Abstract:
The National Head Injury Foundation Task Force concluded in a 1988 summary report that substance abuse is a major etiological factor in 50%-70% of persons who sustain a traumatic brain injury (TBI). It has also been found that the effects of substance abuse on cognition can potentially compromise the recovery and rehabilitation as well as reintegration into family, work, and community of nearly two-thirds of TBI survivors. Some research has found that individuals who abuse substances after TBI are usually abusers prior to injury although the extent of abuse generally declines after injury to a level equal to age cohorts. A more recent study found that there was an increase in quantity and frequency of use over time. Other research has shown that persons with TBI may be more likely than others with disability to abuse substances, particularly alcohol, after their injury. However, little is known about factors associated with changes in patterns of abuse or the ways in which the interactive effects of brain injury and substances influence the outcome of survivorsÂ’ rehabilitation and life within the community.
It is also important to recognize that substance abuse has been causally linked to violence-related TBIs, e.g., gunshot wounds. Substance abuse is also related to more significant problems in community integration for survivors whose recovery is complicated by a history of substance abuse and injury by violence. Unfortunately, there has been a paucity of studies on the relationship between violence and substance abuse in the etiology of TBI or its effect on outcome.
The main objective is to investigate the effects of pre-traumatic substance abuse, violence, and other background variables as determinants of continuation or change in post-TBI abuse. The following are expected results: (a) The vast majority of survivors will continue substance-related behaviors after the injury that are consistent with their pre-traumatic experience regardless of the severity of injury or other factors (people do after TBI what they did before TBI); (b) violence in the background of survivors will stand as a major liability and bar to change from pre-traumatic substance abuse to post-injury abstinence; and (c) pre-traumatic problems in personal, familial, social and academic areas will be strongly correlated to substance abuse before and after injury, violence in the etiology of TBI and more severe deficits in cognition and intellect
This study will also shed light on the role of substance abuse and violence in the etiology of brain injury as well as how other background factors affect rehabilitation outcomes and integration into the community. It is expected that (a) poor rehabilitation and community outcomes will correlate with pre-injury substance abuse and violence in the etiology of brain injury and (b) outcomes will be worse for persons whose brain injury involved both substance abuse and violence.