To quantify the relationship between substance use behaviors before and after TBI, to identify populations that may benefit more from targeted interventions to reduce the impact of substance use on TBI recovery, and to establish areas for further study.
Studies were identified via literature searches using Medline, PsychInfo, PsychArticles, PubMed, and GoogleScholar (published before January 2019), as well as reference section reviews and forward searches. Searches were conducted using search terms for TBI and substance use behaviors.
Studies were included if they 1) contained both a measure of TBI and a measure of substance use behaviors, 2) reported an effect size representing the relationship between substance use behaviors before and after TBI, compared TBI versus non-TBI groups on substance use behaviors controlling for pre-TBI substance use, or compared groups with differing TBI severity on subsequent substance use behaviors controlling for pre-TBI substance use, 3) were written in English, and 4) were human subjects research. Studies examining effects of substance use intervention for people sustaining TBI were excluded from this study.
Study variables included substance use behaviors, TBI severity, time since TBI, military status, age, race, and gender.
Substance use behaviors had a small, but statistically significant decrease after moderate-severe TBI. After moderate-severe TBI, there was a statistically significant decline in both substance use (d= -0.29, p<0.01) and negative substance use consequences (d= -0.67, p=0.01). There was no significant change in substance use behaviors after mild TBI.
Substance use behaviors had a small decrease after moderate to severe TBI, and no significant change following mild TBI. Study findings suggest the need for accurate assessment to identify those at greatest risk for problematic substance use behaviors after TBI.
Copyright © 2020. Published by Elsevier Inc.