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Risk for Addiction-Related Disorders Following Mild Traumatic Brain Injury

This month's issue of the American Journal of Psychiatry, the Aflagship@ journal of the American Psychiatric Association, includes a study entitled ARisk for Addiction-Related Disorders Following Mild Traumatic Brain Injury in a Large Cohort of Active-Duty U.S. Airmen,@ Miller SC, Baktash SH, Webb TS, Whitehead CR, Maynard C, Wells TS, Otte CN and Gore RK, Am J Psychiatry Miller, et al.; (2013).

The objective of the study was the acknowledgment that “military personnel are at increased risk for traumatic brain injury (TBI) from combat and non-combat exposures. The sequelae of moderate to severe TBI are well described, but little is known regarding long-term performance decrements associated with mild TBI (mTBI). Furthermore, while alcohol and drug use are well known to increase risks for TBI, little is known regarding the reverse pattern.” The authors sought to assess possible associations between mTBI and addiction-related disorders in active-duty U.S. military personnel.

The authors conducted a historical perspective study using electronically recorded demographic, medical and military data for more than a half-million active-duty U.S. Air Force service members. Cases were identified by ICD-9CM codes considered by an expert panel to be indicative of mTBI. Outcomes included ICD-9CM diagnoses of selected addiction-related disorders.

The study found that airmen with mTBI were at increased risk for certain addiction-related disorders compared with a similarly injured non-mTBI comparison group. Hazards for alcohol dependence, nicotine dependence and non-dependent abuse of drugs or alcohol were significantly elevated, with a consistent decrease over time.
 
In their discussion, the authors noted:

Mild TBI was associated with an increased risk for alcohol dependence, non-dependent abuse of drugs or alcohol and nicotine dependence in the first thirty days following mild TBI, with alcohol dependence being significant across all three independent time periods. Contrary to published observations of moderate to severe TBI, there was no period during which significant risk did not occur following mild TBI. Furthermore, whereas previous research indicated that mTBI sequelae resolved quickly, our findings suggest that alcohol dependence may be a long-lasting adverse health outcome following mild TBI.

Again, this study exposes the problem that Larrabee, Binder and Rohling have in that they want to use neuropsychology in the narrowest sense - to assess some cognitive metric in the neuropsychologist's office and not the real world and dismiss everything else, subjective symptoms, onset of new psychiatric disorders, suicide, substance abuse, etc.
 

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