Screening for substance abuse in individuals with traumatic brain injury

Primary objective: To determine the utility of the CAGE, the Brief Michigan Alcohol Screening Test (BMAST) and the Substance Abuse Subtle Screening Inventory (SASSI-3) with individuals with traumatic brain injury (TBI), two studies were conducted examining the accuracy, sensitivity and specificity of these instruments. Research design: Data from self-report instruments were compared to a clinical interview, Structured Clinical Interview for DSM-IV (SCID), to determine the accuracy, sensitivity and specificity. Methods and procedures: Two studies were conducted. In study I, 100 individuals with TBI were screened for alcohol abuse using the CAGE and the resulting classifications were compared with those derived from the SCID. In study II, 223 individuals were screened for alcohol abuse and drug abuse using the BMAST and SASSI-3 and the results of these screenings were compared with diagnoses obtained by the SCID. Main outcomes and results: The specificity of the self-report instruments was moderately high, ranging between 81-83%. The specificity of the CAGE for alcohol abuse both pre- and post-TBI was high, 96% and 86%, respectively. The sensitivity of the self-report instruments was most variable, ranging from 32-95%, with the SASSI face valid drug scale and the CAGE alcohol post-TBI indicating the most sensitivity, 95 and 91%, respectively. Conclusions: The findings suggest that the CAGE may be useful in screening for alcohol abuse and the face valid drug sub-scale of the SASSI-3 may be useful in screening for drug abuse in individuals with TBI.