Head Injury and Behavioral Control: Implications for Substance Use Recovery Treatment

Background and Purpose: Head injuries, defined as blacking out or losing consciousness for twenty minutes or more, range from mild damage to severe traumatic brain injury and are associated with impairments in executive functioning, emotional regulation, and impulse control – domains of the brain closely associated with substance misuse. Although head injuries may play an important role in the development and evidence-informed treatment of substance use disorders, little research has accrued on persons in these treatment settings. The present study fills this gap by examining the prevalence and predictors of head injury in a sample of adults enrolled in substance use treatment. There are four hypotheses that are considered in this study. First, head injury prevalence will be elevated relative to the estimates in the general population. Second, impulsivity and psychopathy will be positively associated with history of head injury. Third, greater behavioral activation levels will be associated with a greater likelihood of head injury. Lastly, a history of incarceration will independently predict head injury.

Methods: This quantitative, cross-sectional study consisted of administrative intake data of 893 individuals beginning outpatient substance use disorder treatment. The mean age of the sample was 40.5 (SD = 9.9), and most of the sample was white (65.5%, n = 585) and male (60.8%, n = 543). Psychopathy, impulsivity, and behavioral activation were measured by portions of the Short Dark Triad, Barratt Impulsiveness Scale, and the Multidimensional Fatigue Inventory, respectively. Data were analyzed using descriptive statistics and binary logistic regression to examine the relationships between psychopathy, energy, impulsivity, and incarceration history and head injury.

Results: Over half (52.3%, n = 467) of individuals in the study reported sustaining a head injury. Black participants had significantly greater odds of reporting a head injury, indicated by an odds ratio of 1.36 (95% CI [1.00, 1.83], p = 0.047). Similarly, individuals who reported an incarceration history had 74% greater odds of reporting a head injury, signified by the odds ratio 1.74 (95% CI [1.31, 2.31], p = 0.000). Increased levels of psychopathy as well as energy were associated with greater odds of reporting a head injury, 1.04 (95% CI [1.01, 1.06], p = 0.005) and 1.04 (95% CI [1.01, 1.07], p = 0.010) respectively. Surprisingly, impulsivity was not significantly related to head injury.

Conclusions and Implications: Individuals in the sample who reported head injuries were at elevated risk for several deleterious factors associated with substance misuse, including higher behavioral activation, higher psychopathy, and greater odds of incarceration. These findings provide important considerations for employing evidence-informed screening tools and treatment procedures used by clinicians and community providers for individuals who struggle with substance misuse. Future research may include longitudinal data following individuals who have sustained head injuries, further exploration of the relationship between head injury and various risk factors for substance misuse, and collaboration with neuroscientists to examine how trauma in the brain influences substance misuse behaviors and treatment outcomes.