Back to reality
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
COGNITIVE AND MEMORY PROBLEMS
• 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
PHYSICAL PROBLEMS
• 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
20 | drinkanddrugsnews | June 2018 www . drinkanddrugsnews . com
alcohol
Back to reality
Getting the right treatment can reverse effects of
alcohol-related brain damage, says Alyson Smith
lcohol-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
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.
A
20 | drinkanddrugsnews | June 2018
*****
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.
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