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Co-Occurring Traumatic Brain Injury, PTSD Symptoms, and Alcohol Use in Veterans

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Abstract

Traumatic brain injury (TBI) has been identified as a significant health problem among veterans. Recent research demonstrates the potential interaction and magnification of symptoms of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in veterans with a history of TBI; however, there is very limited research on the co-occurrence of the three conditions. Veterans (N = 115) with comorbid PTSD and SUD completed a baseline assessment for enrollment into a larger treatment study. As part of that assessment, participants completed a TBI screener as well as self-report measures for pain and physical health, affective symptoms, and substance use. Almost half of the sample (48 %) endorsed a history of a previous head trauma with loss of consciousness (LOC). Participants with and without head trauma with LOC were compared across various measures of functioning. Increased severity of physical health complaints and affective symptoms were reported by the TBI group compared to controls. However, the increases in affective symptoms were relatively small. No group differences were observed for alcohol use. Together, the findings suggest that treatment-seeking veterans with a history of head trauma with LOC may present with roughly equivalent symptoms of PTSD and SUD to those without said history.

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References

  • Adams, R. S., Corrigan, J. D., & Larson, M. J. (2012). Alcohol use after combat-acquired traumatic brain injury: what we know and don’t know. Journal of Social Work Practice in the Addictions, 12, 28–51.

    Article  PubMed  PubMed Central  Google Scholar 

  • Back, S. E., Foa, E. B., Killeen, T. K., Mills, K. L., Teesson, M., Dansky Cotton, B.,... & Brady, K. T. (2014). Concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE): Therapist guide. New York: Oxford Press

  • Back, S. E., Killeen, T., Foa, E. B., Santa Ana, E. J., Gros, D. F., & Brady, K. T. (2012). Use of prolonged exposure to treat PTSD in an Iraq veteran with comorbid alcohol dependence. American Journal of Psychiatry, 169, 688–691.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barnes, S. M., Walter, K. H., & Chard, K. M. (2012). Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD? Rehabilitation Psychology, 57, 18–26.

    Article  PubMed  Google Scholar 

  • Beck, A., Steer, R., & Brown, G. (1996). Beck depression inventory-II. San Antonio:Psychological Corporation.

    Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.

    Article  PubMed  Google Scholar 

  • Boyle, E., Cancelliere, C., Hartvigsen, J., Carroll, L. J., Holm, L. W., & Cassidy, D. (2014). Systematic review of prognosis after mild traumatic brain injury in the military: results of the international collaboration of mild traumatic brain injury prognosis. Archives of Physical Medicine and Rehabilitation, 95, S230–S237.

    Article  PubMed  Google Scholar 

  • Brady, K. T., Tuerk, P., Back, S. E., Saladin, M. E., Waldrop, A. E., & Myrick, H. (2009). Combat posttraumatic stress disorder, substance use disorders, and traumatic brain injury. Journal of Addiction Medicine, 3, 179–188.

    Article  PubMed  PubMed Central  Google Scholar 

  • Buysse, D. J., Reynold, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburg sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.

    Article  PubMed  Google Scholar 

  • Cacciola, J. S., Alterman, A. I., McLellan, A. T., Lin, Y. T., & Lynch, K. G. (2007). Initial evidence for the reliability and validity of a “lite” version of the addiction severity index. Drug and Alcohol Dependence, 87, 297–302.

    Article  PubMed  Google Scholar 

  • Capehart, B., & Bass, D. (2012). Review: managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury. Journal of Rehabilitation Research and Development, 49, 789–812.

    Article  PubMed  Google Scholar 

  • Carlson, K. F., Nelson, D., Orazem, R. J., Nugent, S., Cifu, D. X., & Sayer, N. A. (2010). Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment-related traumatic brain injury. Journal of Traumatic Stress, 23, 17–24.

    PubMed  Google Scholar 

  • Corrigan, J. D., & Cole, T. B. (2008). Substance use disorders and clinical management of traumatic brain injury and posttraumatic stress disorder. JAMA, 300, 720–721.

    Article  PubMed  Google Scholar 

  • De Los Reyes, A., Lerner, M. D., Thomas, S. A., Daruwala, S. E., & Goepel, K. A. (2013). Discrepancies between parent and adolescent beliefs about daily life topics and performance on an emotion recognition task. Journal of Abnormal Child Psychology, 41, 971–982.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dikmen, S. S., Machamer, J. E., Donovan, D. M., Winn, H. R., & Temkin, N. R. (1995). Alcohol use before and after traumatic head injury. Annals of Emergency Medicine, 26, 167–176.

    Article  PubMed  Google Scholar 

  • Fals-Stewart, W., O’Farrell, T. J., Freitas, T. T., McFarlin, S. K., & Rutigliano, P. (2000). The timeline followback reports of psychoactive substance use by drug-abusing patients: psychometric properties. Journal of Consulting and Clinical Psychology, 68, 134–144.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences. New York:Oxford University Press.

    Google Scholar 

  • Hanley, J. A., Negassa, A., Edwardes, M. D., & Forrester, J. E. (2003). Statistical analysis of correlated data using generalized estimating equations: an orientation. American Journal of Epidemiology, 157, 364–375.

    Article  PubMed  Google Scholar 

  • Hoge, C. W., McGurk, D., Thomas, J. L.. Cox, A. L., Engel, C. C., Castro, C. A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine, 358, 453–463.

    Article  PubMed  Google Scholar 

  • INTRuST. (2012). Structured assessment for evaluation of TBI. La Jolla, CA:PTSD-TBI INTRuST, University of California San Diego.

    Google Scholar 

  • Iverson, G. L. (2005). Outcome from mild traumatic brain injury. Current Opinions in Psychiatry, 18, 301–317.

    Article  Google Scholar 

  • Kroenke, K., Sptizer, R. L., & Williams, J. B. W. (2002). The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64, 258–266.

    Article  PubMed  Google Scholar 

  • Marshall, K. R., Holland, S. L., Meyer, K. S., Martin, E. M., Wilmore, M., & Grimes, J. B. (2012). Mild traumatic brain injury screening, diagnosis, and treatment. Military Medicine, 177, 67–75.

    Article  PubMed  Google Scholar 

  • McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. (2012). Posttraumatic stress disorder and co-occurring substance use disorders: advances in assessment and treatment. Clinical Psychology: Science & Practice, 19, 283–304.

    Google Scholar 

  • McCrea, M., Guskiewicz, K. M., Marshall, S. W., Barr, W., Cantu, R. C., Onate, J. A., Yang, J., & Kelly, J. P. (2003). Acute effects and recovery time following concussion in collegiate football players. JAMA, 290, 2556–2563.

    Article  PubMed  Google Scholar 

  • McLellan, A. T., Cacciola, J. C., Alterman, A. I., Rikonn, S. H., & Carise, C. (2006). The addiction severity index at 25: origins, contributions and transitions. American Journal of Addiction, 15, 113–124.

    Article  Google Scholar 

  • Ommaya, A. K., & Gennarelli, T. A. (1974). Cerebral concussion and traumatic unconsciousness: correlation of experimental and clinical observations on blunt head injuries. Brain, 97, 633–654.

    Article  PubMed  Google Scholar 

  • Parry-Jones, B. L., Vaughan, F. L., & Cox, W. M. (2006). Traumatic brain injury and substance misuse: A systematic review of prevalence and outcomes research (1994–2004). Neuropsychological Rehabilitation, 16, 537–560.

    Article  PubMed  Google Scholar 

  • Ponsford, J. (2005). Rehabilitation interventions after mild head injury. Current Opinions in Neurology, 18, 692–697.

    Article  Google Scholar 

  • Ragsdale, K. A., Neer, S. M., Beidel, D. C., Frueh, B. C., & Stout, J. W. (2013). Posttraumatic stress disorder in OEF/OIF veterans with and without traumatic brain injury. Journal of Anxiety Disorders, 27, 420–426.

    Article  PubMed  Google Scholar 

  • Rutherford, W. H., Merrett, J. D., & McDonald, J. R. (1977). Sequelae of concussion caused by minor had injuries. Lancet, 1, 1–4.

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The mini-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.

    PubMed  Google Scholar 

  • Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back: a technique for assessing self-reported alcohol consumption. In R. Z. Litten, & J. P. Allen (Eds.), Measuring alcohol consumption: psychosocial and biochemical methods (pp. 41–73). Totowa: Humana Press.

    Chapter  Google Scholar 

  • Spielberger, C. D. (1989). State-trait anxiety inventory: A comprehensive bibliography. Palo Alto:Consulting Psychologists Press.

    Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2008). Using multivariate statistics (6th ed., ). Boston:Allyn and Bacon.

    Google Scholar 

  • Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist: reliability, validity and diagnostic utility. Annual meeting of the international society for traumatic stress studies, San Antonio, TX.

  • Williams, W. H., Potter, S., & Ryland, H. (2010). Mild traumatic brain injury and postconcussion syndrome: a neuropsychological perspective. Journal of Neurology, Neurosurgery, and Psychiatry, 81, 1116–1122.

    Article  PubMed  Google Scholar 

  • Wolf, G. K., Strom, T., Kehle, S. M., & Eftekhari, A. (2012). A preliminary examination of prolonged exposure therapy with Iraq and Afghanistan veterans with a diagnosis of posttraumatic stress disorder and mild to moderate traumatic brain disease. Journal of Head Trauma Rehabilitation, 27, 26–32.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by NIDA grant DA021228 (PI: Back) and Department of Veteran Affairs CSR & D Career Development Award CX000845 (PI: Gros). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of NIDA, Department of Veterans Affairs, or the United States government.

Conflict of interest

Daniel F. Gros, Kristina J. Korte, Michael David Horner, Kathleen T. Brady and Sudie E. Back declare that they have no conflict of interest.

Experiment Participants

All procedures were approved by the local VA Research and Development committee as well as the Institutional Review Board at the affiliated university.

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Authors and Affiliations

  1. Mental Health Service 116, Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, 29401, USA

    Daniel F. Gros, Kristina J. Korte, Michael David Horner, Kathleen T. Brady & Sudie E. Back

  2. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA

    Daniel F. Gros, Kristina J. Korte, Michael David Horner, Kathleen T. Brady & Sudie E. Back

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  1. Daniel F. Gros
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  2. Kristina J. Korte
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  3. Michael David Horner
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  4. Kathleen T. Brady
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  5. Sudie E. Back
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Correspondence to Daniel F. Gros.

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Gros, D.F., Korte, K.J., Horner, M.D. et al. Co-Occurring Traumatic Brain Injury, PTSD Symptoms, and Alcohol Use in Veterans. J Psychopathol Behav Assess 38, 266–273 (2016). https://doi.org/10.1007/s10862-015-9513-y

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