Research Reports - Traumatic brain injury and alcohol/substance abuse

J Clin Exp Neuropsychol. 2017 Aug;39(6):547-562. doi:
10.1080/13803395.2016.1248812. Epub 2016 Nov 10.

Unsworth DJ(1), Mathias JL(1).

Alcohol and substance (drugs and/or alcohol) abuse are major risk factors for
traumatic brain injury (TBI); however, it remains unclear whether outcomes differ
for those with and without a history of preinjury abuse. A meta-analysis was
performed to examine this issue. The PubMed, Embase, and PsycINFO databases were
searched for research that compared the neuroradiological, cognitive, or
psychological outcomes of adults with and without a documented history of alcohol
and/or substance abuse who sustained nonpenetrating TBIs. Data from 22 studies
were analyzed using a random-effects model: Hedges's g effect sizes measured the
mean difference in outcomes of individuals with/without a history of preinjury
abuse, and Bayes factors assessed the probability that the outcomes differed.
Patients with a history of alcohol and/or substance abuse had poorer
neuroradiological outcomes, including reduced hippocampal (g = -0.82) and gray
matter volumes (g = -0.46 to -0.82), and enlarged cerebral ventricles (g = -0.73
to -0.80). There were limited differences in cognitive outcomes: Executive
functioning (g = -0.51) and memory (g = -0.39 to -0.43) were moderately affected,
but attention and reasoning were not. The findings for fine motor ability,
construction, perception, general cognition, and language were inconclusive.
Postinjury substance and alcohol use (g = -0.97 to -1.07) and emotional
functioning (g = -0.29 to -0.44) were worse in those with a history of alcohol
and/or substance abuse (psychological outcomes). This study highlighted the type
and extent of post-TBI differences between persons with and without a history of
alcohol or substance abuse, many of which may hamper recovery. However, variation
in the criteria for premorbid abuse, limited information regarding the history of
abuse, and an absence of preinjury baseline data prevented an assessment of
whether the differences predated the TBI, occurred as a result of ongoing
alcohol/substance abuse, or reflected the cumulative impact of alcohol/substance
abuse and TBI. 

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