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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    • "These negative consequences, along with the large amount of epidemiological data indicating that a substantial subset of patients resume problem drinking, has been recognized as a problem by the rehabilitation community. There has been an effort to include substance abuse treatment in the overall TBI rehabilitation program (Bogner et al., 1997;Corrigan and Cole, 2008). However, relatively little work has been done on assessing the costs of continued substance abuse in brain injury patients, and most studies in this field have used intoxication at the time of injury as a proxy for substance abuse rather than directly assessing alcohol abuse after TBI (Alfonso-Loeches et al., 2010;Bombardier et al., 2003;Chen et al., 2012;Dikmen et al., 1993). "
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    ABSTRACT: Brain injury survivors, particularly those injured early in life are very likely to abuse drugs and alcohol later in life. Alcohol abuse following traumatic brain injury (TBI) is associated with poorer rehabilitation outcomes and a greatly increased chance of suffering future head trauma. Thus, substance abuse among persons with brain injury reduces the chances for positive long-term outcomes and greatly increases the societal costs. In this review, we discuss the evidence for modulation of drinking behavior after TBI and the costs of problem drinking after TBI from both a biomedical and economic perspective. Further, we review the existing animal models of drinking after brain injury and consider the potential underlying psychosocial and neurobiological mediators of this phenomenon. In particular, we highlight the potential interactions among TBI, neuroinflammation and alcohol abuse. Substance abuse is a major problem in this vulnerable patient population and a greater understanding of the underlying biology has the potential to greatly improve outcomes.
    Full-text · Article · Jan 2016 · Neuroscience & Biobehavioral Reviews
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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.
    Full-text · Article · May 2012 · Neuropsychological Rehabilitation
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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.
    Full-text · Article · Mar 2012 · Alcohol research : current reviews
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