U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

Substance Abuse Treatment 

ADVISORY

News for the Treatment Field 

October 2010 

Volume 9 

Issue 2 

Treating Clients With 

Traumatic Brain Injury 

Traumatic brain injury (TBI) is a frequent but underrecognized condition co-occurring with substance 

use disorder (SUD). TBI can cause a wide range of 

cognitive and behavioral consequences that interfere 

with a client’s ability to adhere to substance abuse 

treatment. 

Some clients with TBI enter substance abuse 

treatment with their injury diagnosed, while 

others may enter with an undiagnosed TBI that 

has lingering effects. Treatment counselors also 

may not recognize clients who have been affected 

by TBI because its effects overlap with those of 

SUD and other co-occurring conditions such as 

depression, generalized anxiety disorder, and 

posttraumatic stress disorder (PTSD). 

Substance abuse treatment counselors need to 

be aware that TBI may be a health condition 

affecting their clients. Through observation and 

questioning, counselors can try to identify clients 

whose functioning is affected by TBI and who 

may require special strategies in their treatment 

for SUD. Counselors also can incorporate these 

important facts into relapse prevention messages 

for all clients: that substance abuse increases the 

likelihood of a first or recurrent TBI and that TBI 

compounds the brain function problems caused by 

substance abuse. 

What Is TBI? 

TBI is a disruption of normal brain function that 

occurs when the skull is struck, suddenly thrust out 

of position, penetrated, or struck by blast pressure 

waves.1,2 Common causes of TBI include: 

●		Falls from a height or on the same level. 

●		Motor vehicle crashes, which may include 

collision of the head against a windshield or 

steering wheel or whiplash (the brain striking the 

skull, scraping against its base, or twisting). 

●		An object hitting the head, such as a bullet, 

flying debris, or a falling object.
	

●		The head colliding with an object (e.g., a wall) 

or with another person (e.g., in a contact sport). 

●		Assaults causing either blunt or penetrating 

trauma.
 

●		Explosions in which an intense wave of pressure 

passes through the skull. 

The initial trauma tears, shears, or destroys brain 

tissue. These effects may cause a second injury 

cascade in the brain including internal bleeding, 

edema (swelling), oxygen deprivation, and 

neurochemical responses leading to cell death. A 

TBI can affect a single, specific region of the brain 

(a focal injury), neural cells and tissues distributed 

throughout the brain (a diffuse injury), or both. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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How Common Is TBI? 

Each year, an estimated average of 1.7 million TBIs 

occur in the United States. Of those sustaining these 

injuries, 52,000 die, 275,000 are hospitalized, and 

1.365 million—nearly 80 percent—are treated and 

released from emergency departments. Potentially 

hundreds of thousands more individuals sustain TBI 

each year but are not included in the data sets used to 

form these estimates because they do not seek medical 

treatment or because they are treated in physicians’ 

offices, urgent care clinics, or Federal, military, or 

Veterans Affairs hospitals.3 

In every age group, TBI rates are higher for males than 

for females. Among the age groups that have the highest 

proportions of TBI are adolescents ages 15–19 and 

adults ages 75 and older.3

 Sports-related TBIs alone are 

estimated at between 1.6 million and 3.8 million each 

year.4

 For service members in Iraq or Afghanistan, the 

main TBI risk is from an improvised explosive device 

(IED) such as a roadside bomb. Helmets and body armor 

provide some protection against penetrating head injury 

and, to a lesser extent, head-impact events. However, the 

brain remains vulnerable to the effects of blast waves 

from IEDs. Gunshot wounds as well as combat- or 

training-related falls and motor vehicle crashes are other 

causes of service-related TBI. It is estimated that some 

320,000 of the 1.64 million service members deployed 

to Iraq and Afghanistan through October 2007 may have 

incurred TBI.5 

What Are the Links Between SUD 

and TBI? 

Epidemiological surveys have established that acute 

intoxication or SUD dramatically increases risk of TBI and 

impairs TBI recovery. The data are described below. 

History of substance abuse is a risk factor for TBI. 

Among patients hospitalized for TBI, between one-third 

and four-fifths have histories of substance misuse, with 

alcohol being the most commonly reported misused 

substance.6,7,8 

Alcohol use at time of injury is a common occurrence 

with TBI. Approximately three-quarters of all patients 

with TBI have measurable amounts of alcohol in their 

blood when admitted to the hospital,8

 and one-third to onehalf of them are intoxicated at the time of injury.6,7 

Prior TBI is common among individuals in substance 

abuse treatment. In a review of five studies of people in 

substance abuse treatment, estimates for prior TBI ranged 

from 38 percent to 63 percent.9 In another study of 7,784 

adults in State-funded substance abuse treatment programs, 

almost one-third of persons assessed at intake reported a 

history of one or more head injuries for which they lost 

consciousness or were hospitalized at least 1 night.10 

Substance abuse is linked to worse outcomes from TBI. 

Brain imaging studies and neuropsychological testing 

indicate that SUD and TBI compound the negative effects 

each has on brain structure and function.9 A substance 

abuse history is associated with worse outcomes from TBI 

including greater likelihood of mortality, complications, 

and poorer hospital or emergency department discharge 

status,6

 as well as ongoing disability and nonproductivity a 

year or more after brain injury.11 

Substance abuse is linked to recurrent TBI. TBI related 

to alcohol use increases the risk of subsequent TBI, often 

alcohol-related; this risk extends for several years after the 

first injury.12 

It is not yet known whether a TBI itself increases risk 

of SUD in persons otherwise not at psychological or 

psychiatric risk of addiction at the time of injury. Some 

evidence suggests that TBI, especially to frontal cortex 

regions, may induce deficits in executive function 

(cognitive processes affecting mental control and selfregulation) that confer risk for SUD generally.13 

How Is TBI Diagnosed? 

TBI is initially diagnosed as mild, moderate, or severe, 

based on the individual’s condition at the time of injury. 

About 75 percent of all TBIs are mild.14 Concussion 

is often used as a synonym for mild TBI, especially in 

reference to sports injuries. 

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A TBI diagnosis is based on one or more of the 

following criteria: loss of consciousness, memory 

loss for events immediately before or after the injury, 

confusion and disorientation, and neurologic signs 

such as a wound to the skull, seizures, or headache15 

(a person who does not lose consciousness may still 

be diagnosed with TBI if other criteria are met). Brain 

imaging techniques such as computed tomography 

or magnetic resonance imaging (commonly referred 

to as CT scan and MRI, respectively) can sometimes 

capture signs of TBI. Patients with moderate or severe 

TBI may have pronounced physical symptoms such as 

paralysis. 

Compared with moderate or severe TBI, mild TBI can 

be difficult to diagnose because the acute symptoms 

and signs resolve quickly in most people and there 

may not be a visible head wound to indicate injury. In 

many cases, brain imaging is inconclusive and does 

not aid in diagnosis.15 Also, many people who incur a 

mild TBI do not seek medical treatment. As a result of 

these diagnostic challenges, clients in substance abuse 

treatment may not report a prior TBI when providing 

their medical history on admission. 

What Are the Effects of TBI? 

In the days or weeks after a brain injury, cognitive effects may 

emerge involving the ability to think efficiently, multitask, 

and persevere at a task without becoming mentally exhausted 

or irritable.16 Some individuals have impaired executive 

function. Their sensory functions may be affected so that 

light levels seem too bright and normal noises too loud and 

distracting. These people also may have reduced capacity 

to read, see, or hear. Social judgment, self-awareness, and 

regulation of emotions may be affected. Exhibit 1 lists 

common effects of TBI. This list should be interpreted with 

caution, because many of the effects are characteristic of 

other psychiatric disorders, including affective disorders 

and addiction. Substance abuse treatment counselors should 

therefore be aware that these effects may be difficult to 

differentiate from the effects of a psychiatric disorder, SUD, 

or withdrawal. The level and duration of TBI effects vary 

dramatically from person to person depending on the severity 

and location of the brain injury, time that has elapsed since 

injury, the individual’s age when injured (injury during 

childhood and adolescence carries more risk), health and 

cognitive status of the individual before injury, rehabilitation 

provided after injury, and substance abuse history. 

Exhibit 1. Common Effects of TBI 

Motor and Sensory Effects Cognitive Problems Emotional Effects 

● Dizziness, lightheadedness, or 

vertigo 

● Fatigue or lethargy 

● Gait disorders17 

● Headaches and other pain 

symptoms 

● Nausea17 

● Sensory impairments (blurred 

vision, sensitivity to light or 

sound, ringing in the ears, 

persistent noxious smell or taste 

in mouth, itching)18 

● Sleep disturbances 

● Weakness17 

● Executive function problems 

affecting ability to organize 

thoughts and plans, follow 

through on intended actions, 

do abstract reasoning, solve 

problems, make judgments, or 

read18 

● Impaired attention and 

concentration 

● Language and communication 

impairments18 

● Reduced cognitive speed and 

endurance16 

● Reduced multitasking abilities16 

● Worsened memory 

● Aggression and irritability 

● Anxiety 

● Apathy or lack of spontaneity 

● Difficulty regulating emotions 

● Impulsive, disruptive, or socially 

inappropriate behavior 

● Lack of self-awareness 

(including lack of awareness of 

cognitive deficits)16 

● Personality changes18 

Source: Note 19 unless otherwise indicated. 

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Are TBI Effects Permanent? 

Many individuals with TBI make a full recovery—some 

quickly and others over weeks or months. However, even 

mild TBI can have long-lasting cognitive and behavioral 

effects that impair the ability to work and engage in usual 

activities. Multiple TBIs are cumulative in effect and, even 

if mild, can result in severe brain damage. 

Approximately 1 percent of the U.S. civilian population, or 

3.17 million people, are living with a long-term disability 

from TBI that may limit their ability to work or perform 

daily activities without assistance.20 Some individuals who 

appear to have recovered find that their symptoms recur 

when they are under stress. 

How Does TBI Affect Substance Use? 

TBI is strongly associated with subsequent abstinence 

or reduced consumption.21,22,23 Factors contributing to 

reduced substance use include intense clinical monitoring 

during hospitalization or advice from outpatient healthcare 

providers to abstain, decreased access to alcohol or drugs 

(e.g., because of physical disability or close monitoring 

by caregivers), decreased tolerance to substances, or 

decisions to make life changes after the brain injury. For 

some, however, the reduction in use is only temporary.23 

A minority begins drinking or increases alcohol consumption in the first year after injury.21,22 A history of substance 

abuse before sustaining a TBI is a risk factor for heavy 

drinking afterward.21,22 In addition, stimulants and opioid 

analgesics frequently used to treat cognitive disruption or 

pain from the TBI have abuse potential. These substance 

use patterns have several implications for treatment 

counselors: 

●		TBI can be a triggering event that impels clients to 

reform their substance use patterns.
 

●		Elapsed time from TBI increases the risk for return to 

former patterns of abuse. 

●		Individuals with abuse patterns before the injury may 

need increased continuing care and extra emphasis on 

relapse prevention. 

Is TBI Linked to Other Conditions 

Besides SUD? 

Several conditions that frequently co-occur with SUD also 

co-occur with TBI. These conditions can complicate the 

substance abuse treatment provider’s effort to determine 

whether TBI is contributing to a client’s difficulty in 

treatment. 

Risk is elevated for psychiatric disorders following TBI. 

Susceptibility is greatest for depression, generalized anxiety 

disorder, and PTSD.24,25,26 Conversely, risk is elevated for 

TBI among individuals diagnosed with such psychiatric 

disorders.27 

Suicide Risk 

The risk for committing suicide is two to four times 

greater for individuals with TBI than for the general 

population.28 Even mild brain injury increases risk. 

When a psychiatric disorder or SUD co-occurs with 

TBI, the risk for attempted or completed suicide is 

further increased.28,29 

Chronic pain is another disorder that can co-occur with a 

client’s TBI. It affects about half of all individuals with 

TBI, even those with mild injury.30 The co-occurrence of 

PTSD with TBI appears to exacerbate pain. 

How Can a Counselor Tell Whether 

a Client Is Affected by TBI? 

Consistent failure in completing tasks, disinterest, 

inappropriate social behavior, lack of self-awareness, 

and tangential speech (making irrelevant and unrelated 

statements) are among the red-flag behaviors of the 

person with TBI. They also are typical for the client in 

substance abuse treatment. Counselors are advised to 

investigate whether head injury is involved before imposing 

consequences for a client’s nonadherent treatment behavior. 

Counselors can ask questions using simple, nonmedical 

terms: “Have you ever been knocked out?” or “Did you lose 

any memory after being hit?” For young clients especially, 

it may be appropriate to ask about involvement with contact 

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sports such as football that may have caused hits to the 

head. To help differentiate between a true thought disorder, 

psychosis, and other psychiatric disorders, it is important 

to use a valid and reliable structured or semistructured 

interview when conducting an assessment. Exhibit 2 

provides links to such tools. Counselors should follow their 

facility’s procedures for referring clients with suspected TBI 

impairments to a physician (preferably one who is familiar 

with both SUD and TBI) for a thorough assessment. 

Exhibit 2. TBI Screening and 

Management Tools
 

The Ohio Valley Center for Brain Injury Prevention 

and Rehabilitation has developed a screening tool for 

use by nonexperts to identify clients who may need 

support in treatment because of a TBI history. The 

T-B-I Screening Tool uses a series of questions to 

help clients recall and characterize head injuries.31 It 

also includes information for working with clients who 

have TBI. The tool can be accessed at http://www. 

tbied.com/media/2009/06/15/TBI-Screening_v2_.pdf. 

A clinical practice guideline from the Department 

of Veterans Affairs and the Department of Defense 

includes a structured interview for collecting head 

trauma event characteristics (Appendix B) as well 

as management guidance for the individual with 

concussion/mild TBI.32 It can be accessed at http:// 

www.healthquality.va.gov/mtbi/concussion_mtbi_ 

full_1_0.pdf. 

Treatment Improvement Protocol (TIP) 29: Substance 

Use Disorder Treatment for People With Physical and 

Cognitive Disabilities can be accessed at http://www. 

ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip& 

part=A52487.33 

Clients referred into treatment for TBI may be able to access 

a range of rehabilitative services, including exercises to 

improve memory, problemsolving ability, attention span, 

speech, reading, and physical functioning; instruction 

in coping and compensatory strategies; and skills and 

vocational retraining. TBI treatment also can include therapy 

and medication to treat injury symptoms such as seizures, 

pain, anxiety, depression, or sleep problems. 

What Strategies Should Counselors 

Use for Clients With TBI? 

The tools listed in Exhibit 2 can be helpful to substance 

abuse treatment counselors who have clients with TBIrelated cognitive limitations. Such clients can benefit 

from a low-stimulus counseling environment with few 

distractions and frequent rest breaks. They also are 

best supported by structured instruction, presented in a 

variety of formats and aimed at helping them acquire 

adaptive and coping skills. 

Counselors may need to keep the pace slow and to repeat 

information frequently, in short and concise segments. 

Feedback (including feedback on behavior) should be 

specific, immediate, direct, and positive. Counselors 

should keep in mind that inappropriate client behavior 

may be unintentional; in such cases, the client can 

benefit from gentle redirection. Counselors should avoid 

confrontation, which can agitate the client and shut 

down thinking. Counselors also can encourage clients to 

rehearse desired actions and to adopt reminder systems 

such as calendars, lists, or electronic devices like those 

described in Exhibit 3 (see next page). Other actions 

counselors can take are suggested below. 

Coordinate with other providers of care. 

Collaborative care teams can include physicians 

as well as specialists for physical and neurological 

rehabilitation, psychiatric disorders, vocational 

rehabilitation, employment services, and family 

support services. Case management services are 

helpful for clients with co-occurring SUD and TBI.34 

If the case manager is not from the substance abuse 

treatment facility, the counselor may have to educate 

the case manager about substance abuse treatment and 

how it affects a client’s needs. 

Promote an expectation that the brain injury will 

heal. Many TBIs resolve over time. This reassurance 

can contribute to recovery from TBI. The client who is 

frustrated and discouraged can be helped by knowing 

that the head will continue to “clear” and his or her 

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Exhibit 3. Assistive Technologies 

for Clients With TBI 

Cell phones, smart phones, and other forms of 

personal digital assistants can be used by clients with 

cognitive issues to remember essential information, 

navigate daily tasks, be reminded of appointments 

or times to take medication, and stay focused on 

treatment goals. Counselors can send the client 

text messages or voice reminders (these can be 

automated), and they can help the client program the 

devices to provide timer beeps, visual cues, maps, 

or other cognitive aids. A database of the burgeoning 

variety of assistive devices and software is available 

at http://www.abledata.com. 

ability to adhere to the recovery plan will improve with 

time and practice. 

Educate clients about the need to remain abstinent 

to avoid another TBI.8 Counselors can reinforce the 

client’s motivation for recovery by emphasizing that 

relapse can worsen the adverse cognitive and emotional 

effects of his or her TBI. Relapse also increases risk 

of a repeat TBI, which can cause even greater brain 

damage. 

Encourage clients to join a TBI support group. 

Rehabilitation facilities often organize TBI support 

groups. Alternatively, substance abuse treatment 

programs can form in-house groups or provide peer 

mentors for clients affected by TBI. 

Provide incentives. A small gift certificate (e.g., $20) 

for completing the intake process can accelerate the 

decision by a person with TBI to commit to a substance 

abuse treatment plan.35 Gift certificates also can 

positively affect early attendance and retention.36 

Offer motivational support. Clients with TBI may 

benefit from systematic motivational counseling (an 

intensive form of motivational counseling) when it is 

used as an adjunct to other therapeutic techniques.37 

Booster sessions following motivational counseling 

may help clients remain abstinent. 

Support client’s coping skills. Positive coping styles 

(e.g., actively addressing the problem, using humor to 

counteract stress, making time for enjoyable activities) 

help the client with SUD and TBI adjust to the distress 

that accompanies decreased functional ability. These 

adjustments in turn may reinforce effective coping.38 

Resources for Additional 

Information 

Brain Injury Association of America 

http://www.biausa.org 

Brainline.org 

http://www.brainline.org 

Centers for Disease Control and Prevention, National 

Center for Injury Prevention and Control Traumatic Brain 

Injury Page 

http://www.cdc.gov/TraumaticBrainInjury/index.html 

Defense and Veterans Brain Injury Center 

http://www.dvbic.org 

National Institute of Neurological Disorders and Strokes, 

Traumatic Brain Injury Information Page 

http://www.ninds.nih.gov/disorders/tbi/tbi.htm 

Relevant Publications From 

SAMHSA 

TIP 29: Substance Use Disorder Treatment for People With 

Physical and Cognitive Disabilities (SMA) 08-4078 

Anger Management for Substance Abuse and Mental 

Health Clients: A Cognitive Behavioral Therapy Manual 

(SMA) 08-4213; also available in Spanish (SMA) 07­

4188 

Anger Management for Substance Abuse and Mental 

Health Clients: Participant Workbook (SMA) 08-4210; 

also available in Spanish (SMA) 08-4189 

These publications can be ordered from the Substance 

Abuse and Mental Health Services Administration 

(SAMHSA) by calling 1–877–SAMHSA–7 

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ADVISORY .............................................................................. 
 

(1–877–726–4727). They can also be downloaded from 

the Knowledge Application Program Web site at http:// 

www.kap.samhsa.gov. 

Notes 

1

Centers for Disease Control and Prevention, National Center for Injury 

Prevention and Control. (2009). Traumatic brain injury. Retrieved 

September 21, 2010, from http://www.cdc.gov/traumaticbraininjury 

2

Taber, K. H., Warden, D. L., & Hurley, R. A. (2006). Blast-related 

traumatic brain injury: What is known? Journal of Neuropsychiatry 

& Clinical Neurosciences, 18(2), 141–145. 

3

Faul, M., Xu, L., Wald, M. M., & Coronado, V. G. (2010). Traumatic 

brain injury in the United States: Emergency department visits, 

hospitalizations, and deaths, 2002–2006. Atlanta, GA: Centers 

for Disease Control and Prevention, National Center for Injury 

Prevention and Control. 

4

Langlois, J. A., Rutland-Brown, W., & Wald, M. M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. 

Journal of Head Trauma Rehabilitation, 21(5), 375–378. 

5

Tanielian, T. J., & Jaycox, L. H. (2008). Invisible wounds of war: 

Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation. 

6

Corrigan, J. D. (1995). Substance abuse as a mediating factor in outcome from traumatic brain injury. Archives of Physical Medicine and 

Rehabilitation, 76(4), 302–309. 

7

Parry-Jones, B. L., Vaughan, F. L., & Cox, W. M. (2006). Traumatic 

brain injury and substance misuse: A systematic review of prevalence and outcomes research (1994–2004). Neuropsychological 

Rehabilitation, 16(5), 537–560. 

8

Taylor, L. A., Kreutzer, J. S., Demm, S. R., & Meade, M. A. (2003). 

Traumatic brain injury and substance abuse: A review and analysis of 

the literature. Neuropsychological Rehabilitation, 13(1/2), 165–182. 

9

Corrigan, J. D. (2005). Substance abuse. In W. M. High, Jr., A. M. 

Sander, M. A. Struchen, & K. A. Hart (Eds.), Rehabilitation for 

traumatic brain injury (pp. 133–155). New York: Oxford University 

Press. 

10Walker, R., Cole, J. E., Logan, T. K., & Corrigan, J. D. (2007). 

Screening substance abuse treatment clients for traumatic brain 

injury: Prevalence and characteristics. Journal of Head Trauma 

Rehabilitation, 22(6), 360–367. 

11Willemse-van Son, A. H., Ribbers, G. M., Verhagen, A. P., & Stam, 

H. J. (2007). Prognostic factors of long-term functioning and productivity after traumatic brain injury: A systematic review of prospective 

cohort studies. Clinical Rehabilitation, 21(11), 1024–1037. 

12Winqvist, S. H., Luukinen, H., Jokelainen, J., Lehtilahti, M., Näyhä, 

S., & Hillbom, M. (2008). Recurrent traumatic brain injury is predicted by the index injury occurring under the influence of alcohol. 

Brain Injury, 22(10), 780–785. 

13Bjork, J. M., & Grant, S. J. (2009). Does traumatic brain injury 

increase risk for substance abuse? Journal of Neurotrauma, 26(7), 

1077–1082. 

14Gerberding, J. L., & Binder, S. (2003). Report to Congress on mild 

traumatic brain injury in the United States: Steps to prevent a serious public health problem. Atlanta, GA: Centers for Disease Control 

and Prevention, National Center for Injury Prevention and Control. 

15Ruff, R. M., Iverson, G. L., Barth, J. T., Bush, S. S., Broshek, 

D. K., & the NAN Policy and Planning Committee. (2009). 

Recommendations for diagnosing a mild traumatic brain injury: A 

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Clinical Neuropsychology, 24(1), 3–10. 

16Lux, W. E. (2007). A neuropsychiatric perspective on traumatic brain 

injury. Journal of Rehabilitation Research and Development, 44(7), 

951–962. 

17Department of Veterans Affairs. (2004). Traumatic brain injury. 

Retrieved September 21, 2010, from http://www.publichealth.va.gov/ 

docs/vhi/traumatic_brain_injury.pdf 

18National Institute of Neurological Disorders and Stroke. (2002). 

Traumatic brain injury: Hope through research. NIH Publication No. 

02-2478. Retrieved September 21, 2010, from http://www.ninds.nih. 

gov/disorders/tbi/detail_tbi.htm 

19American Psychiatric Association. (2000). Diagnostic and statistical 

manual of mental disorders (4th ed., text revision). Washington, DC: 

Author. 

20Zaloshnja, E., Miller, T., Langlois, J. A., & Selassie, A. W. (2008). 

Prevalence of long-term disability from traumatic brain injury in 

the civilian population of the United States, 2005. Journal of Head 

Trauma Rehabilitation, 23(6), 394–400. 

21Bombardier, C. H., Temkin, N. R., Machamer, J., & Dikmen, S. S. 

(2003). The natural history of drinking and alcohol-related problems after traumatic brain injury. Archives of Physical Medicine and 

Rehabilitation, 84(2), 185–191. 

22Horner, M. D., Ferguson, P. L., Selassie, A. W., Labbate, L. A., 

Kniele, K., & Corrigan, J. D. (2005). Patterns of alcohol use 1 year 

after traumatic brain injury: A population-based, epidemiological 

study. Journal of the International Neuropsychological Society, 

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23Ponsford, J., Whelan-Goodinson, R., & Bahar-Fuchs, A. (2007). 

Alcohol and drug use following traumatic brain injury: A prospective 

study. Brain Injury, 21(13–14), 1385–1392. 

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24Kennedy, J. E., Jaffee, M. S., Leskin, G. A., Stokes, J. W., Leal, F. O., 

& Fitzpatrick, P. J. (2007). Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain 

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895–920. 

25Rogers, J. M., & Read, C. A. (2007). Psychiatric comorbidity following traumatic brain injury. Brain Injury, 21(13–14), 1321–1333.

26Silver, J. M., Kramer, R., Greenwald, S., & Weissman, M. (2001). 

The association between head injuries and psychiatric disorders: 

Findings from the New Haven NIMH Epidemiologic Catchment 

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27Vassallo, J. L., Proctor-Weber, Z., Lebowitz, B. K., Curtiss, G., & 

Vanderploeg, R. D. (2007). Psychiatric risk factors for traumatic 

brain injury. Brain Injury, 21(6), 567–573.

28Teasdale, T. W., & Engberg, A. W. (2001). Suicide after traumatic 

brain injury: A population study. Journal of Neurology, Neurosurgery 

and Psychiatry, 71(4), 436–470.

29Mainio, A., Kyllönen, T., Viilo, K., Hakko, H., Särkioja, T., & 

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suicide: A population-based study of suicide victims during the years 

1988–2004 in northern Finland. Brain Injury, 21(8), 851–855.

30Nampiaparampil, D. E. (2008). Prevalence of chronic pain after traumatic brain injury: A systematic review. JAMA, 300(6), 711–719.

31Ohio Valley Center for Brain Injury Prevention and Rehabilitation. 

(2009). T-B-I screening. Retrieved September 21, 2010, from http://

www.tbied.com/media/2009/06/15/TBI-Screening_v2_.pdf

32Department of Veterans Affairs/Department of Defense (Management 

of Concussion/mTBI Working Group). (2009). Clinical practice 

guideline: Management of concussion/mild traumatic brain injury.

Retrieved September 21, 2010, from http://www.healthquality.

va.gov/mtbi/concussion_mtbi_full_1_0.pdf

33Center for Substance Abuse Treatment. (1998). Substance use disorder treatment for people with physical and cognitive disabilities. 

Treatment Improvement Protocol 29. HHS Publication No. (SMA) 

08-4078. Rockville, MD: Substance Abuse and Mental Health 

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34Heinemann, A. W., Corrigan, J. D., & Moore, D. (2004). Case management for traumatic brain injury survivors with alcohol problems. 

Rehabilitation Psychology, 49(2), 156–166.

35Corrigan, J. D., Bogner, J., Lamb-Hart, G., Heinemann, A. W., & 

Moore, D. (2005). Increasing substance abuse treatment compliance 

for persons with traumatic brain injury. Psychology of Addictive 

Behaviors, 19(2), 131–139. 

36Corrigan, J. D., & Bogner, J. (2007). Interventions to promote retention in substance abuse treatment. Brain Injury, 21(4), 343–356.

37Cox, W. M., Heinemann, A. W., Miranti, S. V., Schmidt, M., Klinger, 

E., & Blount, J. (2003). Outcomes of systematic motivational counseling for substance use following traumatic brain injury. Journal of 

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38Anson, K., & Ponsford, J. (2006). Coping and emotional adjustment following traumatic brain injury. Journal of Head Trauma 

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Substance Abuse Treatment Advisory

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Recommended Citation: Center for Substance Abuse Treatment. (2010). 

Treating Clients With Traumatic Brain Injury. Substance Abuse Treatment 

Advisory, Volume 9, Issue 2.

HHS Publication No. (SMA) 10-4591 

First Printed 2010

Substance Abuse Treatment Advisory 

Treating Clients With Traumatic Brain Injury