A Comparison of Substance Abuse and Violence as Predictors of Long Term Function

Past Studies

Past Studies report that 20% of all traumatic brain injuries result from violence. Death rates from violence related brain injury have increased. Most prior studies have focused on gunshot wound relatedbrain injuries in military populations. A history of substance abuse was not a factor considered in those studies. Brain injuries from gunshot wounds usually result in death, but when the person survives the long-term effects are relatively mild. A few studies have shown that persons assaulted with blunt objects have poorer long term outcomes.

A history of substance abuse has strongly been associated with traumatic brain injury and violent activity. One study found that persons at highest risk for violence-related brain injury were male, African American, less educated, unemployed, living alone, and intoxicated at the time of injury. They were also more likely to be drinking one year after the injury. Other studies have found that substance abuse has been linked to assaults. It is not clear how the relationship between violence and substance abuse is linked to the long term outcomes of persons with traumatic brain injuries or what special care this population may need.

This Study

This Study included 351 persons consecutively admitted for traumatic brain injury rehabilitation at one center. Information was gathered for one year following discharge from the rehabilitation center. The Satisfaction with Life Scale and Community Integration Questionnaire were used to evaluate outcomes after rehab. Other information was collected from medical chart review. Survey results from the persons with brain injuries and their relatives were obtained.

Almost 80% of persons with violence related traumatic brain injuries had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfaction and productivity. A violence related cause of traumatic brain injury did not. The characteristics of persons at highest risk for violence related brain injury were found to be the same as in previous studies.

Who May Be Affected By These Findings

Persons with violence related traumatic brain injury, family members, health care providers, and researchers.

Caveats

The authors caution that the models used to test hypotheses in their study should not be considered to be the best possible predictive measures. They point out that the purpose of this study was not to find the best models of prediction, but instead determine if substance abuse is important to include in prediction models. This study was limited by participant drop out rates during the follow up studies. Because over 40% of the sample could not be contacted, generalizations about the entire population should be made with caution. In comparisons to people who did participate in follow-up, persons who did not participate had a history of substance abuse and unemployment, were more likely to be injured by violent means, and had better functional abilities at the time of discharge from rehabilitation.

Bottom Line

Substance abuse history appeared to be a strong predictor of long-term outcomes. The fact itself, that violence was the cause of the traumatic brain injury, did not appear to be a significant predictor of long-term functional abilities. These results emphasize the need for professionals to include substance abuse history in all out-comes research. Traumatic brain injury prevention efforts need to address substance abuse issues to be most effective.

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