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Interventions for Substance Misuse following TBI: A Systematic Review

Question: What is the evidence for effective treatment to reduce alcohol or other drug (substance) misuse following traumatic brain injury (TBI)?

Background: Researchers agree that TBI and substance misuse often occur together and can worsen outcomes. It is important to find effective ways to prevent or reduce substance misuse after a person has a TBI. These individuals fall into four categories, based on how severe their brain injury and substance misuse (SUD) is, and each category may need a different type of treatment. Category I is mild TBI and low SUD; these persons are usually seen in the primary care or emergency room setting, where the best treatment option may be a screening of their substance use and a brief intervention, which has been shown to be effective in reducing substance misuse in persons without TBI. Category II is moderate-severe TBI and low SUD; screening, education, brief interventions, and connections to substance use specialists in the community are possible for persons in the TBI rehabilitation setting. Category III is mild TBI and severe SUD; these people are often treated in programs that specialize in substance abuse, where the special needs of a person with TBI may not be taken into account. Community-based substance misuse treatment specialists may be trained to provide TBI screening and accommodations to improve treatment success for persons with TBI. Category IV is moderate-severe TBI and severe SUD; these persons may need specialized programs.

This study: Researchers looked at past studies for evidence of effective treatment for substance misuse with TBI. They found six studies that used a comparison group; three were done using brief interventions soon after injury (acute care or rehabilitation) and three were done later after the injury using more intensive treatment.   Each of the studies was vulnerable to bias due to problems with the research methods.  Although firm evidence for effective treatment was not found, each study provided important information for future research:
  • The severity of injury, length of time since injury, and the severity of the substance misuse should determine the form of the intervention. 
  • Educational materials may affect how people with TBI think about alcohol and other drugs. 
  • All studies had problems with attracting and keeping participants in the study, which can affect the conclusions to be drawn.  Strategies have been developed that can improve the size of the samples.
  • Soon after injury, the goal of treatment is to prevent individuals from resuming substance misuse. When working with people injured months and years before the intervention, then the focus of the intervention will be to decrease use and will likely need to be more intensive.
Bottom line:  Conducting research on interventions to reduce substance misuse following TBI is very challenging.  Researchers should consider the severity of TBI, severity of substance misuse, the type of intervention, and time after injury when designing and testing interventions to reduce substance misuse in persons with TBI. Studies with stronger research designs are needed. 

Find this study at: Bogner, Jennifer, Corrigan, John D. Interventions for Substance Misuse following TBI: A Systematic Review. Brain Impairment doi: 10.1017/brimp.2013.5

Keywords:  substance use, treatment, intervention, TBI, review

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