Screening substance abuse treatment clients for traumatic brain injury: Prevalence and characteristics

OBJECTIVES: To examine clinical characteristics of clients in state-funded substance abuse treatment who report traumatic brain injury with loss of consciousness (TBI-LOC). PARTICIPANTS: Adult clients (N = 7784) entering state-funded substance abuse treatment in a rural state during a 12-month period. MEASUREMENT TOOLS: Substance use and mental health problems were measured using the federal Substance Abuse and Mental Health Services Administration (SAMHSA) adaptation of the Addiction Severity index (ASI). A brain injury screening question was used to determine the number of TBI-LOCs in a client's lifetime. DESIGN: Cross-sectional study of intake characteristics as part of a state-mandated treatment outcome study. RESULTS: Almost one-third (31.7%) of substance abuse treatment clients reported 1 or more TBI-LOCs. The clients reporting 2 or more TBI-LOCs were more likely than clients with none or 1 TBI-LOC to have serious mental health problems (ie, depression, anxiety, hallucinations, and suicidal thoughts and attempts), trouble controlling violent behavior, trouble concentrating or remembering, and more months of use of most substances. When depression and anxiety were held constant, and controlling for race and gender, clients with TBI-LOC had more months of marijuana and tranquilizer use. CONCLUSIONS: Findings suggest that treatment providers may need to be attentive to the complex conditions that co-occur with TBI-LOC. Future research should examine whether there are differences in treatment outcome for clients reporting TBI-LOC.