Interventions for Substance Misuse following TBI: A Systematic Review

Abstract

Objective: Review the literature to evaluate the evidence for effective treatment to mitigate substance misuse and substance use disorders (SUD) following traumatic brain injury (TBI). Design: Systematic review. Data source: Scopus. Study eligibility criteria: A study was considered eligible for review if (a) the intended population specifically included persons with TBI; (b) the experimental intervention targeted misuse of alcohol, illegal drugs or prescription drugs; (c) the intervention was compared to the standard of care, control or another intervention; (d) the outcomes under study included substance use or misuse; and (e) the study design was a controlled trial. Results: Six studies were identified that met the inclusion criteria. Three studies were conducted during the acute phase of recovery using brief interventions, while the remaining three were conducted with individuals in the post-acute phase (usually several years post-injury) using more intensive treatment. All studies were found to be vulnerable to bias due to methodological weaknesses. Conclusions: While firm conclusions could not be drawn from the results of the studies, each study provided important information about the challenges to conducting SUD intervention trials with persons with TBI. The choices researchers will have to make to address these challenges are delineated.Models for chronic disease management maximise quality of life and health by promoting healthy lifestyles that reduce risk for deterioration and disease-related complications. One mechanism of deterioration following traumatic brain injury (TBI) results from engaging in behaviours that increase health risks, in particular substance misuse. Among persons with TBI, a history of substance misuse has been associated with increased risk of re-injury, suicide attempt and poor life satisfaction (Baguley et al.

Challenging Behaviours, Co-morbidities, Service Utilisation and Service Access among Community-dwelling Adults with Severe Traumatic Brain Injury: A Multicentre Study

“…Furthermore, the percentage of clients with pre-morbid co-morbidities needing post-injury mental health or drug and alcohol services highlights the need for clinical pathways that address this need. The findings also reinforce calls for specialist services that are able to manage extremely challenging cases (Manchester et al, 1997; Bogner & Corrigan, 2013), albeit for a relatively small proportion of all community-dwelling adults with severe TBI. Finally, future research could examine the costs associated with the various types and intensity of services provided to people with TBI in non-inpatient settings, as there are limited data available about the costs associated with longer-term community support.…”

“…This additional level of impairment may mean that some people with TBI are unable to meet the higher demand characteristics that drug and alcohol services require of clients in taking individual responsibility and motivation to access treatment. The finding once again reinforces the call for services with specialist expertise to manage people with both severe TBI and co-morbid substance use disorders (Bogner & Corrigan, 2013).…”

Implementing traumatic brain injury screening in behavioral healthcare: protocol for a prospective mixed methods study

“…The expansion of literature over the past two decades has uncovered clear relationships between TBI and psychiatric comorbidities. However, few interventions have been developed specifically for individuals with these co-occurring conditions [ 73 ], and even fewer have penetrated the service landscape. This study is the first to take an existing TBI screening innovation used in physical health and community-based social service settings and brings it to the behavioral health treatment context using principles of implementation research and science.…”

Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan

“…Behavioral rehabilitation was assessed for psychological outcomes in 11 systematic reviews, six of which demonstrated a positive effect (Cattelani, Zettin, and Zoccolotti, 2010;Little, Byrne, and Coetzer, 2021;Möller, Lexell, and Wilbe Ramsay, 2021;Morris, Fletcher-Smith, and Radford, 2017;Wobma et al, 2016;Ylvisaker et al, 2007) and two of which demonstrated mixed effects (Mueller et al, 2018;Ownsworth and Haslam, 2016). Of the three systematic reviews that stated uncertain effects of behavioral interventions on psychological outcomes ( Bahraini et al, 2013;Bogner and Corrigan, 2013;Wilson et al, 2016), one assessed populations restricted to veterans (Wilson et al, 2016).…”