R4: Effectiveness of a Brief Educational Intervention for Reducing Substance Abuse after TBI
Co-Principal Investigators: Angelle M. Sander, Ph.D., John Corrigan, Ph.D. & Jennifer Bogner, Ph.D.
- This project was conducted in collaboration with Ohio State University and Grant Hospital in Columbus, Ohio.
- This project investigated the effectiveness of a brief educational and motivational intervention for reducing problem use of alcohol and/or drugs after a traumatic brain injury (TBI).
- Persons with TBI who have a history of problem use of alcohol and/or drugs were randomly assigned to receive a specialized educational and motivational intervention or to receive services normally offered by the hospital (usually a referral for substance abuse counseling or programs).
- Participants were tested at a 3-month follow-up to determine if people who received the specialized intervention expected less positive consequences from alcohol or drug use, showed more readiness to change their alcohol or drug use, and actually used less alcohol or drugs.
Many persons with TBI have a history of heavy use of alcohol and/or drugs. Alcohol or drug use may have even contributed to their injuries, such as leading to a motor vehicle accident. After injury, many people return to using alcohol and drugs. People who did not use alcohol or drugs before injury may begin to do so after injury because they are bored and/or depressed.
Research studies have shown that use of alcohol and other drugs can have a negative impact upon recovery. For example, alcohol abuse has been associated with emotional difficulties, subsequent injuries, slowed brain activity, poorer thinking abilities, decreased employment, and less independence.
Few studies have investigated treatments for substance abuse after TBI. For persons without TBI, treatments work best when people are ready to change their behaviors. After a TBI, people may be more ready to change their behaviors because the occurrence of a life-threatening injury may cause them to re-evaluate their actions and the consequences of those actions. Brief interventions, involving motivational interviewing and education, have been shown to be effective in reducing substance use for general trauma patients.
The purpose of the study was to assess the effectiveness of a brief educational and motivational intervention for decreasing positive expectations regarding the effects of alcohol use, increasing negative expectations, increasing readiness to change, and decreasing actual use of alcohol and drugs. The intervention was conducted as early as possible, up to a month following discharge from the acute trauma hospital. Effectiveness of the intervention was assessed by randomly assigning persons who met the criteria for at-risk use of substances to receive either the brief educational intervention or the hospital standard of care. Follow-up assessment was conducted at 3-4 months.
- After controlling for age, gender, education, employment history, baseline problem drinking, # of binges in the month prior to injury, and whether the participants attributed their injury to alcohol use, there was no treatment effect for alcohol expectancies or readiness to change.
- There was a significant injury severity * treatment interaction for expectancy that alcohol use could result in cognitive and physical impairment. For persons with more severe injuries, the treatment was less effective in increasing the expectancy that alcohol use would result in cognitive and physical impairment. This interaction suggests that the impairment level of the person with injury impacts their ability to benefit from a brief intervention. This information is important because current Level I trauma guidelines require that brief intervention be offered to all persons with trauma who have a positive pre-injury history of use, regardless of their ability to benefit from the information. The results of this study indicate that this may not be cost-efficacious, and that perhaps a caregiver should be provided with the information if the person with injury is too impaired. Alternatively, the information could be provided at a later time point, once the cognitive abilities of the person with TBI have improved.
- There was a significant binge history * treatment interaction for expectancy that alcohol use could result in cognitive and physical impairment. Persons who had binged in the month prior to injury were less likely to benefit from the treatment. This indicates that persons who drank excessively prior to injury may be less likely to benefit from a brief intervention.
- Participants’ attribution of alcohol use as a cause of injury was positively associated with readiness to change alcohol use. This is consistent with prior research indicating that catastrophic injury may result in a “teachable moment,” when persons with injury may be more susceptible to interventions that target increasing readiness to change.