Table 8.31 Programs for the Treatment of Substance Abuse Post ABI
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Author Year Country Research Design PEDro Sample Size |
Methods |
Results |
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Sander et al. (2012) USA RCT PEDro=5 N=104 |
Population: TBI. Intervention Group (n=54): Mean Age=36.1yr; Gender: Male=44, Female=10; Median GCS Score=14. Control Group (n=50): Mean Age=35.4yr; Gender: Male=41, Female=9; Median GCS Score=12. Intervention: Participants were randomly assigned to receive intervention or control. The intervention group received a motivational interview and education: they watched a 10min educational video about potential negative effects of substance abuse after TBI, and were then asked to consider pros/cons of substance abuse. The control group received standard care: information and referrals typically given to those with substance issues. Assessments were conducted at 3mo follow-up. Outcome Measure: CAGE Alcohol Questionnaire (CAGE-AQ), Alcohol Expectancy Questionnaire-III (AEQ), Readiness to Change Question (RTC). | 1. There was no treatment effect on CAGE-AQ, AEQ, or RTC. 2. After treatment, individuals with severe injury indicated alcohol use could result in physical and cognitive impairment 3. Individuals who attributed their TBI to alcohol use indicated alcohol use could result in physical and cognitive impairment. | |
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Tweedly et al. (2012) USA RCT PEDro=5 N=60 |
Population: TBI; ID Group (n=20): Mean Age=36.5yr; Gender: Male=15, Female=5; Mean Time Post Injury=8 mo. INFO Group (n=20): Mean Age=35.1yr; Gender: Male=14, Female=6; Mean Time Post Injury=7.95 mo. MI Group (n=20): Mean Age=33.9yr; Gender: Male=16, Female=4; Mean Time Post Injury=7.79mo. Intervention: Participants were randomly assigned to one of three conditions: Informal Discussion (ID), a general 30min discussion about changes that had occurred since injury; Information (INFO), a package outlining cognitive, physiological, and behavioural changes that can occur following injury, plus ID; or Motivational Interviewing (MI), plus ID and INFO. Assessments were conducted at baseline and 6mo follow-up. Outcome Measure: Alcohol Use Disorders Identification Test (AUDIT), Timeline Follow-Back (TLFB), Readiness to Change Questionnaire (RTCQ), Hospital and Anxiety and Depression Scale (HADS). | 1. Both MI and INFO groups were drinking less frequently and consuming fewer drinks than ID at follow-up, but the differences were not significant. | |
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Corrigan & Bogner (2007) USA RCT PEDro=5 N=74 |
Population: TBI; Mean Age=42.5yr; Gender: Male=46, Female=28. Intervention: Participants were randomly assigned to one of three conditions: financial incentive (FI, n=24), barrier reduction (BR, n=26), or attention control (AC, n=24). Participants then participated in a treatment program. Assessments were conducted at follow-up. Outcome Measure: Treatment attendance, Premature termination, Perceived therapeutic alliance. | 1. FI resulted in significantly fewer missed appointments and less premature termination (p<0.05). 2. BR did not result in fewer missed appointments or prevent premature termination. 3. There were no significant differences within or between groups in perceived therapeutic alliance between participant and counsellor. | |
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Corrigan et al. (2005) USA RCT PEDro=5 N=195 |
Population: TBI; Mean Age: 36.6yr; Gender: Male=138, Female=57. Intervention: Participants were randomly assigned one of four groups: motivational interviewing (MI), barrier reduction (BR), financial incentive (FI), or attention control (AC). Participants were then asked to sign up for an Individualized Service Plan (ISP). Assessments were conducted at 30d, 3mo, and 6 mo. Outcome Measure: ISP signup, ISP compliance, ISP attrition, Addiction Severity Index (ASI). | 1. The proportion of participants who signed the ISP within 30d differed among conditions (p<0.001): FI (83%) and BR (74%) had greater signing than MI (45%) and AC (45%). 2. The mean number of days to sign the ISP differed among conditions (p=0.01): FI had quicker signing than MI (22.8d versus 44.0d, p<0.001). There were no significant differences with BR (32.1d) or AC (34.8d). 3. ISP compliance (missed appointments) did not differ between FI (40%), BR (42%), MI (57%), or AC (64%). 4. ISP attrition at 3mo (premature termination) did not differ between FI (4%), BR (6%), MI (9%), or AC (15%). 5. ISP attrition at 6mo significantly differed among conditions (p<0.05): FI (21%) and BR (16%) had lower attrition than AC (47%), but not MI (34%). 6. ASI was a significant, negative predictor of ISP signing (p<0.05), time to ISP signing (p<0.05), and ISP attrition (p<0.05). | |
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Cox et al. (2003) USA PCT N=94 |
Population: TBI; Treatment Group (n=40): Mean Age=32.5yr; Gender: Male=33, Female=7; Mean Time Post Injury=4.4 yr. Comparison Group (n=54): Mean Age=35.6yr; Gender: Male=38, Female=16; Mean Time Post Injury=4.4yr. Intervention: The treatment group received 12 sessions of individual systematic motivational interviewing for substance abuse. The control group received no counselling. Assessments were conducted at baseline, after treatment, and at follow-up. Outcome Measure: Substance use, Motivational Structure Questionnaire (MSQ), Positive Affect Negative Affect Scale (PANAS). | 1. Substance use significantly decreased in the treatment group across all time points (p=0.02), but was not significant when compared to the control group (p=0.056). 2. The proportion of participants who were abstinent in the treatment group after treatment was greater than in the control group (50% versus 21%, p=0.057). 3. The proportion of participants who ‘improved’ in terms of substance use over time was greater in the treatment group than in the control group (47% versus 18%, p=0.040). 4. There were no significant differences in the number of each substance used over time within or between groups. 5. On PANAS, the treatment group experienced a significant reduction in negative affect over time (p=0.02), but there were no significant differences when compared with the control group (p>0.10). 6. On MSQ, the treatment group experienced a significant improvement in motivational structure over time (p<0.05) over time, which was significantly greater than the control group (p<0.05). 7. Substance use was correlated with joy, commitment, sorrow, and success on MSQ. | |
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Bogner et al. (1997) USA Case Series N=72 |
Population: TBI; Mean Age=26yr; Gender: Male=56, Female=16; Mean Time Post Injury=44.3mo. Intervention: Subjects received a substance abuse treatment plan and were monitored for 1yr. Some subjects had support of a community team. Outcome Measure: Quantity-Frequency-Variability Index, General Health and History Questionnaire, Addiction Severity Index. | 1. A positive substance abuse outcome was found in 75% of subjects: 18% maintained abstinence, 32% attained abstinence, and 25% reduced alcohol use. 2. A significant difference in abstinence was found between initial assessment and 1yr follow-up (p<0.05). 3. Subjects with a community team had more positive substance abuse outcomes than those without (p<0.05). 4. A greater proportion of subjects with community teams attained abstinence, but a greater proportion of those without teams maintained it. | |