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Substance Use and Related Harms Among Adolescents With and Without Traumatic Brain Injury

Ilie, Gabriela PhD; Mann, Robert E. PhD; Hamilton, Hayley PhD; Adlaf, Edward M. PhD; Boak, Angela MA; Asbridge, Mark PhD; Rehm, Jürgen PhD; Cusimano, Michael D. MD, PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

The Journal of Head Trauma Rehabilitation: September/October 2015 - Volume 30 - Issue 5 - p 293–301
doi: 10.1097/HTR.0000000000000101
TBI in Children & Adolescents 2015

Objective: The relationship between self-reported lifetime traumatic brain injury (TBI) and drug and alcohol use and associated harms was examined using an epidemiological sample of Canadian adolescents.

Settings and Design: Data were derived from a 2011 population-based cross-sectional school survey, which included 6383 Ontario 9th–12th graders who self-completed anonymous self-administered questionnaires in classrooms. Traumatic brain injury was defined as loss of consciousness for at least 5 minutes or a minimum 1-night hospital stay due to symptoms.

Results: Relative to high schoolers without a history of TBI, those who acknowledged having a TBI in their lifetime had odds 2 times greater for binge drinking (5+ drinks per occasion in the past 4 weeks), 2.5 times greater for daily cigarette smoking, 2.9 times greater for nonmedical use of prescription drugs, and 2.7 times greater for consuming illegal drug in the past 12 months. Adolescents with a history of TBI had greater odds for experiencing hazardous/harmful drinking (adjusted odds ratio [aOR] = 2.3), cannabis problems (aOR = 2.4), and drug problems (aOR = 2.1), compared with adolescents who were never injured.

Conclusion: There are strong and demographically stable associations between TBI and substance use. These associations may not only increase the odds of injury but impair the quality of postinjury recovery.

St. Michael's Hospital, Division of Neurosurgery (Drs Ilie and Cusimano), and Social and Epidemiological Research, Centre for Addiction and Mental Health (Drs Mann, Hamilton, Adlaf, and Rehm and Ms Boak), Toronto, Ontario, Canada; and Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada (Dr Asbridge).

Corresponding Author: Gabriela Ilie, PhD, Division of Neurosurgery and Injury Prevention Research Office, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada (

This work was financially supported by a STAIR Team Grant from the Canadian Institutes of Health Research (TIR-103946) and by the Ontario Neurotrauma Foundation. Additional funding was obtained from a grant from AUTO21, a member of the Networks of Centres of Excellence program that is administered and funded by the Natural Sciences and Engineering Research Council, the Social Sciences and Humanities Research Council, in partnership with Industry Canada, and ongoing funding support from the Ontario Ministry of Health and Long-Term Care.

The authors thank schools and students for their participation and the data collection team from the Institute for Social Research for the dedicated work.

The funding agencies had no role in design and conduct of the study, the collection, management, analysis, and interpretation of the data, or the preparation, review, or approval of the manuscript. All authors are independent from the funding agencies.

The authors declare no conflicts of interest.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.