Pilot study of traumatic brain injury and alcohol misuse among service members

Lifetime History of Traumatic Brain Injury and Behavioral Health Problems in a Population-Based Sample

OBJECTIVE

To investigate the relationships between indices of lifetime history of traumatic brain injury (TBI) exposure and measures of behavioral health status among Ohioans.

PARTICIPANTS

A random sample (n = 6996) of Ohioans contacted to complete the 2014 Ohio Behavioral Risk Factors Surveillance System (BRFSS).

DESIGN

A cross-sectional survey.

MAIN MEASURES

The Ohio State University TBI Identification Method adapted for BRFSS module and BRFSS behavioral indicators.

RESULTS

After demographic adjustment, lifetime history of TBI was found to be associated with increased odds of binge drinking, heavy drinking, smoking, a depressive disorder, or mental health not being good (≥2 days and ≥14 days in last 30 days). Mixed findings across behavioral indicators were observed in regard to number and severity of injury. Age at first injury showed no remarkable associations with the behavioral health indicators.

CONCLUSIONS

Ohioans who have sustained at least one TBI with loss of consciousness in their lifetime are at increased risk for poor behavioral health, including alcohol misuse, smoking, and depression. The findings underscore the need for community-based mental health treatment programs to screen for TBI history in their intake evaluations, and to train clinicians on the provisions of accommodations for cognitive and behavioral deficits.

TBI as a Risk Factor for Substance Use Behaviors: A Meta-analysis

OBJECTIVE

To quantify the relationship between substance use behaviors before and after traumatic brain injury (TBI), to identify populations that may benefit more from targeted interventions to reduce the effect of substance use on TBI recovery, and to establish areas for further study.

DATA SOURCES

Studies were identified via literature searches using MEDLINE, PsychInfo, PsychArticles, PubMed, and GoogleScholar (published before January 2019), as well as reference section reviews and forward searches. Searches were conducted using search terms for TBI and substance use behaviors.

STUDY SELECTION

Studies were included if they (1) contained both a measure of TBI and a measure of substance use behaviors; (2) reported an effect size representing the relationship between substance use behaviors before and after TBI, compared TBI vs non-TBI groups on substance use behaviors controlling for pre-TBI substance use, or compared groups with differing TBI severity on subsequent substance use behaviors controlling for pre-TBI substance use; (3) were written in English; and (4) were human subjects research. Studies examining effects of substance use intervention for people sustaining TBI were excluded from this study.

DATA EXTRACTION

Study variables included substance use behaviors, TBI severity, time since TBI, military status, age, race, and sex.

DATA SYNTHESIS

Substance use behaviors had a small but statistically significant decrease after moderate-severe TBI. After moderate-severe TBI, there was a statistically significant decline in both substance use (d=-0.29, P<.01) and negative substance use consequences (d=-0.67, P=.01). There was no significant change in substance use behaviors after mild TBI.

CONCLUSIONS

Substance use behaviors had a small decrease after moderate to severe TBI and no significant change after mild TBI. Study findings suggest the need for accurate assessment to identify those at greatest risk for problematic substance use behaviors after TBI.

Is Pediatric Traumatic Brain Injury Associated with Adult Alcohol Misuse?

Evidence suggests that pediatric traumatic brain injury (TBI) may be causally related to alcohol misuse later in life; however, the nature and extent of the association has not been well described. This study examined the relationship between pediatric TBI and adult alcohol misuse in a population sample ≥20 years of age. We sought to determine (1) whether first self-reported incidence of TBI with loss of consciousness (LOC) before the age of 20 increased the risk for alcohol misuse later in life; and (2) whether sex, injury severity, and age at time of injury modified the association. We found a greater likelihood of binge but not heavy drinking for those whose first self-reported TBI with LOC occurred before the age of 20 when compared with those whose first self-reported TBI with LOC occurred later in life (28.5% vs. 20.4%, p = 0.003). When limited to those with only mild TBI, the relationship to binge drinking remained significant (31.9% vs. 19.3%, p < 0.001) and was evident for both males (38.4% vs. 25.6%, p = 0.016) and females (20.9% vs. 12.4%, p = 0.044). When controlling for sex, age, and race/ethnicity, reporting a first TBI with LOC before age 20 was associated with binge drinking only for those with mild TBI (adjusted odds ratio [AOR] = 1.32; 95% confidence interval [CI] = 1.00-1.74). Results also showed that those with first TBI with LOC occurring between the ages of 10 and 19 years were more likely to binge drink as adults than those first injured earlier in life, regardless of TBI severity. Further research is needed at both the epidemiological and pre-clinical levels to better understand this relationship.