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: 30.39). 09/2008; 300(6):720-1. DOI: 10.1001/jama.300.6.720
Source: PubMed
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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.
    03/2012; 34(4):401-7.
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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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    ABSTRACT: To assess whether alcohol misuse was associated with functional impairment in the military, and whether an association between any of the measures of alcohol misuse and impairment would be explained by psychiatric comorbidity. Large cross-sectional study. 8585 responders of a random sample of the regular United Kingdom Armed Forces who completed a questionnaire in 2005 were included in the analyses. Five items of the Short Form Questionnaire-36 (SF-36) specifically dealing with functional impairment, and the main independent variable was alcohol misuse based on the Alcohol Use Disorders Identification Test (AUDIT). An AUDIT score of > or = 20 was consistently associated with impairment with odds ratios between 1.8 (95% confidence interval 1.4-2.3) and 3.7 (2.8-4.8). AUDIT scores <20 did not increase impairment. Those with a hazardous pattern of drinking (AUDIT score 8-15) perceived their functioning to be better than those with an AUDIT score <8. A score indicating alcohol dependence was associated with impairment, as, to a lesser extent, was alcohol related-harm. Binge drinking was not associated with impairment. Half of those with an AUDIT score of > or = 20 had psychological comorbidities. Perception of impairment was mainly related to those with an AUDIT score of > or = 20 or more, those who had an indication of alcohol dependence or alcohol related-harm. Intervention on an individual basis should be focused on these groups, while effective public health interventions could be enhanced for everyone.
    Drug and alcohol dependence 04/2010; 108(1-2):37-42. DOI:10.1016/j.drugalcdep.2009.11.014 · 3.28 Impact Factor