Alcohol use before and after traumatic head injury.

Study Objective: To determine (1) the significance of blood alcohol level in the emergency department in history of alcohol abuse and (2) the significance of habitual alcohol use in head-injured patients before and after injury.

Design: Inception cohort study with 1-year follow-up.

Setting: Level I trauma center.

Participants: One hundred ninety-seven hospitalized adult head-injury survivors with a broad spectrum of head-injury severity.

Results: Alcohol use and behavioral problems associated with alcohol use were assayed before injury and in the month and year after injury. The patients' blood alcohol levels in the ED were also examined. Preinjury alcohol abuse was frequent; 42% of the subjects were legally intoxicated while in the ED. The amount of drinking and magnitude of reported preinjury alcohol problems decreased soon after the injury but was followed by an increase by 1 year, although the amount of drinking did not return to the preinjury level (P < .0001). Patients with more severe head injuries decreased their drinking more than did those with less severe head injuries. The patients' blood alcohol levels in the ED were a good indicator of the magnitude of their preinjury alcohol problems (r = .51 to .59; each, P < .001).

Conclusion: Preinjury habitual alcohol abuse is frequent in head-injured patients. Blood alcohol levels in the ED are indicative of history of problem drinking and might serve as a basis for treatment referral. The first weeks after injury in hospitalized patients may provide an opportunity to begin interventions because head-injured patients drink less at that time.