Traumatic brain injury and substance misuse: A systematic review of prevalence and outcomes research (1994–2004)

Abstract

A systematic review of the evidence on substance misuse prevalence in patients with traumatic brain injury (TBI) and outcomes associated with this population is presented. Building upon an earlier review of the area by Corigan (1995), this review is limited to research published between 1994 and 2004. Psycinfo and Medline abstract databases were searched for English-language publications citing research from Western countries on the epidemiology and outcomes of adult TBI patients (aged 15 years or older). The majority of reviewed studies were undertaken in the USA and the investigation foci and methods used were multifarious, constraining the generalisation of the review findings. Prevalence for alcohol intoxication at time of injury in the review was found to be almost identical to that in Corrigan's review: 37-51% and 36-51%, respectively. Pre-TBI history of alcohol misuse was found to be less prevalent in the present as opposed to Corrigan's review: 37-51% and 55-66%, respectively. Outcome findings were mixed (also found by Corrigan), but mainly in the expected direction of poorer outcomes (neurological, medical, neuropsychological, and functional) in patients with pre-TBI substance misuse. Further research and implications for services are outlined.

Alcohol Use at Time of Injury and Survival Following Traumatic Brain Injury: Results From the National Trauma Data Bank

“…Evidently, the NTDB only captures a portion (<5%) of the overall TBI cases annually, but in light of the gravity of TBI morbidity and mortality, it certainly is inadvisable to consume alcohol or administer alcohol to patients either before or after TBI for the purpose of reducing mortality. Even if many of these alcohol-related TBIs do not result in near-term mortality, they still can lead to poorer neurological, medical, neuropsychological, and functional outcomes (Parry-Jones et al, 2006); have longterm consequences for mental, physical, and social functioning (Safaz et al, 2008); and increase the risk of recurrent TBI (Winqvist et al, 2008) and premature death (McMillan and Teasdale, 2007).…”

Global neurotrauma research challenges and opportunities

“…Alcohol and substance misuse associated with TBI is a further key topic that needs to be addressed in LMICs. Poorer outcomes have been associated with alcohol and substance misuse in high-income countries, but the findings were mixed and further research is required in different contexts 34 .…”

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…A disproportionate number of those intoxicated will be younger, will be men, will be injured in a motor vehicle accident and assaults, and have a history of alcohol abuse (55% -66%). Those TBIs with positive blood alcohol levels will have more medical complications such as longer stays on a ventilator (Chatham-Showalter et al, 1996), longer acute hospital stays, show poorer neuropsychological test performance (Bombardier & Thurber, 1998;Tate, Freed, Bombardier, Harter, & Brinkman, 1999), and significantly poorer functional outcomes (Corrigan, 1995;Parry-Jones et al, 2006). Rates of substance abuse post-injury are inversely related to functional status, with higher rates in individuals with fewer residual deficits (Bombardier, Temkin, Machamer, & Dikmen, 2003;Kreutzer, Witol, & Marwitz, 1996).…”

“…This is particularly true when the damage has been to the frontal cortical areas of the brain (Jentsch & Taylor, 1999) and has been associated with high rates of substance abuse and risk taking behaviors (van Reekum et al, 2000). Thirty-six to fifty-one percent of people experiencing a TBI will be intoxicated at time of injury (Corrigan, 1995;Parry-Jones, Vaughan, & Cox, 2006). A disproportionate number of those intoxicated will be younger, will be men, will be injured in a motor vehicle accident and assaults, and have a history of alcohol abuse (55% -66%).…”

“…For example, despite the intimate relationship between TBI and alcohol abuse and that two-thirds of patients admitted to brain injury rehabilitation units have a history of alcohol or illicit drug abuse (Corrigan, 1995;Parry-Jones et al, 2006), the vast majority of rehabilitative programs focus on cognitive, physical and occupational functioning in the context of physical medicine and rehabilitation and ignore issues of substance abuse.…”