Articles
The magnitude and correlates of alcohol and drug use before traumatic brain injury,☆☆,

https://doi.org/10.1053/apmr.2002.36085Get rights and content

Abstract

Bombardier CH, Rimmele CT, Zintel H. The magnitude and correlates of alcohol and drug use before traumatic brain injury. Arch Phys Med Rehabil 2002;83:1765-73. Objective: To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent traumatic brain injury (TBI). Design: Survey. Setting: Acute inpatient rehabilitation program. Participants: A total of 142 (91%) of 156 consecutive admissions who met inclusion criteria and were screened. Interventions: Not applicable. Main Outcome Measures: Alcohol and drug use questionnaires, alcohol problem questions, toxicology results, readiness to change, and treatment preference questions. Results: Subjects were on average 37 years old, 80% were men, and 80% were white. Fifty-nine percent of the sample was considered “at-risk” drinkers and, as a group, subjects reported a high degree of preinjury alcohol-related problems. Thirty-four percent reported recent illicit drug use, and 42 (37%) of 114 cases with toxicology results were positive for illicit drugs. Motivation to change alcohol use correlated positively with greater self-reported alcohol consumption and problem severity. Most at-risk drinkers wanted to change on their own, whereas a minority were interested in treatment or Alcoholics Anonymous. Conclusion: Both alcohol abuse and drug use are common before TBI. Inpatient brain injury rehabilitation represents an important opportunity to identify and intervene in substance abuse problems. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Participants

Subjects were drawn from 203 consecutive inpatients with recent TBI. One hundred fifty-six persons met our inclusion criteria. Forty-seven were excluded for the following reasons: too cognitively impaired (n=18), non–English speaking (n=15), severe psychiatric disorder (n=6), younger than 18 years of age (n=3), not the initial rehabilitation admission (n=3), and discharged to homeless shelter or to prison (n=2). Of the 156 persons who met inclusion criteria, 144 (92%) were successfully

Definition of at-risk drinkers

This research is part of an ongoing treatment study. The treatment study has specific inclusion criteria that were devised to identify persons whose preinjury drinking pattern might place them at risk for alcohol-related problems generally.25 The inclusion criteria were as follows: (1) being a current drinker and scoring in the “alcoholic” range on the SMAST; (2) being intoxicated at the time of admission to the emergency room (BAL, ≥99mg/dL); or (3) having a recent history of “risky drinking,”

Discussion

The results of the present study are consistent with previous research on people who sustained TBI as well as on trauma survivors more generally. Both groups have high rates of alcohol use and alcohol-related problems before injury. In our sample, approximately one third were intoxicated at the time of injury. This rate of intoxication is slightly below the range reported in other studies of persons with TBI, that is, 36% to 51%.1 Alternatively, it is quite similar to the rate of intoxication

Conclusion

The results of the present study highlight the need for universal screening for drug and alcohol problems in acute rehabilitation settings. The data also describe the opportunity that exists for secondary prevention programs. Surgeons and other trauma specialists are recognizing the need to address the fact that alcoholism is the most common health problem among those who sustain trauma.30 Rehabilitation professionals are enjoined to recognize this silent epidemic as well and to consider

Acknowledgements

We thank Kristin Knight, for her help with data collection, as well as Susan Pilcher and the Harborview Trauma Registry.

References (47)

  • MR Hibbard et al.

    Axis I psychopathology in individuals with traumatic brain injury

    J Head Trauma Rehabil

    (1998)
  • (1994)
  • JS Kreutzer et al.

    A prospective longitudinal multicenter analysis of alcohol use patterns among persons with traumatic brain injury

    J Head Trauma Rehabil

    (1996)
  • MJ Langley et al.

    A comprehensive alcohol abuse treatment programme for persons with traumatic brain injury

    Brain Inj

    (1990)
  • G. Jones

    Substance abuse treatment for persons with brain injuries

    Neurorehabilitation

    (1992)
  • FP Rivara et al.

    The magnitude of acute and chronic alcohol abuse in trauma patients

    Arch Surg

    (1993)
  • JR McKay

    Studies of factors in relapse to alcohol, drug and nicotine use: a critical review of methodologies and findings

    J Stud Alcohol

    (1999)
  • Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury

    JAMA

    (1999)
  • Broadening the base of treatment for alcohol problems

    (1990)
  • WR Miller et al.

    The brief drinker profile

    (1987)
  • M Selzer et al.

    A self-administered Short Michigan Alcoholism Screening Test (SMAST)

    J Stud Alcohol

    (1975)
  • GR Jacobson

    A comprehensive approach to pretreatment evaluation: I. Detection, assessment and diagnosis of alcoholism

  • S Rollnick et al.

    Development of a short ‘readiness to change’ questionnaire for use in brief, opportunistic interventions among excessive drinkers

    Br J Addict

    (1992)
  • Cited by (0)

    Supported by the National Center for Injury Prevention and Control and the Disabilities Prevention Program, National Center for Environmental Health (grant no. R49/CCR011714-01). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Center of Injury Prevention and Control.

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    Correspondence to Charles Bombardier, PhD, Dept of Rehabilitation Medicine, Box 359740, Harborview Medical Ctr, 325 9th Ave, Seattle, WA 98104, e-mail: [email protected]. Reprints are not available.

    View full text