Chapter 23
Substance Abuse and SCI
WHAT IS SUBSTANCE ABUSE?
Substance abuse is a major social and health-care problem that affects millions of people. It is a problem that cannot be denied when considering spinal cord injury (SCI). Substance abuse is known to be a major factor in the cause of many traumatic injuries. People who abuse substances are at a higher risk for physical complications and poor adjustment following SCI. For many people with SCI, substance abuse is a short-term solution to the challenges of disability that creates long-term problem.
What is substance abuse? Substance abuse refers to the harmful use of alcohol and a variety of other drugs that affect mood and thinking. These drugs include prescription medications as well as illegal drugs. The prescription medications most commonly abused by patients are those used for the treatment of pain (e.g., "narcotics" such as morphine, oxycodone, codeine, Tylenol #3®, or Percocet®), spasticity (e.g., Valium®), anxiety (e.g., Xanax® or Ativan®), or sleep. Illegal drugs include cocaine, heroin, and a variety of other chemicals that have no accepted therapeutic value. Marijuana is a more controversial drug in terms of its usefulness with problems such as spasticity versus its use to alter mood. Regardless of the intended purpose, the excessive or inappropriate use of any of these substances can have serious consequences for the person with SCI.
Alcohol or drug use is a factor in at least 50 percent of the incidents that resulted in SCI.
Almost half of all people with SCI use prescription medications with abuse potential; among these people, almost 25 percent admit misusing medications on one or more occasions.
Substance abuse problems that exist prior to an SCI tend to continue or worsen.
SUBSTANCE ABUSE AND YOUR REHABILITATION
SCI is a catastrophic event in the lives of all patients and their families. Your life has been disrupted and changed in many ways. Rehabilitation and adjustment are difficult and demand that you put out significant effort and learn new skills. It can be frightening and exhausting and seem like more than you can handle. Unfortunately, alcohol and drugs offer many people a quick escape from the demands of rehabilitation.
The realities of SCI can be very harsh. Because of this, it is very important that you understand that the relief provided through alcohol and drugs is, at best, temporary. There is no problem faced by people with SCI that is so difficult that it can’t be made worse by the additional problem of substance abuse.
For some people, substance abuse after SCI is simply a return to their lifestyle before injury. If drugs or alcohol played a role in your injury, you are at high risk for returning to your old habits and patterns. Problems with substance abuse tend to continue and worsen after SCI. Perhaps you think of yourself as "cured" or believe you’ve "learned a lesson". That’s great. Many people change after life-threatening experiences.
But to keep up the progress, you need to recognize that the temptations will be plentiful. Alcohol and drug use may be common among your friends and family. There may be pressure to fit back in and act just the same as before your injury. You will need a plan for dealing with social situations where others are using drugs or alcohol. Talk with your health-care providers about strategies or programs where you can find support for your good intentions.
For other people, substance abuse after SCI is more subtle. Perhaps you never had a problem with alcohol or never used drugs for recreation. You may have never wanted to "get high". How can you be at risk for substance abuse?
Unfortunately, many of the same medications that have legitimate medical uses in SCI also have potential for misuse. Many people develop problems with increasing doses of prescription medications for pain, anxiety, or sleep. Work closely with your doctor to develop a rational plan for using these types of medications. Be particularly aware that drinking alcohol while using these types of medications is dangerous.
It is well known that the excessive use of alcohol, prescription medications, or illegal drugs is particularly harmful to the person with an SCI. Physical complications such as skin ulcers, urinary tract infections, malnutrition, and constipation are more common among people who abuse substances. Psychological complications such as depression, lack of motivation, and poor concentration are common in people with SCI who have such problems.
Adjusting to SCI will require all of your attention, skills, and abilities. You can’t afford to burden yourself with another problem, even if it seems like you feel better in the short term. Alcohol and the common prescription medications are actually central nervous system depressants. They slow down your body and your thinking and will eventually make problems like depression worse.
DO YOU HAVE A PROBLEM?
The professional journals are full of complicated criteria and different tests for determining whether or not an individual has a problem with substance abuse. A simple but useful tool is the CAGE. The CAGE questionnaire is often used in medical settings to screen for problems with alcohol. It has been adapted to include drugs (both prescription and illegal).
- Have you ever attempted to Cut down on drinking or drug use?
- Have you ever felt Annoyed with criticisms about your drinking or drug use?
- Have you ever felt Guilt about your drinking or drug use?
- Have you ever used alcohol or other drugs as an Eye-opener?
Answering yes to any two of these questions has been shown to be predictive of alcoholism or substance abuse. If your answers suggest you might have a problem but you disagree, you might want to consider another way of thinking. John de Miranda (1992) said that the important questions to answer is, "Does a person’s alcohol or drug use create negative consequences?" These problems can occur in any area of a person’s life: personal relationships, work, recreation, finances, and physical health and wellness. Stated another way, if your drug or alcohol use causes you any problems, then you have a substance abuse problem.
WHAT TO DO
Many resources are available to people who might have a substance abuse problem. This chapter lists some references that contain valuable information. You can ask your health-care provider to refer you to professionals for a more complete evaluation to determine how best to help you.
There are many different ways to find and get help with a substance abuse problem. But it all begins with you. Only you can take an honest look at yourself and your behavior. Only you can make the decision to change the way you drink or use prescription medications. Think about it. It might be one of the most important decision you will ever make as you continue in your rehabilitation.
RESOURCES
Books and Pamphlets
Inform Yourself: Alcohol, Drugs, and Spinal Cord Injury. J. de Miranda
Purchase:
Novation, Inc.
2165 Bunker Hill Drive
San Mateo, CA 94402
(415) 578-8047
Alcohol, Drug, and Prescription Medicine Use after SCI.
Purchase:
Medical College of Wisconsin
SCI Center
5000 West National Avenue
Milwaukee, WI 53295
(414) 259-2785
Web Sites
www.caas.brown.edu
The Center for Alcohol and Addiction Studies at Brown University offers training, research, and medical resources.
www.health.org
National Clearinghouse for Alcohol and Drug Information (NCADI) is the information service of the Center for Substance Abuse and Mental Health Services Administration. NCADI is the world’s largest resource for current information and materials concerning substance abuse.
|
Substance Abuse and SCI