By Geeta Arora and Tobi Gilbert, Bradenton Herald

Traumatic brain injury is a trauma to the brain caused by an outside force, which may result in a reduced or altered state of mind. Those who have experienced a brain injury may be dealing with cognitive, behavioral and functional deficits.

Often, victims of a brain injury may experience problems thinking, changes in behavior and changes in personality. Survivors are at risk of memory, attention and concentration impairments. Neuropsychologists have found that individuals with TBI may have decreased problem-solving skills, decreased reasoning, faulty decision-making and impaired judgment.

Other neurobehavioral problems include increased irritability, lowered frustration tolerance, difficulty controlling impulses, increased angry aggression, increased apathetic indifference and problems relating well with others.

Because of the complexity of the brain, the specific effects of an injury depend on the cause, location and severity of the trauma.

Many people with TBI, who did not use alcohol or drugs before their injury, are more susceptible to alcohol and drug use. Vulnerability to substance misuse and abuse can be a result of chronic pain, cognitive problems, adjustment and grief issues, and reduced ability to cope with life's new challenges.

In some cases, substance abuse may be related to the occurrence of the brain injury. Sometimes people's insight is impaired, increasing one's risk of misusing substances. A lack of insight and self-awareness can make it difficult for them to understand their behaviors or to predict the negative consequences of those behaviors.

Individuals with a brain injury and substance-related addictions are at risk for seizures and additional brain injuries. Slower-paced substance abuse treatment programs are helpful in accommodating the cognitive and behavioral deficits inherent with a brain injury.

Alcoholics or Narcotics Anonymous-type groups can be helpful for individuals with a brain injury and substance abuse issues; however, the informational material used in these 12-Step programs may need to be modified to become more comprehensible for brain-injured persons.

Stress management techniques such as meditation can also be helpful for recovery. Preventative alcohol and drug abuse education for suffers of TBI who are not currently using substances is critically important.

Local head injury foundations or mental health centers can help identify appropriate programs that cater to brain injury survivors and their families. Involving a survivor's family in the addiction recovery process is often crucial and necessary for the brain-injured patient to recover from addiction.

It's important to understand that TBI and addictions frequently exist together and that early prognosis and intervention can help a suffering individual recover successfully.

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Geeta Arora is pursuing a doctorate in clinical psychology at Argosy University in Tampa and currently works with substance-abusing adults at Manatee Glens. Tobi Gilbert is a clinical neuropsychologist and certified addictions professional currently working at the Florida Institute for Neurologic Rehabilitation Inc. in Wauchula. Manatee Glens, a nonprofit health care provider that delivers services from seven Manatee County locations, produces this biweekly column and welcomes your questions about mental health and substance abuse matters.

Bradenton Herald, September 15, 2007