RESUMEN
OBJECTIVES: To compare individuals with mild and moderate/severe traumatic brain injury (TBI) on alcohol and drug use and substance use disorders before and in the first year post-TBI; to explore sociodemographic and injury-related variables associated with substance use disorders. PARTICIPANTS: A total of 225 adults hospitalized in a level I trauma center after TBI. DESIGN: Observational cohort study with retrospective (pre-TBI) and prospective (4, 8, and 12 months post-TBI) assessments. MAIN MEASURES: Mini International Neuropsychiatric Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS: The percentage of participants using alcohol or drug declined shortly after the injury (4 months) but increased closer to preinjury levels by the end of the first year. Post-TBI alcohol use was higher after mild than moderate/severe TBI, but drug use was similar. About 11% of participants met criteria for a substance use disorder in the first year after TBI. Younger age, not being in a relationship, and suspected substance intoxication at the time of TBI were associated with the presence of a post-TBI substance use disorder. CONCLUSION: Individuals with milder injuries return to alcohol use earlier than those with more severe injuries. Given that substance use may alter recovery, preventive recommendations and systematic follow-ups are warranted regardless of injury severity and access to rehabilitation.