The magnitude and correlates of alcohol and drug use before traumatic brain injury

Objective: To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent traumatic brain injury (TBI). Design: Survey. Setting: Acute inpatient rehabilitation program. Participants: A total of 142 (91%) of 156 consecutive admissions who met inclusion criteria and were screened. Interventions: Not applicable. Main Outcome Measures: Alcohol and drug use questionnaires, alcohol problem questions, toxicology results, readiness to change, and treatment preference questions. Results: Subjects were on average 37 years old, 80% were men, and 80% were white. Fifty-nine percent of the sample was considered "at-risk" drinkers and, as a group, subjects reported a high degree of preinjury alcohol-related problems. Thirty-four percent reported recent illicit drug use, and 42 (37%) of 114 cases with toxicology results were positive for illicit drugs. Motivation to change alcohol use correlated positively with greater self-reported alcohol consumption and problem severity. Most at-risk drinkers wanted to change on their own, whereas a minority were interested in treatment or Alcoholics Anonymous. Conclusion: Both alcohol abuse and drug use are common before TBI. Inpatient brain injury rehabilitation represents an important opportunity to identify and intervene in substance abuse problems. (C) 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.