Spinal Cord Injury & Alcohol Use
Source: Toronto Rehab (adapted from an earlier version developed in collaboration with the Centre for Addiction and Mental Health and the Canadian Paraplegic Association Ontario)
Note: This is important information about alcohol use after spinal cord injury. It does not address all of the issues relevant to your particular situation. If you have additional questions, please discuss them with your physician or another health care professional.
Heavy alcohol use is a major cause of physical injuries and other health problems. At the same time, alcohol use is legal and socially acceptable in moderation. You may wish to continue enjoying alcohol when you return to the community following your spinal cord injury (SCI), and are wondering how safe it is for you to do so.
Because of your spinal cord injury, alcohol can pose additional risks to your health. Even if you only drink occasionally, it’s important to understand the effects of alcohol and how to reduce these risks.
What should I know about alcohol?
Alcohol is a drug—a depressant drug. It is just as powerful as some street drugs and many prescription drugs. Alcohol slows down your ability to:
- think
- react, and
- make judgments
Alcohol can cause diseases of the:
- liver
- heart
- brain, and
- digestive system
It also affects the bladder and kidneys.
Alcohol is alcohol—whether you are drinking beer, wine or liquor. It’s not so much what you drink that counts, but the amount of alcohol in your drink and the number of drinks that you have.
As a rough guide, one 12-ounce bottle of regular beer contains the same amount of alcohol as:
- one 5-ounce glass of table wine
- a 1½-ounce shot of liquor (whisky, rum, vodka, gin) or the popular summer coolers.
The amount of alcohol in these drinks is typically referred to as a “standard drink.”
What are the risks related to spinal cord injury?
Bladder and kidney damage
Alcohol causes your body to produce a larger volume of urine. Your bladder fills more quickly and your body can dehydrate.
If you wait too long to empty your bladder, the muscle lining can be excessively stretched and weakened. Waiting too long can also cause urine to back-flow into the kidneys. This can lead to infection and kidney damage.
Dysreflexia
An overly full bladder can lead to autonomic dysreflexia (also known as hyperreflexia or AD). This is a potentially dangerous condition. The sudden rise in blood pressure associated with dysreflexia can lead to convulsions, stroke or even death.
Watch for these signs of dysreflexia:
- excessive sweating above the level of your injury
- a flushed face
- goose bumps and chills
- a pounding headache
Skin breakdown
Using alcohol may increase your risk of damaging your skin in the following ways:
- Alcohol may make you dehydrated, leaving your skin more prone to pressure sores.
- While drinking, you may forget to shift positions to relieve pressure points. If you fall asleep in your wheelchair, you are more likely to develop a serious pressure sore.
- If you drink heavily on a regular basis, you may pay less attention to good nutrition, which is important for maintaining healthy skin.
Risk of choking
Anyone who drinks to the point of becoming sick is at risk of choking on his or her vomit. For those with certain levels of SCI, the risk of choking is much greater.
Interactions between alcohol and medications
If you drink alcohol while you’re using medication, the alcohol may react to the other drug (or combination of drugs) in unexpected ways. Depending on the type of medication you are taking, alcohol may interact with the medication to cause:
- increased drowsiness, dizziness, fatigue and loss of coordination
- a decrease in the effectiveness of the medication
- new side effects that you would never experience using alcohol or medication alone
Even medications that are sold over-the-counter can interact with alcohol. These include:
- painkillers
- cold medications
- some types of antihistamines
Don’t think that simply skipping your medication on the day your drink will help. Some drugs can stay in your body for many days. Always consult your doctor or pharmacist before deciding to use alcohol.
Physical injuries
After a spinal cord injury, it is important to stay alert and prevent falls, burns or other accidents. This is particularly important in the early months following your injury, when you might be healing and are learning new skills.
If you drink alcohol, you may find your coordination, reaction time and judgment affected, even before you begin to feel intoxicated. Alcohol also tends to disrupt newly learned skills more than it does old ones.
Alcohol addiction
People with SCI are no more likely to become addicted to alcohol than anyone else. However, learning to live with a spinal cord injury is very stressful. Because alcohol is a powerful painkiller and mood modifier, you might be tempted to use it to help you deal with problems related to your SCI. While alcohol can give temporary relief from these problems, over the long term it will make them much worse.
What can I do to reduce the risks associated with alcohol and my SCI?
Not drinking at all, of course, is the safest way to avoid alcohol-related problems. But if you decide you want to use alcohol in moderation, you may find the following suggestions useful in reducing your risks:
- Talk to your doctor about any alcohol-related risks that are particular to you and your physical condition.
- Check with your pharmacist or doctor to learn the effect of mixing your medications with alcohol. Remember that in most cases, skipping doses of medication won’t greatly reduce the risk of drugs and alcohol interacting.
- When you do drink alcohol, keep track of how much your drink. Know the quantity of alcohol in your favourite beverages. Measure your drinks and keep track of the number of standard drinks you are consuming.
- Sip—don’t gulp—your drinks. And space them out—have no more than one per hour.
- Avoid using alcohol daily. Drinking daily gradually builds up your body’s resistance to alcohol, which can lead to heavier use.
- Make at least every other drink a non-alcoholic beverage. This will help prevent dehydration and make it easier to space your drinks.
- Try alcohol-free or low-alcohol beer or wine as an alternative. Shop around until you find a brand you like. Many people find that these alternatives taste just as good as regular beer and wine.
- Be kinder to your bladder. Keep track of your total fluid intake (non-alcohol as well as alcohol) and be aware of the effect that alcohol has on your urine output. If you have more than 1 or 2 drinks, be prepared to use a catheter more frequently.
- Watch for signs of dysreflexia.
- Stay alert to prevent accidents or falls. If you are drinking for the first time in a while, or your medications have changed since you last drank alcohol, be particularly careful. You may become impaired by a much smaller amount of alcohol than before.
- Never drink and drive. Drinking and driving is unsafe for you and others.
- Don’t use alcohol as a medication for spasms, pain or sleep disturbances. Don’t use it to cope with problems and worries. In the long term, drinking to cope with physical or emotional problems will just make life more difficult. Talk to your doctor.
Alcohol: How much is too much?
Canada’s Low-Risk Drinking Guidelines recommend that:
- individuals drink more than 2 standard drinks on any one day
- women have no more than 9 drinks over the period of one week
- men have no more than 14 drinks per week
These recommendations are based on research with the general population. For people with spinal cord injuries, the safe level of alcohol consumption is likely to be less than it is for people without disabilities.
Where can I get more information?
Take action quickly—before problems get out of control—if you are concerned that drinking is interfering with the following aspects of your life:
- health
- safety
- rehabilitation
- relationships
- job
- studies
- ability to care for yourself
Many people find they can quit or cut down on their drinking on their own or with very little help. Others seek the guidance of professional counsellors or self-help groups.
Don’t let personal pride stop you from getting help if you need it. More than 25% of all alcohol users run into problems with drinking at some point in their lives. Drinking problems do not indicate personal weakness. They can and do affect men and women of all ages and from every walk of life.
Many sources of help are available including:
- individual or group counselling
- inpatient or outpatient treatment programs
- self-help books
- self-help groups
Your local Canadian Paraplegic Association office or regional alcohol and drug information centre can help you locate the closest accessible services.