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***** the Brynawel approach


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Alcohol-related brain damage ( ARBD ) refers to the damaging effects of long term alcohol consumption on the brain . Alcohol toxicity , vitamin deficiencies and disrupted blood supply to the brain can result in a range of serious conditions , including Wernicke ’ s Encepalopathy , Korsakoff ’ s Syndrome , alcohol-related dementia and alcohol amnestic syndrome .

It has been suggested that these disorders are best regarded as occurring on a spectrum ( Jacques and Stephenson 2000 ). It is not the same thing as age-related dementia ; ARBD occurs when a person is deficient in thiamine ( vitamin B1 ) and if untreated can lead to memory problems and frontal lobe dysfunction ( Chiang , 2002 ).
The impact of ARBD ranges from mild to very severe . The good news is that this need not necessarily be progressive if people can engage in cognitive rehabilitation , abstain from alcohol and maintain a good diet . While intellectual functioning appears to remain intact , memory and social functioning can be improved through targeted rehabilitation . Smith and Hillman ( 1999 ) suggest that 75 per cent of clients can expect some level of recovery , with 25 per cent making full recovery .
It is very difficult to obtain accurate prevalence figures for ARBD . However , a service for those under 65 years of age in Cheshire and the Wirral reportedly receives three new referrals per month , suggesting an annual incidence of 13.9 / 100,000 in those aged under 65 ( Wilson quoted in Smith and Emmerson , 2015 ).
Research ( Wilson , 2014 ) suggests that the experiences of people with ARBD within the healthcare system are very poor . They include a lack of diagnostic expertise , general ignorance of psychiatric , medical and nursing staff , lack of care pathways and resources and stigma . Patients can fall between services and

Getting the right treatment can reverse effects of alcohol-related brain damage , says Alyson Smith

have higher rates of morbidity and mortality .
A report from Public Health Wales ( Emmerson and Smith , 2015 ) suggested that given the estimated prevalence of ARBD , residential rehabilitation required for this group is inadequate . In 2014 , a task and finish group was set up at Brynawel Rehab to address this gap in service provision locally .

***** the Brynawel approach

A six-month programme was developed at Brynawel which focuses upon both neuropsychological rehabilitation as well as problematic alcohol use . Admission criteria are shown in the table on the opposite page .
Clients are admitted to Brynawel following initial diagnosis and physical stabilisation ( detox ). Each client undertakes formal psychiatric and neuropsychological assessment at the beginning , middle and towards the end of their stay . Alongside qualitative daily observations , the results of these assessments are used to inform their individual rehabilitation plan during their
• Confusion regarding time and place
• Impaired attention and concentration
• Difficulty processing new information
• Inability to screen out irrelevant information
• Confabulation – filling gaps with irrelevant information
• Apathy – loss of motivation , spontaneity and initiative
• Depression and irritability

‘ Research suggests that the experiences of people with ARBD within the healthcare system are very poor .’

stay and make any recommendations for their ongoing support needs upon discharge . Clients are supported by a dedicated ARBD team throughout their stay , with a support ratio of three to one , with the option to ‘ step this up to one-to-one support ’ if needed .
The assessment phase is an opportunity for clients to settle into a calm stable environment . During this time , a holistic approach is taken to supporting clients with abstinence ( including thiamine ), nutrition , regular sleep , and other aspects of lifestyle . Psychosocial support is introduced very early on , and engagement of family / significant
• Ataxia – poor balance , disordered gait
• Damage to liver , stomach , and pancreas
• Possibility of traumatic brain injury
• Peripheral neuropathy – numbness , pins and needles in hands , feet , or legs
• Nystagmus and opthalmoplegia – involuntary eye movement
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