As a family member who is living with someone who has suffered a traumatic brain injury and dealing with their subsequent deficits, I initially could not say which deficit was the most difficult to live with.
That is until my partner began to drink.
I suspect that the problem began as a result of having extra time on his hands which led to extreme boredom.
Because I was dealing with my mother's health issues and her eventual move into an assisted living home, I have been spending many hours and weeks downsizing her from two bedrooms and a den to a studio apartment.
Unfortunately, that has often left my partner alone with little interest in doing anything.
My first indication that he was drinking was when, on several occasions I came home and realized he was slurring his words.
He initially denied that he had been.
In spite of reminding him of the harm drinking can do after a brain injury, his behavior has escalated.
And as a result, his poor judgment has increased (poor reasoning and judgment are already part of his deficits).
One day I received a phone call from friends, while I was taking my mother to the doctor, to tell me that my partner had arrived at their home exceedingly inebriated.
He then drove home, in spite of their efforts to detain him, and was still drunk when he arrived.
Alcohol and drugs have a more intense affect after a brain injury.
According to my research, substance abuse, even in small amounts, further decrease cognitive and physical function.
Because of the already existing memory problems, they may incorrectly underestimate the amount they have consumed.
Alcohol and drugs will also further impair an already faulty memory.
According to the Brain Injury Association of America there is no safe amount to drink after a brain injury.
Those who use alcohol or other drugs after a brain injury do not recover as well and can in fact lose much of the progress they have gained.
It is recommended that in order to maximize the quality of their life they be encouraged to join support groups, recreational groups and other activities so they will have fewer times to be alone and therefore avoid becoming bored.
This will only work of course if the injured person is agreeable to becoming involved in activities.
It is also suggested that liquor not be kept in the home.
However, if the injured person is able to drive this will not be a solution.
Another important consideration is that alcohol and other drugs can interfere with prescribed medications.
There is also the increased risk and potential for seizures when substance abuse is an issue.
And those who use alcohol, etc.
after a brain injury have a greater chance of having another brain injury because of their lack of reasoning skills and poor judgment creating the potential for future accidents.
Since my partner has begun drinking again following his accident, he has regressed.
In the fall I was so pleased to see that there had been a spurt of improvement - a huge step forward.
But since beginning to drink around Christmas time, he is now at the stage of his last year springtime development - two big steps backwards.
His motivation level has also deteriorated and his short-term memory is worse than it has been for some time.
His lack of self-awareness and insight mean he can not see the relationship between his behavior and the resulting consequences.
It is difficult to convince someone who has a substance abuse issue that a problem does indeed exist.
Before they understand there is a problem, they will make no attempt to change their behavior.
However, once they admit there is a problem, they can commit to making changes.
In order to do that, they will have to establish a goal, make changes in their behavior and possibly change their environment or way of doing things.
The family member can help by controlling their own frustration with the situation since becoming frustrated themselves only makes an already bad situation worse; by realizing you are not responsible for someone else's drinking problem; by not enabling them; by not feeling guilty and by remembering that you are not a victim.