To determine the relative contributions of substance abuse history and violent etiology to the prediction of outcomes for individuals who sustained a traumatic brain injury (TBI) requiring inpatient rehabilitation.
Longitudinal study of outcomes 1 year postdischarge from rehabilitation.
Specialized TBI acute rehabilitation unit.
Three hundred fifty-one individuals consecutively admitted for rehabilitation.
Gathered data from patients' medical records (including etiology of injury, initial Glasgow Coma Scale scores, and FIMtrade mark instrument scores at discharge), demographic details, and history of substance abuse; phone and mail survey data from individuals (Satisfaction with Life Scale [SWLS]; Community Integration Questionnaire [CIQ]).
CIQ and SWLS; relative contributions of injury etiology, demographic and injury-related dependent variables, and substance abuse history to predictive model.
Almost 80% of persons with injuries from violence-related causes had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfacton and productivity, while violent etiology was not a significant contributor to predictive models.
Substance abuse history proved to be a strong predictor of long-term outcomes, while violent etiology of injury was less influential. The results of this study emphasize the need to include substance abuse history in all studies of outcomes after TBI, and to increase prevention efforts to limit the effects of such a history.
"Traumatic brain injury (TBI) and substance use disorders (SUDs) frequently co-occur. Individuals with histories of alcohol or other drug use are at greater risk for sustaining TBI, and individuals with TBI frequently misuse substances pre-and post-injury      . Research suggests that members of general population who consume alcohol are at four times the risk of sustaining a TBI than those who do not . "
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury (TBI) and substance use disorders (SUDs) frequently co-occur. Individuals with histories of alcohol or other drug use are at greater risk for sustaining TBI, and individuals with TBI frequently misuse substances before and after injury. Further, a growing body of literature supports the relationship between comorbid histories of mild TBI (mTBI) and SUDs and negative outcomes. Alcohol and other drug use are strongly associated with risk taking. Disinhibition, impaired executive function, and/or impulsivity as a result of mTBI also contribute to an individual's proclivity towards risk-taking. Risk-taking behavior may therefore, be a direct result of SUD and/or history of mTBI, and risky behaviors may predispose individuals for subsequent injury or continued use of substances. Based on these findings, evaluation of risk-taking behavior associated with the co-occurrence of SUD and mTBI should be a standard clinical practice. Interventions aimed at reducing risky behavior among members of this population may assist in decreasing negative outcomes. A novel intervention (Substance Use and Traumatic Brain Injury Risk Reduction and Prevention (STRRP)) for reducing and preventing risky behaviors among individuals with co-occurring mTBI and SUD is presented. Areas for further research are discussed.
"Another possibility is socioeconomic factors could influence psychological outcomes following violent TBI. As noted previously, risk for violence in general as well as violence resulting in TBI is higher for those of lower SES (Bogner et al., 2001; Harrison-Felix et al., 1998). Numerous studies have examined the relationship between SES and risk for psychiatric illness, with many finding higher rates of psychiatric disorders among those of lower SES (Holzer et al., 1986; Kessler et al., 1994; Ostler et al., 2001; Weich & Lewis, 1998), including symptoms of depression and anxiety (Bruce, Takeuchi, & Leaf, 1991; Gallo & Matthews, 1999; Ross, 2000). "
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