University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Alcohol and Drugs

What does "living life to the fullest" mean to you? Does it mean having a family, or being a "player"? Would it be having a good job that you enjoy, or having lots of time for hobbies or sports that are important to you? Taking part in exciting and thrilling activities, like racing cars, skateboarding or bungee jumping? Becoming rich? Traveling? For one of our study participants, Robert, "living life to one's fullest" when he was a young man meant partying with girls, and doing a variety of drugs from marijuana to cocaine. Another study participant, Helen, feeling weighed down by the responsibilities of being a wife and mother of four children by time she was 20, started going out with friends to dance and party all night long. For both Robert and Helen, drinking and using drugs continued even after their spinal cord injuries, now with the thought in mind of escaping the physical and emotional pain they felt. These stories aren't unusual, as researchers have found that between 27% and 50% of all people who were alcohol or drug users before experiencing a brain or spinal cord injury continued using after the injury 1. Additionally, some studies have found that, among all people with physical disabilities including spinal cord injury, the rate of use of alcohol, crack cocaine, prescription medications and street drugs is two to three times higher than the rate of substance abuse in the general population 2. But for both Robert and Helen, getting clean and sober improved their health, helped them to make better decisions about their lives, led to closer family relationships, and, as they would probably agree, truly allowed them to start "living life to the fullest."

Probably the biggest surprise about drug and alcohol use is the real effect it has on the way a person feels. Although many people get into drinking or using drugs to feel better or to forget about problems, the truth is that substance abuse can have the opposite effect. Alcohol is classified chemically as a depressant, that is, it makes you feel less energetic and more depressed, even if you feel "loosened up" at first. One study even found that increased alcohol use, for example, helped lead to reduced overall quality of health, less rest, poorer nutrition, higher rates of depression and stress, and a lower level of satisfaction with life; and increased recreational marijuana use was also linked to higher rates of depression and stress 3. Some people use alcohol or drugs because they are already depressed; for example, our study participant Chris stated that "I got into the drinking and the drugs because I'd given up on life - 'ah, what the hell, might as well just go party.'" But this made Chris' life even harder, because his drinking problem caused his girlfriend to leave him. A person who is "messed up" by substance abuse is just not clear-headed enough to make good decisions or handle situations carefully, so the problems they were trying to "escape" wind up just getting worse.

Although some people, like our study participants Aaron and Rachel, report drinking or doing recreational drugs to reduce pain, it can sometimes do just the opposite, by hurting your health, which, in turn, creates more pain. (A recent U.S. Supreme Court decision ruled that most states which had allowed prescriptions for medical marijuana for certain conditions including glaucoma and HIV/AIDS were breaking federal law, and so the states' laws allowing medical marijuana were thrown out. Even if someone had a doctor's prescription for marijuana and lived in one of the very few places where medical marijuana was still allowed, that would never allow people with prescriptions to buy marijuana from street dealers, and, like any medication, marijuana is not the right choice for everyone.) Using alcohol and drugs can lead to physical health problems for anyone who overdoes it, but the dangerous possibilities are increased for people with spinal cord injuries. For example, people with spinal cord injuries are always susceptible to urinary tract infections, and excessive alcohol consumption makes it even more likely to develop such illnesses because alcohol irritates the urinary system. And pressure ulcers (which means the same thing as "pressure sores" or "bedsores") are most definitely one of the conditions that can come from substance abuse. In fact, studies show that people with spinal cord injuries who continue using drugs after their injuries, or who increase their drug use, are more likely to develop pressure ulcers 4 5 6, and that an unhealthy lifestyle that includes habits such as drinking and smoking creates a higher chance of developing a number of medical complications including pressure ulcers 7. Using drugs or drinking can even make an existing pressure ulcer worse; Gary, who participated in our study, had a pressure ulcer that got infected because his substance abuse had lowered his immune system, that is, the ability of his body to fight infection or illness.

Being aware of your surroundings is the best way to avoid damaging your skin, important because even a minor scrape or cut can provide the opening for an infection that can result in a pressure ulcer. Being under the influence makes it more likely that an accident or injury can occur, as the ability to judge distances and make accurate movements is lessened. Researchers found some of the physical risks of getting drunk or high for people with spinal cord injury include falls, scrapes, making a bad transfer, getting urine on their skin (which can cause a pressure ulcer because urine has a high level of acid), or getting burned by resting a hot object, such as a crack pipe, against their skin 8. Aaron, for example, stepped on a nail while he was high on crack and didn't notice it; the result was an infection that led to having his foot amputated.

Another connection between drug or alcohol abuse and the risk of developing pressure ulcers has to do with impaired judgement. Drinking too much or doing drugs can cloud anyone's mind and lead them to doing dangerous things, such as driving while drunk or high. But for a person with a spinal cord injury, the truth is that there are more risks to their health than the nondisabled, including being more likely to develop some kind of illness or medical complication, requiring more specialized or complicated health care 9. The result is that a person with a spinal cord injury does not have the "luxury" of getting too high to think straight or act right, even though they might have "gotten away with it" before their injury. Aaron, for example, talked about getting his first pressure ulcer in part because he was "drinking...[then] get drunk, fall asleep anywhere," and forget to do his pressure reliefs. After her spinal cord injury, Helen went out partying for her birthday and stayed up in her wheelchair all night; in the morning, a friend noticed she had a pressure ulcer the size of an egg on her bottom. This is not surprising, or unusual; studies confirm that being too wasted to follow a routine to prevent pressure ulcers, and by spending too much time in an awkward position or place (like falling asleep anywhere but in a well-padded bed or chair) create the conditions that can make pressure ulcers happen 7.

And there is another complication of drinking or drug use that many people may not take into account: there are a number of hospitals, rehabilitation facilities, and nursing homes that will not accept patients who fail a drug test. Among our study participants, three people, or 15% of our group, were denied entrance into a top rehabilitation hospital because they tested positive for marijuana or other drugs. Are you willing to take the risk of not being able to get into a good medical care facility because tests show you are not drug-free?

Of course, the positive side of this is that, although it is not easy, people do get clean and sober every day, such as our study participants Robert and Helen did. Most health care plans include coverage for drug and/or alcohol treatment, including the Veterans Administration and Medicaid (but please note that the substance abuse services offered through Medicaid are different in each state); some state Medicaid programs and private insurers provide services that are specifically designed to meet the needs of people with disabilities 2. Support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and Cocaine Anonymous (CA) are free of any cost and found all over the country, with meetings in a variety of locations and times. You might also be able to find out from your doctor, case worker or drug-and-alcohol counselors if there are meetings or support groups in your area that are specifically for people with spinal cord injuries, as studies have found that such groups can be a very effective part of recovery 7. Sobriety is not always easy, but you can do it, one day at a time!

If you are interested in using the Internet to learn more about the effects of substance abuse, and about how to get clean and sober, there are many very useful websites to try. A page about Substance Abuse on the website of the Spinal Cord Injury Model System, which is maintained by the University of Alabama at Birmingham, provides links to their pages on the topics of alcohol, street drugs, smoking and substance abuse, where referrals to other websites and publications can be found. An article titled Alcohol and Your Health after Spinal Cord Injury appears in the July 2003 newsletter of the Arkansas Spinal Cord Commission; scroll down the document a few pages to find it. Interestingly, this article points out that having only one drink a day can have health benefits, but that there are many risks of drinking too much, including an increased chance of stroke, cancer, bleeding ulcers in the stomach, and damage to the liver or kidneys.

If you are wondering whether you, a friend or a family member might be drinking too much, an article about Alcohol Abuse on the website of Craig Hospital in Denver, Colorado, has good questions to ask yourself, and suggestions of where you can go for support. Try finding out more about Alcoholics Anonymous, a community-based, no-cost support group based on 12 steps to recovery and fellowship. A similar program for cocaine or crack users is Cocaine Anonymous, and Narcotics Anonymous helps users of heroin or other narcotic drugs. Remember that recovery from addiction is possible!

1 Kolakowsky-Hayner, S. A., Gourley III, E. V., Kreutzer, J. S., Marwitz, J. H., Meade, M. A., & Cifu, D. X. (2002). Post-injury substance abuse among persons with brain injury and persons with spinal cord injury. Brain Injury, 16, (7), 583-592.

2 Bachman, S. S., Drainoni, M-L., & Tobias, C. (2003). Substance abuse treatment services for people with disabilities. Journal of Disability Policy Studies, 14, (3), 154-162.

3 Young, M. E., Rintala, D. H., Rossi, C. D., Hart, K. A., & Fuhrer, M. J. (1995). Alcohol and marijuana use in a community-based sample of persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 76, 525-532.

4 Waters, R. L., Adkins, R. H., Sie, I., & Cressy, J. (1998). Postrehabilitation outcomes after spinal cord injury caused by firearms and motor vehicle crash among ethnically diverse groups. Archives of Physical Medicine and Rehabilitation, 79, 1237-1243.

5 McKinley, W. O., Kolakowsky, S. A., & Kreutzer, J. S. (1999). Substance abuse, violence and outcome after traumatic spinal cord injury. American Journal of Physical Medicine and Rehabilitation, 78, (4), 306-312.

6 Consortium for Spinal Cord Medicine. (2000). Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health-care professionals. Washington, DC: Paralyzed Veterans of America.

7 Krause, J. S., & Broderick, L. (2004). Patterns of recurrent pressure ulcers after spinal cord injury: Identification of risk and protective factors 5 or more years after onset. Archives of Physical Medicine and Rehabilitation, 85, 1257-1264.

8 Perez, M., & Pilsecker, C. (1994). Group psychotherapy with spinal cord injured substance abusers. Paraplegia, 32, 188-192.

9 DeJong, G., Palsbo, S. E., Beatty, P. W., Jones, G. C., Kroll, T. & Neri, M. T. (2002). The organization and financing of health services for persons with disabilities. The Milbank Quarterly, 80, 2, 261-301.