Pilot study of traumatic brain injury and alcohol misuse among service members

Objective: Explore relationships among traumatic brain injury (TBI), substance misuse and other mental health disorders in US service members and to identify risk factors for substance misuse. Participants: Service members (n=93 in final sample) injured while deployed to Operation Enduring Freedom or Operation Iraqi Freedom. Methods and materials: Longitudinal survey at 6 and 12 months post-intake. The following measures were used: problem substance use, Alcohol Expectancies Questionnaire-HI, MINI International Neuropsychiatric Interview Substance Abuse Modules, Ohio State University TBI Identification Method, Neurobehavioural Symptom Inventory, Rivermead Post-Concussion Symptoms Questionnaire, Buss-Perry Aggression Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version, Beck Depression Inventory-II, Beck Anxiety Inventory. Results: More severe TBI and post-traumatic stress disorder (PTSD) symptoms at 6 months post-enrolment were associated with decreased odds of substance misuse 12 months after study enrolment. Alcohol expectancies and incurring a TBI at a younger age increased the odds of substance misuse. Conclusions: While the ability to generalize the current findings to a larger population is limited, the results provide direction for future studies on the prevention and treatment of substance misuse following TBI. The unexpected protective effect of more severe TBI may result from prospective attention to the injury and its consequences. Greater preventive benefit may result from identifying more service members with elevated risk. Lifetime history of TBI and alcohol expectancies may be candidate indicators for greater attention.