and its persistence post-TBI, is a strong contributor to alcoholism.¹⁴

Summary

Alcoholism appears to increase TBI occurrence and reduce the effectiveness of recovery and rehabilitation. High alcohol consumption post-TBI slows down wound healing and reintegration into the social environment. Whether TBI  directly causes increased alcohol consumption, however, remains uncertain. Personal and external pressure to reduce alcohol use post-injury seems to drastically decrease alcohol consumption following TBI, but cognitive and emotional vulnerability caused by trauma during injury can give rise to PTSD. This, in turn, increases the likelihood of returning to or exceeding pre-injury drinking habits. 

FAQs

How is TBI treated?

Treatment for TBI depends on its severity. Mild TBI usually does not require any treatment, but patients must rest properly and be monitored by a doctor to watch for worsening symptoms. Emergency treatment is required for more severe cases, as oxygen supply, blood flow, and blood pressure management are essential. 

Medications such as anti-anxiety and anti-depressant drugs can be used to reduce emotional stress caused by the trauma of injury.¹⁹ Diuretics may be used to remove liquid that increases pressure inside the brain, while anticoagulants can prevent the formation of blood clots, allowing sufficient blood flow. In terms of surgical procedures, studies show that an aggressive and early approach tends to result in better treatment outcomes.²⁰

What are the best approaches to reduce alcohol consumption?

It is difficult to completely eliminate alcohol consumption. Therefore, it is advised to set limits, gradually decrease the amount of drinking, or avoid occasions where alcohol is involved (e.g., clubbing or pub socials). Another approach is to reduce accessibility by removing alcohol products from the household or avoiding bars and pubs.

What are the survival rates of TBI?

Statistical analysis based on data collected in the UK shows that the survival rate for TBI is 86.2%.²¹ Although this may appear high, it includes a range of severity, from mild to severe TBI. Naturally, patients with more severe cases of TBI are more likely to experience long-term symptoms or disabilities post-injury, as well as a higher risk of death or remaining in a vegetative state.