Table 1.
Human Studies of the Association Between TBI and Risky Substance Use
| Study | Sample and Population | Method | Risky Alcohol Use or Alcohol Use Disorder | Use of Other Substances |
|---|---|---|---|---|
| Corrigan et al. (20) | N = 4464 adults 1–20 years after acute rehabilitation for TBI and enrolled in TBI model systems | Prospective cohort (retrospective self-report of TBI; past-month [preindex injury] or past-year [postindex injury] use) | Those with history of TBI vs. those without more likely to engage in risky drinking before index injury (42.4% vs. 31.3%) and after index injury (22.8% vs. 13.5%) | Those with history of TBI vs. those without more likely to use illicit drugs before index injury (27.9% vs. 20.3%) and after index injury (17.8% vs. 8.1%) |
| Dams-O’Connor et al. (21) | N = 586 adults treated for TBI and enrolled in the TRACK-TBI study | Prospective cohort (retrospective self-report of TBI; past-month use) | Those with history of TBI vs. those without more likely to engage in risky drinking before index injury (56.6% vs. 37.1%) | Those with history of TBI vs. those without more likely to use illicit drugs before index injury (35.3% vs. 14.9%) |
| Adams et al. (22) | N = 4645 army soldiers following combat deployment who participated in Army STARRS study | Prospective cohort (retrospective self-report of TBI; past-month drinking) Adjusted for predeployment drinking, predeployment psychiatric diagnosis, combat/deployment stress severity, personal life stress during deployment, PTSD symptoms during deployment, and sociodemographic and military service characteristics |
Three months after deployment, lifetime TBI, but not deployment-acquired TBI, associated with increased binge (AOR = 1.39, 95% CI: 1.20–1.60) and heavy drinking (AOR = 1.28, 95% CI: 1.09–1.49). Having both predeployment lifetime history and a deployment-acquired TBI increased heavy drinking 6 months later (AOR = 1.42, 95% CI: 1.03–1.95) | Not studied |
| Silver et al. (23) | N = 5034 adults from greater metropolitan New Haven, Connecticut | Population survey (retrospective self-report of lifetime TBI; use disorders from standardized interview) Adjusted for sociodemographics and health-related quality of life variables |
Alcohol abuse or dependence (AOR = 2.2, 95% CI: 1.7–2.8) | Drug abuse or dependence (AOR = 1.8, 95% CI: 1.2–2.5) |
| Anstey et al. (24) | N = 7485 adults from 2 southeast Australian metropolitan areas | Population survey (retrospective self-report of lifetime TBI; past-month drinking) Adjusted for age group, gender, financial problems, physical health, and psychoticism |
No difference for TBI vs. no TBI except young adult females (p = .045) | Not studied |
| Ilie et al. (25) | N = 1988 adults in the province of Ontario, Canada | Population survey (retrospective self-report of lifetime TBI; past-month substance use) Adjusted for age, sex, marital status, family income, and education |
Not studied | Uses marijuana (AOR = 2.80, 95% CI: 1.79–4.39) Uses nonprescription opioids (AOR = 2.90, 95% CI: 1.50–5.59) |
| Ilie et al. (26) | N = 6074 adults in the province of Ontario, Canada | Population survey (retrospective self-report of lifetime TBI; past-month harmful or hazardous drinking) | Of persons with history of TBI, 21.4% reported harmful or hazardous drinking vs. 13.2% of no TBI respondents | Not studied |
| Whiteneck et al. (27) | N = 2701 noninstitutionalized adults residing in the state of Colorado | Population survey (retrospective self-report of lifetime TBI history; past-month drinking) Adjusted for place of medical care, age, sex, and race |
At-risk alcohol use no more prevalent for persons with history of TBI than general population | Not studied |
| Bogner et al. (28) | N = 6996 noninstitutionalized adults residing in the state of Ohio | Population survey Behavioral Risk Factors Surveillance System (retrospective self-report of lifetime TBI; past-month alcohol use) Adjusted for age, sex, and race/ethnicity |
Binge drinking (AOR = 1.5, 95% CI: 1.1–2.0) Heavy drinking (AOR = 1.7, 95% CI: 1.1–2.6) Those with first TBI before age 15 years: no difference in binge or heavy drinking |
Not studied |
| Corrigan et al. (29) | N = 2935 noninstitutionalized adults with history of TBI with loss of consciousness residing in the state of Ohio | Population survey Behavioral Risk Factors Surveillance System (retrospective self-report of lifetime TBI; past-month alcohol use) Adjusted for age, sex, and race/ethnicity |
Those with first TBI before age 20 more likely to binge drink in adulthood (28.5% vs. 20.4%, p = .003) Those with first mild TBI before age 20 more likely to binge drink in adulthood (31.9% vs. 19.3%, p < .001) |
Not studied |
| Waltzman et al. (30) | N = 3605 noninstitutionalized adults with history of TBI with loss of consciousness residing in the state of North Carolina | Population survey Behavioral Risk Factors Surveillance System (retrospective self-report of lifetime TBI; past-month alcohol use) Adjusted for sex, age, veteran status, marital status, educational attainment, employment status, and annual income |
Those with history of TBI more likely to binge drink (AOR = 1.7, 95% CI: 1.2–2.4) Those with first TBI before age 18: no difference in binge drinking |
Not studied |
| McKinlay et al. (138) | N = 1265 children born in 1977 in Christchurch, New Zealand | Birth cohort followed to age 25 (TBI from medical record abstraction of prospectively collected medical records; standardized structured interview to determine substance use disorder) Adjusted for sociodemographic factors, early behavioral problems, and parental substance abuse |
Alcohol dependence n.s. for each group of age at first injury (0–5, 6–15, 16–21 years old) | Drug dependence for first injury 0–5 years old: AOR = 2.85, 95% CI: 1.11–7.32 Drug dependence for first injury 6–15 years old: AOR n.s. Drug dependence for first injury 16–21 years old: AOR = 2.55, 95% CI: 1.07–6.12 |
| Timonen et al. (33) | N = 10,934 children born in 1966 in Northern Finland | Birth cohort followed to age 31 (medically diagnosed TBI; heavy drinking defined by diagnosis of alcohol abuse or dependence [DSM-III criteria] or having at least 2 registered drunk driving offenses) Adjusted for mother’s marital status and father’s social class at time of birth and urban vs. rural residence at approximately age 14 |
Heavy alcohol use no different for childhood TBI vs. no childhood TBI Among heavy drinkers, children with first TBI before age 12 began heavy drinking 6 years before those with first TBI at 12–15 years old |
Not studied |
| Kennedy et al. (34) | N = 11,412 children born 1991–1992 in South West region of England (n = 800 with mild TBI; n = 2305 with orthopedic injury; n = 8307 uninjured children) | Birth cohort followed to age 17 (medically diagnosed injuries through age 16; self-reported recent use) Adjusted for prebirth sociodemographic factors, family environment and parenting style, and history of criminal activity |
Alcohol use disorder vs. orthopedic injured: AOR = 1.69, 95% CI: 1.17–2.45 Alcohol use disorder vs. general population: AOR = 1.31, 95% CI: 0.94–1.82 |
Cannabis misuse vs. orthopedic injured (n.s.) Nicotine dependence vs. orthopedic injured (n.s.) |
AOR, adjusted odds ratio; CI, confidence interval; n.s., nonsignificant; PTSD, posttraumatic stress disorder; STARRS, Study to Assess Risk and Resilience in Servicemembers; TBI, traumatic brain injury; TRACK-TBI, Transforming Research and Clinical Knowledge in Traumatic Brain Injury.