Integrating substance abuse treatment and vocational rehabilitation after traumatic brain injury

Objective: To describe and evaluate a resource and service coordination model for integrating substance abuse treatment and vocational rehabilitation following brain injury. Design: Retrospective study, consecutive sample. Setting: Community-based treatment. Subjects: Seventy-two clients who received services from the TBI Network. Only subjects that had received a comprehensive assessment, agreed to a treatment plan, and had been monitored fcr at least 1 year after initiation of the plan were included in the sample. Main Outcome Measures: Substance use and productivity, as measured by the Quantity-Frequency-Variability Index, General Health;md History Questionnaire, Addiction Severity Index, and the Employability Rating Scale. Results: Pre-and postcomparisons showed significantly better vocational status and greater Likelihood of abstinence from alcohol and other drugs after the intervention. Investigation of a priori hypotheses regarding mediating variables was limited by sample size and selection biases. Time after injury was not associated with positive outcomes, though a trend was evident for decreased substance use among those referred within 3 months after injury. The engagement of a community team was associated with decreased substance use but not greater productivity. Results are discussed in terms of possible ingredients for replication of this approach in other settings.