Integrated Care for Traumatic Brain Injury and Substance Use Disorder

(ExpandAccess Trial)

Overseen By Russell K Gore, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Shepherd Center, Atlanta GA

Disqualifiers: Other brain injury, Neurological disorder, Psychosis

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

360 Participants Needed

Trial Summary

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the Integrated Model of Care treatment for Traumatic Brain Injury and Substance Use Disorder?

Research shows that integrated care models, like the one used for veterans with PTSD and mild traumatic brain injury, improve access to and engagement in psychiatric care, suggesting potential benefits for treating traumatic brain injury and substance use disorder together. ^{1 2 3 4 5}

Is the Integrated Care for Traumatic Brain Injury and Substance Use Disorder generally safe for humans?

The research articles do not provide specific safety data for the Integrated Care model for Traumatic Brain Injury and Substance Use Disorder. However, they highlight the importance of integrating substance use screening and tailored care in treatment protocols to optimize management and resource utilization for TBI patients with substance use issues. ^{3 6 7 8 9}

What makes the Integrated Model of Care treatment unique for traumatic brain injury and substance use disorder?

The Integrated Model of Care is unique because it combines treatment for traumatic brain injury (TBI) and substance use disorder (SUD) into a single, cohesive approach, addressing both conditions simultaneously rather than separately. This integrated care model aims to overcome the fragmentation in healthcare services by using multidisciplinary teams and cognitive accommodations to provide comprehensive support for individuals with both TBI and SUD. ^{1 2 10 11 12}

What is the purpose of this trial?

The purpose of this research is to determine whether military veterans and service members with mild traumatic brain injury with and without co-occurring substance use can complete and benefit from integrated interdisciplinary care individualized to their symptoms, goals, and needs. Participants will complete surveys about substance use and other symptoms at the beginning and end of treatment in an intensive outpatient program and 6 months after discharge.

Eligibility Criteria

This trial is for military veterans and service members who have experienced a mild traumatic brain injury (mTBI), also known as a concussion, with or without substance use issues. Specific eligibility criteria are not provided.

Inclusion Criteria

US military service member or veteran

Participating in the SHARE Military Initiative intensive outpatient program

I have been diagnosed with a mild traumatic brain injury or have had repeated head injuries.

Exclusion Criteria

Active psychosis

I have a history of brain injury or progressive neurological disorder other than mild traumatic brain injury.

I am unable to give consent for medical procedures.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intensive Outpatient Program (IOP) Treatment

Participants engage in interdisciplinary intensive outpatient program treatment for mild traumatic brain injury with individualized support for substance use

8-12 weeks

Weekly in-person sessions

Transition Support Program

Participants receive support for substance use in the transition support program following the IOP treatment

4-6 weeks

Bi-weekly in-person sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 6 months post-treatment

6 months

1 visit (in-person) at 6 months

Treatment Details

Interventions

• Integrated Model of Care

Trial Overview The study is testing an integrated model of care tailored to the individual's symptoms, goals, and needs. Participants will be assessed through surveys at the start and end of treatment in an outpatient program, plus six months after discharge.

Participant Groups

Group I: Integrated Model of Care Experimental Treatment 1 Intervention

Participants will engage in interdisciplinary intensive outpatient program (IOP) treatment for mild traumatic brain injury with individualized support for substance use (SU) following which they will receive support for SU in the transition support program.

Who Is Running the Clinical Trial?

Shepherd Center, Atlanta GA

Lead Sponsor

Trials

30

Recruited

4,000+

Findings from Research

The Integrated Care (IC) model significantly improved access to psychiatric care and engagement among veterans with comorbid PTSD and mild traumatic brain injury (mTBI), as evidenced by increased timely completion of psychiatric consults and higher rates of initiating and completing evidence-based therapies.

In a study reviewing 100 veteran charts, the IC model demonstrated better outcomes compared to the Usual Care (UC) model, suggesting that co-locating psychiatric care within rehabilitation teams can enhance treatment effectiveness for PTSD in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing Access to Psychiatric Care for Posttraumatic Stress Disorder in Veterans with Mild Traumatic Brain Injury through Integrated Services. Baig, MR., Tapia, RN., Meraj, A., et al.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

A systematic review on integrated care for traumatic brain injury, mental health, and substance use. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Systematic review protocol for facilitators and barriers to integrating health services for traumatic brain injury and mental health or addictions. [2023]

3. England pubmed.ncbi.nlm.nih.gov

The presence and impact of traumatic brain injury among clients in treatment for co-occurring mental illness and substance abuse. [2014]

4. England pubmed.ncbi.nlm.nih.gov

A systematic scoping review of interventions to integrate physical and mental healthcare for people with serious mental illness and substance use disorders. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Enhancing Access to Psychiatric Care for Posttraumatic Stress Disorder in Veterans with Mild Traumatic Brain Injury through Integrated Services. [2020]

6. Scotland pubmed.ncbi.nlm.nih.gov

Substance use on admission toxicology screen is associated with peri-injury factors and six-month outcome after traumatic brain injury: A TRACK-TBI Pilot study. [2020]

7. England pubmed.ncbi.nlm.nih.gov

Pilot study of traumatic brain injury and alcohol misuse among service members. [2015]

8. United States pubmed.ncbi.nlm.nih.gov

Social Work Care in Traumatic Brain Injury and Substance Use Disorder Treatment: A Capacity-Building Model. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Alcohol and Drug Use Before and During the First Year After Traumatic Brain Injury. [2019]

10. England pubmed.ncbi.nlm.nih.gov

Integrated care of severe infectious diseases to people with substance use disorders; a systematic review. [2023]

11. United States pubmed.ncbi.nlm.nih.gov

Psychiatric diagnoses, mental health utilization, high-risk behaviors, and self-directed violence among veterans with comorbid history of traumatic brain injury and substance use disorders. [2018]

12. England pubmed.ncbi.nlm.nih.gov

Co-morbid traumatic brain injury and substance use disorder: childhood predictors and adult correlates. [2014]