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Patients with traumatic brain injury should be screened for alcohol problems that can interfere with neurologic recovery

People with traumatic brain injury (TBI) are frequently intoxicated at the time of injury and often have a history of chronic alcohol problems. Screening TBI patients for pre-injury alcohol problems can identify most of those who will develop alcohol-related problems within a year after the injury, according to a study supported in part by the Agency for Healthcare Research and Quality (HS05304). This supports current recommendations for doctors to screen all people hospitalized for traumatic injury for preinjury alcohol problems.

Even people with drinking problems before TBI tend to decrease their drinking shortly after the injury. However, one-fourth of the survivors in this study reported heavy drinking, significant alcohol problems (for example, family complaints or trouble at work), or both, within 1 year after their injury, a time when alcohol use is thought to interfere with neurologic recovery.

The window of opportunity to prevent relapses seems to be soon after injury, perhaps within the first month, when drinking is at the lowest point, suggest the University of Washington School of Medicine researchers who conducted the study. They examined changes in alcohol use from before TBI to 1 year after TBI among 197 adults hospitalized at a trauma center for a broad range of head injuries that resulted in loss of consciousness, posttraumatic amnesia, or other evidence of brain trauma.

Overall, drinking and alcohol-related problems decreased considerably from preinjury to 1 year after injury. Light to moderate drinking or abstinence increased from 49 percent preinjury to 74 percent 1 year later. However, of those who were heavy or problem drinkers before injury, 44 percent remained heavy or problem drinkers 1 year after TBI. Individuals with a history of alcohol problems were nearly 11 times as likely to have significant alcohol problems after TBI as those without preinjury alcohol problems.

See "The natural history of drinking and alcohol-related problems after traumatic brain injury," by Charles H. Bombardier, Ph.D., Nancy R. Temkin, Ph.D., Joan Machamer, M.A., and Sureyya S. Dikmen, Ph.D., in the February 2003 Archives of Physical Medicine and Rehabilitation 84, pp. 185-191.

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