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		Substance Abuse and Traumatic Brain Injury in College Students By Shammah Bermudez, Brain Injury Association of Pennsylvania Introduction There is no question that substance abuse, mainly excessive alcohol consumption, is a major issue on college campuses today. For those who are involved with the world of higher education, it has become one of the major focuses of student life, and rightfully so. Everyday, school administrators from the President on down are faced with the challenge of figuring out what to do about a problem that has reached “epidemic proportions” (Biden, 2001). The dangers of substance abuse are often not taken seriously enough by students and sadly, most do not realize how dangerous it is until it is too late. One of the most serious and often overlooked consequences of substance abuse is Traumatic Brain Injury (TBI), a consequence that affects approximately 1.5 million people a year. Approximately 80,000 Americans will experience the onset of long-term disability following a TBI, while another 50,000 will die. In the state of Pennsylvania alone, 41,000 visit the emergency room, 7,800 are hospitalized, and 2,700 experience permanent disability and 2000 die annually. Furthermore, it is the leading cause of death and disability among adolescents and young adults (Strauss, 2002). According to the TBI Model Systems national database, 24% of all TBI occurrences happen between the ages of 15 and 24. Within that 24%, 19% are listed as full or part-time students. As you can see college students are disproportionately affected by Traumatic Brain Injury. This article will discuss the consequences of TBI related to substance abuse that affect college students. These consequences are permanent, as well as life altering. Traumatic Brain Injury A Traumatic Brain Injury is defined as: An insult to the brain, not of degenerative or congenital nature, caused by an external physical force that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. As I stated earlier, often times the consequences of TBI are permanent as well as life altering. A person, who sustains a traumatic brain injury, may be affected cognitively and physically as well as emotionally. Cognitive consequences include short-term memory loss, spatial disorientation, trouble concentrating for long periods of time, lack of initiative, as well as other consequences. Physical consequences can include muscle spasticity, double vision, headaches, balance problems and paralysis. Emotional problems may include increased anxiety, depression, mood swings, agitation, and egocentric behaviors. For many, TBI is not something they are familiar with and because of this, TBI is known as a “silent epidemic” (Brain Injury Association of America). The Scope of the Problem It is a reality that college students drink alcohol. They drink for reasons that may include acceptance, peer pressure and stress. Unfortunately, the fact that many students are underage does not seem to affect the decision to drink. Furthermore the parents of students today seem to be content with accepting the fact that drinking is a part of the college experience, overlooking the fact that their son or daughter just broke the law and put themselves in harms way. In an editorial by David Strauss, PhD in the Fall 2001 issue of Brain Injury Source, Strauss writes “We seem to find comfort when our youth drink alcohol-as opposed to drugs- as though it is an acceptable “right of passage”. Strauss goes on to say that he has heard many a parent who has caught their underage child drinking comment “Thank god it is not drugs”. It is a frightening statement considering alcohol is the leading cause of death and disability among our youth (Strauss, 2001). Furthermore, two in five students were found to be heavy episodic drinkers (Wechsler, 2000) also known as “binge drinking”. The term “binge drinking” which refers to the specific practice of heavy episodic drinking by students, (Knight, et. al., 2002) was first used in 1992 by Henry Wechsler and his colleagues of the Harvard University College Alcohol Study. Such drinking is defined as five or more drinks for men and four or more drinks for women in one sitting at least once during the past two weeks (Knight, et al., 2002). Once a student drinks 4, 5 or more drinks, the potential for risk-behavior is greatly increased. The feeling of invincibility combined with peer pressure can lead to deadly consequences. Tragically, many students don’t realize the true dangers of alcohol until it is to late. Chronic Alcohol Use and the Brain Alcohol use without trauma can have a profound effect on the brain, and the effects can be permanent. When students drink however, damaging the brain is not something they are worried about. What most students are concerned about are blackouts, vomiting, hangovers, and maybe alcohol poisoning. Today’s research, however, dictates that students should be very concerned with alcohol and brain function. Teenagers who drink heavily may loose as much as 10 percent of their mental capacity, affecting tasks as varied as learning new information and thinking through complex thoughts (Wechsler, H. & Wuethrich, B., 2002). The neurological effects of alcohol can occur directly, because alcohol is a toxic substance, or they can occur indirectly, through damage to other body organs (e.g. liver) that subsequently interferes with the workings of the nerve cells (Oscar-Berman, et al., 1997). Studies involving MRI and CT images have shown brain shrinkage and tissue damage in some alcoholics, which can result in poor temperature regulation, muscle weakness, and alterations of sleep patterns (Oscar-Berman, et al., 1997). Another serious effect is damage to the cerebellum, as a result of chronic alcohol consumption. The cerebellum is the part of the brain that helps control muscle coordination. This damage can cause difficulties in balance, resulting in staggering and imbalance. Cognitive effects, such as memory loss and the ability to concentrate and make decisions may not appear right away and they also may not be obvious when they do appear. A student who chronically abuses alcohol, may suffer academically as a direct result of a decline in cognitive functions. However, it is not something that you recognize easily, for example a failing test grade. It is more likely to be a gradual decline in overall academic performance, such as a falling grade point average. More serious cognitive effects include loss of short and long-term memory. TBI and Alcohol Related Causes There is a direct correlation between alcohol usage and the occurrence of traumatic brain injury. Alcohol is the best-established predisposing factor for sustaining a traumatic brain injury (Strauss, 2002). Furthermore, studies have shown that alcohol has been indicated in 50% or more of all TBI occurrences. Among the causes of brain injury, motor vehicle crashes represent 44% of the total number of occurrences. Following motor vehicle crashes are falls, which represent 26%, non-firearm violent acts represent 9% and firearms represent 8%. Despite the hard work and progress of organizations like Mothers Against Drunk Driving (MADD), alcohol related crashes are still a serious problem among young adults. According to the recent survey released by the Substance Abuse and Mental Health Services Administration (SAMHSA), 23% of young adults ages 18-25, drove under the influence. In addition alcohol plays a factor in about one-third of the car-crash deaths involving teenagers. Another role that alcohol plays is that it can complicate both the injury and the recovery process. In an article written by David Strauss PhD, Dr. Strauss talks about two studies. The first study, which looked at consecutive head injury admissions over a two-year period, found that patients with a positive blood alcohol level (BAL) had a lower level of consciousness when admitted and a longer duration of coma. The second study that looked at patients with brain injuries admitted to a surgical clinic found that the length of hospitalization was longer in patients with alcohol dependency. Conclusion Working in the field of brain injury rehabilitation, I see clients on a daily basis whose lives were changed forever following a single event involving alcohol misuse. The great majority of my clients were injured as a result of risk behavior. Many of the clients I work with sustained a brain injury as a result of a combination of alcohol, risk behavior and poor decision-making. For most of the clients, they were young and in the prime of their youth. Furthermore alcohol was the chief predisposing factor in many of the cases. The end result for many of the clients is living in a residential facility, having staff help them get through tasks that we often take for granted, like getting dressed, eating, and going to the bathroom. Some clients are able to live at home with family or a friend. However, it is not uncommon for clients to be alienated by their friends and family. For a lot of families it proves to be too much to handle both emotionally, physically and financially. Substance abuse and traumatic brain injury are two things that can be prevented. However the prevention aspect can not happen without educating and raising the awareness of those who are not only at-risk, but also those who have a direct impact on those at risk. If you would like more information on substance abuse and traumatic brain injury, please refer to the references and resources at the end of this article. About the Author Shammah Bermudez is a facilitator at Remed’s Community Outpatient Services, a post acute brain injury provider. In addition, he serves as a member of the Prevention Committee for the Brain Injury Association of Pennsylvania ( BIAPA). Bermudez is also the Project Coordinator for a brain injury and alcohol awareness prevention initiative for college students run by the BIAPA. He has given lectures at colleges throughout Pennsylvania as well as working with several school administrators on the issues of substance abuse and brain injury. Resources Brain Injury Association of America (BIAA) 105 Alfred Street Alexandria, VA 22314 (703) 236-6000 Family Helpline (800) 444-6443 Website: www.biausa.org Brain Injury Association of Pennsylvania 2400 Park Drive Harrisburg, PA 17110 Brain Injury Resource Line: 1-866-635-7097 Website: www.biapa.org Higher Education Center for Alcohol and Other Drug Prevention Educational Development Center, Inc. 55 Chapel Street Newtown, MA 02158-1060 Phone (800)-676-1730 Website: www.edc.org/hec/ References Strauss D. Guest Editorial Message: Brain Injury Source. 5: pg 6, 2001 Strauss D. An Overview and Substance Abuse and Brain Injury: Brain Injury Source. 5: 9-11, 40, 41. 2001 Oscar-Berman Marlene, Shargrin Barbara et al. Alcohol Health and Research World, v.21no1(1997) p.65-75 Knight John, Wechsler Henry, Kuo Meichun. Journal of Studies on Alcohol, v.63 no3 (May 2002) p.263-70. Wechsler Henry & Wuerthrich Bernice. (2002) Dying to Drink: Confronting Binge Drinking on College Campuses, Rodale Publishing