Substance Use Disorders and Clinical Management of Traumatic Brain Injury and Posttraumatic Stress Disorder

Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2008; 300(6):720-1. DOI: 10.1001/jama.300.6.720
Source: PubMed
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    • "HSIEH ET AL. memory and/or executive function, there is a need to adapt treatment delivery (Corrigan & Cole, 2008). We have previously developed and tested the feasibility of an adapted CBT programme on clients with post-TBI anxiety (Hsieh et al., 2012) and developed a three-session preparatory programme as a prelude for CBT, as a means of enhancing treatment engagement and response (Hsieh et al., in press). "
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    ABSTRACT: Although cognitive-behavioural therapy (CBT) is the treatment of choice for anxiety, its delivery needs to be adapted for individuals with traumatic brain injury (TBI). It also requires clients' active engagement for maximum benefit. This study was a pilot randomised controlled trial involving an anxiety treatment programme adapted for people with TBI, based on CBT and motivational interviewing (MI). Twenty-seven participants with moderate/severe TBI (aged 21-73 years, 78% males) recruited from a brain injury rehabilitation hospital were randomly allocated to receive MI + CBT (n = 9), non-directive counselling (NDC) + CBT (n = 10) and treatment-as-usual (TAU) (n = 8). CBT and MI were manualised and delivered in 12 weekly individual sessions. Primary outcome was self-reported anxiety symptoms assessed at baseline, at the end of NDC/MI and immediately following CBT. Assessment was conducted by assessors blinded to group assignment. Intention-to-treat analyses showed that the two active treatment groups demonstrated significantly greater anxiety reduction than TAU. Participants receiving MI showed greater response to CBT, in terms of reduction in anxiety, stress and non-productive coping, compared to participants who received NDC. The results provided preliminary support for the adapted CBT programme, and the potential utility of MI as treatment prelude. Longer follow-up data are required to evaluate the maintenance of treatment effects.
    Neuropsychological Rehabilitation 05/2012; 22(4):585-608. DOI:10.1080/09602011.2012.678860 · 1.96 Impact Factor
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    • "However, many of these OEF and OIF veterans who now survive combat trauma are left with the repercussions of TBI. These TBI events often result from blast exposure during combat, which also can lead to posttraumatic mental health disorders (Corrigan and Cole 2008). Some studies have found that up to 44 percent of veterans who reported loss of consciousness and 27 percent of veterans who reported altered mental status also met criteria for PTSD (Hoge et al. 2008). "
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    ABSTRACT: Although research has independently linked stress experienced by military personnel to both alcohol use and posttraumatic stress disorder, more recently researchers have noted that there also is a significant overlap between stress reactions and alcohol use in veterans and active-duty service members. This overlap seems to be most understood in individuals who have experienced combat or military sexual trauma. This article will provide a brief review of some potential causal mechanisms underlying this relationship, including self-medication and genetic vulnerability models. It also addresses the possible implications for assessment and treatment of military personnel with co-occurring disorders.
    Alcohol research : current reviews 03/2012; 34(4):401-7.
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    • "Research should address which treatment models are most efficacious. For instance, we do not know if integrated treatment for substance use disorders and TBI is better (Lew, et al., 2008), or if individualized staging of treatment is preferred (Corrigan & Cole, 2008). Others have suggested important treatment components, such as a combination of group treatment and community case management (Delmonico, Hanley-Peterson, & Englander, 1998). "
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    ABSTRACT: Military personnel engage in unhealthy alcohol use at rates higher than their same age, civilian peers, resulting in negative consequences for the individual and jeopardized force readiness for the armed services. Among those returning from combat deployment, unhealthy drinking may be exacerbated by acute stress reactions and injury, including traumatic brain injury (TBI). Combat-acquired TBI is common among personnel in the current conflicts. Although research suggests that impairments due to TBI leads to an increased risk for unhealthy drinking and consequences among civilians, there has been little research to examine whether TBI influences drinking behaviors among military personnel. This article examines TBI and drinking in both civilian and military populations and discusses implications for clinical care and policy.
    Journal of Social Work Practice in the Addictions 01/2012; 12(1):28-51. DOI:10.1080/1533256X.2012.647580
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