Co-Occurring Traumatic Brain Injury, PTSD Symptoms, and Alcohol Use in Veterans

Abstract

Traumatic brain injury (TBI) has been identified as a significant health problem among veterans. Recent research demonstrates the potential interaction and magnification of symptoms of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in veterans with a history of TBI; however, there is very limited research on the co-occurrence of the three conditions. Veterans (N = 115) with comorbid PTSD and SUD completed a baseline assessment for enrollment into a larger treatment study. As part of that assessment, participants completed a TBI screener as well as self-report measures for pain and physical health, affective symptoms, and substance use. Almost half of the sample (48 %) endorsed a history of a previous head trauma with loss of consciousness (LOC). Participants with and without head trauma with LOC were compared across various measures of functioning. Increased severity of physical health complaints and affective symptoms were reported by the TBI group compared to controls. However, the increases in affective symptoms were relatively small. No group differences were observed for alcohol use. Together, the findings suggest that treatment-seeking veterans with a history of head trauma with LOC may present with roughly equivalent symptoms of PTSD and SUD to those without said history.

The influence of traumatic brain injury on treatment outcomes of Concurrent Treatment for PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) in veterans

“…The baseline assessment involved semi-structured clinical interviews, including the CAPS to assess PTSD symptoms and the Mini International Neuropsychiatric Interview (MINI) to assess SUD and other disorders. 28–29 Participants also completed a series of self-report measures, including the Structured Assessment for Evaluation of TBI (INTRuST, 2012), 9,30 PTSD Checklist (PCL), 31 Beck Depression Inventory II (BDI-II), 32 and Timeline Follow-Back (TLFB). 33 Participants were then randomized to receive either COPE or Relapse Prevention as part of a larger clinical trial.…”

“…30 In addition, the SAFE-TBI demonstrated reasonable convergent validity with more extensive measures of TBI in a VA sample. 9,30 The SAFE-TBI has been used to assess mTBI in similar recent studies. 30 …”

“…2 Other studies have found that veterans with PTSD and mTBI history report more severe PTSD symptoms than veterans with PTSD and no history of mTBI. 4–5,9 In addition, studies of TBI and SUD suggest a trend of increased alcohol use over time in participants with TBI, 10–12 although the clinical significance of the increased severity remains unclear. 9 …”

“…22–24 However, similar to the TBI/PTSD literature, comparison of treatment response among patients with and without TBI history is strikingly rare, and this literature has predominantly focused on differences in baseline severity rather than treatment response. 22–25 Interestingly, baseline studies have shown that patients with TBI histories tend to use alcohol and drug less than patients without TBI histories, 9,23 although preliminary findings have found that SUD in patients with TBI, especially milder TBIs, may be more resistant to treatment. 23 Together, these findings indicate that more research is needed to investigate the potential influence of mTBI history on outcomes of EBPs for PTSD, SUD and related conditions.…”

The Impact of Exercise and Virtual Reality Executive Function Training on Cognition Among Heavy Drinking Veterans With Traumatic Brain Injury: A Pilot Feasibility Study

“…Increased bidirectional risk between AUD and TBI is likely related to disruption of prefrontal cortical functioning in the areas of impulse control, reward expectation, and emotion regulation (Bjork and Grant, 2009 ). Many other conditions, including post-traumatic stress disorder (PTSD; Hoge et al, 2004 ; Corrigan and Cole, 2008 ; Brady et al, 2009 ; Gros et al, 2016 ), anxiety (Hoge et al, 2004 ), and depression (Hoge et al, 2004 , 2008 ) also commonly co-occur among Veterans with TBI. Although effective interventions for the cognitive sequelae of TBI do exist, most are time-intensive for providers and patients (Cicerone et al, 2019 ) and very few studies have examined effective treatments specifically for Veterans with co-occurring AUD and TBI (Pennington et al, 2020 ).…”