Treatment of alcohol abuse in persons with recent spinal cord injuries.

Treatment of Alcohol Abuse in Persons with Recent Spinal Cord Injuries

The prevalence of alcohol-related problems in persons with physical disabilities has emerged as an issue in medicine and physical rehabilitation. Physicians, rehabilitation specialists, and service providers increasingly are aware that alcohol abuse not only can contribute to onset of disability, but also can undermine the rehabilitation process by impairing the learning process and increasing morbidity.

In patients whose disabilities are the result of traumatic injury, these effects may be exacerbated. In one study, O'Donnell and colleagues (1981-1982) reported a 68-percent rate of alcohol or other drug use at the time of a disabling spinal cord injury (SCI) among 54 patients on a spinal cord injury unit; 68 percent of patients also resumed drinking during hospitalization. Other researchers have found that the rate of intoxication varies between 17 and 49 percent for persons who incur traumatic injury (Galbraith et al. 1976; Fullerton et al. 1981; Gale et al. 1983; Frisbie and Tun 1984; Heinemann et al. in press). Impaired judgment resulting from intoxication appears to have been responsible for increased risk-taking - the cause of many of these injuries.

The prevalence of alcohol use and abuse following initial care for traumatic disability also has been reported in several recent studies. In a 1985 study of vocational rehabilitation and independent living center clients with SCI, the rate of moderate and heavy drinking reported was 46 percent, nearly twice the rate reported in the general population (Johnson 1985). The rate of alcoholic symptomatology has been observed to vary from 49 percent of persons with recent onset SCI (Heinemann et al. 1988a) to 62 percent of vocational rehabilitation facility clients (Rasmussen and DeBoer 1980-1981).

Although there are reports on the nature and extent of alcohol abuse among traumatic injury patients, less information is available about traumatic injury patients who recognize and seek treatment for alcohol-related problems. Knowledge of the factors leading to recognition and treatment for these patients should enable rehabilitation professionals to assist other patients in need of similar services. If, as Marlatt and colleagues (1988) suggest, personal injury contributes to a drinker's awareness of an alcohol-related problem, then the period following injury may be a particularly productive point at which to intervene.

In fact, failure to intervene can threaten the entire rehabilitative process. Unrecognized alcohol abuse may contribute to neglect of self-care and, consequently, to increased morbidity. Psychological and social adjustments - formidable enough already for persons who incur traumatic injury - may be complicated further by alcohol abuse. Continuation or resumption of drinking following personal injury also may interfere with productive physical activity by a rehabilitation client (Heinemann et al., in press). For these and other reasons, it is critical that rehabilitation professionals understand and, where necessary, facilitate the identification and treatment of alcohol abusing clients.

THE REHABILITATION INSTITUTE OF

CHICAGO STUDY

The need to improve understanding of the behaviors associated with the perceived need for alcoholism treatment among persons who incur traumatic injury resulted in NIAAA-supported research at the Rehabilitation Institute of Chicago, a 176-bed, nonprofit hospital in the Midwest Regional Spinal Cord Injury Care System. The goal of the study was to describe the extent to which persons who had incurred traumatic injuries experienced alcohol-related problems, recognized they had problems, and then acted to reduce abusive drinking. The objectives of the study were to assess the rate of alcohol use, problems resulting from drinking, perceived need for treatment, and actual receipt of treatment for alcohol abuse from 6 months prior to 18 months after spinal cord injury.

A total of 168 patients admitted consecutively met inclusion criteria for this study. Patients in the sample were between 13 and 65 years of age, cognitively …