Patterns and Trends in Prevalent Central Nervous System Stimulant Use in US Veterans with Traumatic Brain Injury

Yan Cheng, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Youxuan Ling, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Joel Scholten, Veterans Affairs Medical Center, Washington, DC.
David Atkins, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Joseph L. Goulet, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Yale University, New Haven, CT.
Helen M. Sheriff, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Charity J. Morgan, Veterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham, Birmingham, AL.
Mary R. Lee, Veterans Affairs Medical Center, Washington, DC.
Cherina M. Cyborski, Veterans Affairs Medical Center, Washington, DC.
Jose D. Vargas, Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Friedhelm Sandbrink, Veterans Affairs Medical Center, Washington, DC.
Vamsee Potluri, Veterans Affairs Medical Center, Washington, DC.
Qing Zeng-Treitler, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Ali Ahmed, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC.
Charles Faselis, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Uniformed Services University, Washington, DC. Electronic address: charles.faselis@va.gov.

Document Type

Journal Article

Publication Date

10-17-2025

Journal

The American journal of medicine

DOI

10.1016/j.amjmed.2025.10.010

Keywords

CNS stimulants; Veterans; prescribing trends; substance use disorder; traumatic brain injury

Abstract

BACKGROUND: Patients with chronic mild traumatic brain injury (TBI) may experience cognitive and behavioral symptoms resembling attention-deficit/hyperactivity disorder (ADHD). Central nervous system (CNS) stimulants, used for ADHD, are not recommended for TBI but are prescribed off-label. We examined patterns and trends of prevalent stimulant use among Veterans with TBI. METHODS: Of the 966,953 U.S. Veterans with TBI (2001-2023), 11,710 were prevalent users of CNS stimulants, defined as prescription fills during six months before first TBI diagnosis in Veterans Affairs (VA) healthcare system. Patients were categorized into 2001-2014 (combat in Iraq and Afghanistan wars), 2015-2019 (post-combat), and 2020-2023 (COVID-19 pandemic). Prevalence (95% CI) of stimulant use per 10,000 Veterans with TBI and yearly temporal trends were estimated. Estimates during 2015-2019 and 2020-2023 were compared with 2001-2014 using absolute standardized differences (ASD; ≥10% suggesting clinically significant difference). RESULTS: Prevalent CNS stimulant use (95% CI) during 2001-2014, 2015-2019, and 2020-2023 were 83 (81-85), 150 (145-155; ASD=6%) and 194 (188-200; ASD=11%) per 10,000 Veterans, respectively. Respective rates in subgroups with opioid use disorder were 174 (165-182), 351 (333-369; ASD=11%), and 457 (434-480; ASD=16%), and attention-deficit/hyperactivity disorder were 2054 (1934-2174), 1764 (1681-1847; ASD=7%), and 1950 (1871-2029; ASD=3%). CONCLUSIONS: Prevalent CNS stimulant use among Veterans with TBI is low, despite higher temporal trends, including in high-risk subgroups. Future studies need to examine patterns and trends of incident CNS stimulant use, as well as their safety and effectiveness.

Department

Medicine

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