Examining the association of traumatic brain injury (TBI) and alcohol misuse among army service members returning from Iraq and Afghanistan using self-report and provider-assessments of TBI

Rationale: Combat-acquired traumatic brain injury (TBI) is common among military service members serving in Afghanistan and Iraq with reported prevalence ranging from 12-23% of returning service members. In addition to the culture of excessive drinking in the military, studies suggest that TBI may be a risk factor for post-deployment unhealthy alcohol use. Research is needed to determine how routinely collected screening information on TBI and alcohol problems on post-deployment health assessments (PDHA) are used by providers when referring service members for behavioral healthcare visits.

Research Question: The purpose of this study is to: 1) examine the prevalence of TBI on the PDHA using 3 specifications used in the literature, including a) self-reported probable TBI (without ongoing symptoms), b) self-reported TBI with persistent post-concussive symptoms, and c) provider -assessed TBI with persistent post-concussive symptoms, 2) assess if there is an association between TBI (using 3 specifications) with a positive screen for possible alcohol misuse on the AUDIT-C (≥4 for men and ≥3 for women), and 3) examine if behavioral healthcare referral rates differ for those with comorbid TBI and alcohol problems, by TBI specification.

Data Source: This presentation examines data from The Substance Use and Psychological Injury Combat Study (SUPIC) on a cohort of 460,020 Army service members returning from deployment FY2008-11 who completed a PDHA within 60 days of the deployment end date.

Results: The sample is comprised of mostly males (89.3%). About two-thirds are active duty personnel (66.1%) with the remainder from the National Guard/Reserves. By selecting their first deployment in the study period, we found that 7.1% of the sample had a provider-assessed TBI with persistent post-concussive symptoms. Among those with provider-assessed TBI, 36.3% screened positive for potential alcohol misuse with the AUDIT-C, yet only half of these service members (51.4%) were referred for a behavioral health visit on the PDHA.

Implications: When reviewing PDHAs, providers are instructed to assess potential TBI only if service members endorse persistent post-concussive symptoms. These analyses will allow us to understand if those who experienced a TBI while deployed, without reporting persistent post-concussive symptoms, are also at risk for increased alcohol problems, informing clinical guidance on what information is clinically relevant for follow up in primary care and behavioral health settings. Implications for preventing alcohol problems, future research, and policy will be discussed.