Substance abuse as a mediating factor in outcome from traumatic brain injury

  • John D. Corrigan
    Correspondence
    Reprint requests to John D. Corrigan, PhD, Dodd Hall, 480 W. 9th Ave, Columbus, OH 43210.
    Affiliations
    Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
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      Abstract

      A review of recent research addressed two questions: how common are problems of substance abuse in traumatic brain injury (TBI), and to what extent does alcohol and other drug use mediate outcome? Studies showed alcohol intoxication present in one third to one half of hospitalizations; data for other drug intoxication were not available. Nearly two thirds of rehabilitation patients may have a history of substance abuse that preceded their injuries. Intoxication was related to acute complications, longer hospital stays, and poorer discharge status; however, these relationships may have been caused by colinearity with history. History of substance abuse showed the same morbidity, and was further associated with higher mortality rates, poorer neuropsychological outcome, and greater likelihood of repeat injuries and late deterioration. The effect of history may be caused by subgroups with more severe substance abuse problems. Implications for rehabilitation are discussed, including the potential negative impact of untreated substance abuse on the ability to document efficacy of rehabilitation efforts.
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      References

        • Moore D
        • Polsgrove L
        Disabilities, developmental handicaps, and substance misuse: a review.
        Int J Addict. 1992; 26: 65-90
        • Moore D
        Substance abuse assessment and diagnosis in medical rehabilitation.
        NeuroRehabilitation. 1992; 2: 7-15
        • National Head Injury Foundation
        Substance Abuse Task Force: white paper.
        National Head Injury Foundation, 1988
        • Sparadeo FR
        • Strauss D
        • Barth JT
        The incidence, impact and treatment of substance abuse in head trauma rehabilitation.
        J Head Trauma Rehabil. 1990; 5: 1-8
        • Kreutzer JS
        • Marwitz JH
        • Wehman PH
        Substance abuse assessment and treatment in vocational rehabilitation for persons with brain injury.
        J Head Trauma Rehabil. 1991; 6: 12-23
        • Langley MJ
        Preventing post-injury alcohol-related problems: a behavioral approach.
        in: McMahon BT Shaw LR Work worth doing: advances in brain injury rehabilitation. Paul M. Deutsch Press, Southborough, MA1991: 251-275
        • Langley MJ
        • Lindsay WP
        • Lam CS
        • Priddy DA
        A comprehensive alcohol abuse treatment programme for persons with traumatic brain injury.
        Brain Inj. 1990; 4: 77-86
        • Desai BT
        • Whitman S
        • Coonley-Hoganson R
        • Coleman TE
        • Gabriel G
        • Dell J
        Urban head injury: a clinical series.
        J Natl Med Assoc. 1983; 75: 875-881
        • Jurkovich GJ
        • Rivara FP
        • Gurney JG
        • Fligner C
        • Ries R
        • Mueller BA
        • et al.
        The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma.
        JAMA. 1993; 270: 51-56
        • Gurney JG
        • Rivara FP
        • Mueller BA
        • Newell DW
        • Copass MK
        • Jurkovich GJ
        The effects of alcohol intoxication on the initial treatment and hospital course of patients with acute brain injury.
        J Trauma. 1992; 33: 709-713
        • Kraus JF
        • Morgenstern H
        • Fife D
        • Conroy C
        • Nourjah P
        Blood alcohol tests, prevalence of involvement and outcomes following brain injury.
        Am J Public Health. 1989; 79: 294-299
        • Sparadeo FR
        • Gill D
        Effects of prior alcohol use on head injury recovery.
        J Head Trauma Rehabil. 1989; 4: 75-82
        • Rimel RW
        • Giordani B
        • Barth JT
        • Jane JA
        Moderate head injury: completing the clinical spectrum of brain trauma.
        Neurosurgery. 1982; 11: 344-351
        • Ruff RM
        • Marshall LF
        • Klauber MR
        • Blunt BA
        • Grant I
        • Foulkes MA
        • et al.
        Alcohol abuse and neurological outcome of the severely head injured.
        J Head Trauma Rehabil. 1990; 5: 21-31
        • Gordon WA
        • Mann N
        • Willer B
        Demographic and social characteristics of the traumatic brain injury model system database.
        J Head Trauma Rehabil. 1993; 8: 26-33
        • Drubach DA
        • Kelly MP
        • Winslow BA
        • Flynn JPG
        Substance abuse as a factor in the causality, severity, and recurrence rate of traumatic brain injury.
        Md Med J. 1993; 42: 989-993
        • Kaplan CA
        • Corrigan JD
        Effect of blood alcohol level on recovery from severe closed head injury.
        Brain Inj. 1992; 6: 337-349
        • Wong PP
        • Dornan J
        • Schentag CT
        • Ip R
        • Keating AM
        Statistical profile of traumatic brain injury: A Canadian rehabilitation population.
        Brain Inj. 1993; 7: 283-294
        • Kreutzer JS
        • Wehman PH
        • Harris JA
        • Burns CT
        • Young HF
        Substance abuse and crime patterns among persons with traumatic brain injury referred for supported employment.
        Brain Inj. 1991; 5: 177-187
        • Kreutzer JS
        • Doherty KR
        • Harris JA
        • Zasler ND
        Alcohol use among persons with traumatic brain injury.
        J Head Trauma Rehabil. 1990; 5: 9-20
        • Callahan D
        • Cisin IH
        American drinking practices: summary of findings from a national probability sample: I. extent of drinking by population subgroup.
        Q J Stud Alcohol. 1968; 29: 130-151
        • Lehmkuhl LD
        • Hall KM
        • Mann N
        • Gordon WA
        Factors that influence costs and length of stay of persons with traumatic brain injury in acute care and inpatient rehabilitation.
        J Head Trauma Rehabil. 1993; 8: 88-100
        • Dikmen SS
        • Donovan DM
        • Loberg T
        • Machamer JE
        • Temkin NR
        Alcohol use and its effects on neuropsychological outcome in head injury.
        Neuropsychol. 1993; 7: 296-305
        • Selzer ML
        • Vinokur A
        • Van Rooijen L
        A self-administered short Michigan Alcohol Screening Test (SMAST).
        J Stud Alcohol. 1975; 36: 117-126
        • Selzer ML
        The Michigan Alcohol Screening Test: the quest for a new diagnostic instrument.
        Am J Psychiatry. 1971; 127: 1653-1658
        • Dunlop TW
        • Udvarhelyi GB
        • Stedem AF
        • O'Connor JM
        • Isaacs ML
        • Puig JG
        • et al.
        Comparison of patients with and without emotional/behavioral deterioration during the first year after traumatic brain injury.
        J Neuropsychiatry. 1991; 3: 150-156
        • Levin HS
        • High WM
        • Goethe KE
        • Sisson RA
        • Overall JE
        • Rhoades HM
        • et al.
        The Neurobehavioral Rating Scale: assessment of the behavioral sequelae of head injury by the clinician.
        J Neurol Neurosurg Psychiatry. 1987; 50: 183-193
        • Bach-y-Rita P
        A conceptual approach to neural recovery.
        in: Bach-yrita P Traumatic brain injury. Demos Publications, Orlando, FL1989: 81-85
        • Jensen GB
        • Pakkenberg B
        Do alcoholics drink their neurons away?.
        Lancet. 1993; 342: 1201-1204
        • Solomon DA
        • Malloy PF
        Alcohol, head injury, and neuropsychological function.
        Neuropsych Rev. 1992; 3: 249-280
        • Alterman AI
        • Tarter RE
        Relationship between familial alcoholism and head injury.
        J Stud Alcohol. 1985; 46: 256-258
        • Tarter RE
        • Alterman AI
        Neuropsychological deficits in alcoholics: etiological considerations.
        J Stud Alcohol. 1984; 45: 1-9
        • Corrigan JD
        Substance abuse as a mediating factor in traumatic brain injury outcome.
        in: Spring Meeting of the Association of Academic Physiatrists, Naples, FL1994 Jan 19–22
        • Williams GD
        • Debakey SF
        Changes in levels of alcohol consumption: United States, 1983–1988.
        Br J Addict. 1992; 87: 643-648
        • Kreutzer JS
        • Harris JA
        Model systems of treatment for alcohol abuse following traumatic brain injury.
        Brain Inj. 1990; 4: 1-5
        • Blackerby WF
        • Baumgarten A
        A model treatment program for the head-injured substance abuser: preliminary findings.
        J Head Trauma Rehabil. 1990; 5: 47-59
        • Langley MJ
        • Ridgely MS
        Skill-based substance abuse counseling.
        in: Integrating Substance Abuse Interventions to Maximize Vocational Rehabilitation Outcomes for People with Traumatic Brain Injury;. Rehabilitation Institute of Chicago, New York1994 May 19–20
        • Jones GA
        Substance abuse treatment for persons with brain injuries: identifying models and modalities.
        NeuroRehabilitation. 1992; 2: 27-34
        • Corrigan JD
        • Schmidt MF
        • Paluck R
        Substance abuse following traumatic brain injury: three models of intervention.
        in: 102nd Annual Convention of the American Psychological Association, Los Angeles, CA1994 Aug 12–16