Early recovery following traumatic brain injury and alcohol withdrawal management


Klyce, D.W., Graham, K.M., Lacey, R.W., & Carter, W.E. (2018). Early recovery following traumatic brain injury and alcohol withdrawal management. Rehabilitation Psychology, 63(4), pp. 588-594..


This article sought to compare the early recovery course of individuals with TBI admitted for inpatient rehabilitation based on whether they required intervention for alcohol withdrawal during the acute hospitalization. Participants completed rehabilitation at a TBI Model Systems site. Disability Rating Scale (DRS) scores were completed at admission and discharge, and compared for the group treated with the CIWA protocol (Clinical Institute Withdrawal Assessment for Alcohol, N = 67), and the group without (N = 167). The two groups did not differ in demographics except for age, with the TBI + CIWA group being slightly older than the TBI only group; and there were no differences in injury severity variables. With regard to functional outcomes, the two groups did not differ on DRS admission scores. However, at discharge the TBI + CIWA group had significantly lower DRS scores compared with the TBI only group. Further analyses accounting for posttraumatic amnesia (PTA) duration showed that within the “moderate” TBI group at discharge, the TBI + CIWA group had a lower DRS score compared with the TBI only group. The authors suggest that the overlap between symptoms of alcohol withdrawal and PTA (both reflecting states of delirium) are confounding when determining TBI severity in early recovery. Thus, there may be an “overestimation” of injury severity in individuals undergoing treatment for alcohol withdrawal, particularly for those with a moderate TBI.

I chose this article because it is one of the first to examine early recovery in TBI for individuals with comorbid alcohol withdrawal treatment during the initial hospitalization. These findings will serve as a guide for clinicians working with patients/families during inpatient rehabilitation in discussion of recovery expectations when alcohol treatment has been provided. There is a relatively high comorbidity between TBI and alcohol use disorders, and further exploration of the unique aspects of recovery in patients with both will allow improved identification, management, and intervention with this population. 

THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Kelley D. Beck, Ph.D., Licensed Psychologist at Baylor Scott & White Institute for Rehabilitation in Frisco TX.