Alcohol related brain impairment

About alcohol related brain impairment

Alcohol is one of the many causes of acquired brain injury. The problems caused by alcohol misuse are called alcohol related brain impairment (ARBI). A person with ARBI might experience problems with new learning, memory, thinking-related abilities and physical coordination.

More than 2,500 Australians are treated for ARBI every year, with approximately 200,000 Australians currently undiagnosed. Around 2 million Australians are potentially at risk of developing ARBI due to their drinking habits.

How much damage is done depends on a number of factors, which can include your age, gender, nutrition and your overall alcohol consumption. A younger person has a better chance of recovery, and complete cognitive recovery can take up to 12 months following abstinence. However, the effects of ARBI can be permanent for many people.

Alcohol and brain injury

Brain injury can be caused by alcohol because it:

• has a toxic effect on the central nervous system
• results in changes to metabolism, heart functioning and blood supply
• interferes with the absorption of vitamin B1 (thiamine), which is an important brain nutrient
• may be associated with poor nutrition
• can lead to falls and accidents that injure the brain.

Alcohol consumption and alcohol related brain impairment

Alcohol is one of the most popular drugs in Australia. Around 40% of Australian adults drink alcohol on a weekly basis and 10% drink every day. Alcohol consumption ranges from light (social drinkers) to heavy consumption.

Alcohol related brain impairment is more likely to occur if a person drinks heavily on a regular basis over many years. A decline in thinking-related abilities is gradual and depends on how much alcohol is consumed and for how long.

It is also possible for damage to the brain to occur over a short period of time, if the drinking is excessive enough and diet is compromised. This is known as ‘binge drinking’ or ‘heavy episodic drinking’ and is a short-term, high-risk way of drinking alcohol.

Men and women who consume more than 4 standard drinks on any single occasion are at risk. Mixing alcohol and other drugs – either illegal drugs or some prescription drugs – can cause serious health problems.

Guidelines to reduce health risks from alcohol

The Australian Government's National Health and Medical Research Council's (NHMRC) Australian guidelines to reduce the health risks from alcohol consumption recommend:

• healthy adults – drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day
• children and young people (under 18 years) – should avoid drinking alcohol (there is no ‘safe’ or ‘no-risk’ level)
• pregnancy, planning pregnancy or breastfeeding – avoid drinking alcohol (to reduce the risk of harm to your baby).

Disorders linked with alcohol related brain impairment

ARBI is associated with changes in cognition (memory and thinking abilities), difficulties with balance and coordination, and a range of medical and neurological disorders.

Some alcohol-related disorders include:

• Cerebellar atrophy – the cerebellum is the part of the brain responsible for muscle coordination. Damage results in difficulties with balance and walking, which is called ‘ataxia’.
• Frontal lobe dysfunction – the brain’s frontal lobes are involved in abstract thinking, planning, problem solving and emotion. Damage results in cognitive (thought) difficulties.
• Hepatic encephalopathy – many people with alcohol-related liver disease develop particular psychiatric symptoms, such as mood changes, confusion and hallucinations.
• Wernicke’s encephalopathy – this is a disorder caused by a severe deficiency of vitamin B1. Some of the symptoms include ataxia, confusion and problems with vision.
• Korsakoff’s amnesic syndrome – this includes a loss of short-term memory, an inability to acquire new information and ‘confabulation’ (the person fills in gaps in their memory with fabrications that they believe to be true).
• Peripheral neuropathy – the body’s extremities are affected by numbness, pain, and pins and needles.

Alcohol related brain impairment and memory loss

Impaired new learning or ‘taking in’ information and executive functioning are the most common problems associated with ARBI. Some people struggle to remember things from day-to-day, to plan and organise as required, to control their impulses, and to multi-task or divide their attention.

People with ARBI can experience problems with:

• learning new information
• focusing on a topic of conversation
• retrieving information from the past stored in their memory. They often have difficulty remembering what happened when (the timing of events in memory)
• remembering recent events or information they have recently acquired, usually due to not being able to ‘take in’ the information adequately in the first place
• making errors when recalling information from memory. This can result in information being muddled or incorrect, and is sometimes called ‘confabulation’. Importantly, the confabulations are caused by memory failures – they are not lies.

There are strategies that can help a person with ARBI to improve their new learning and memory and cope with the daily frustrations of their impairment.

Understanding memory limits with ARBI

Don’t assume that people with ARBI will understand and remember what is being discussed. They may nod their head and say they understand when in reality they don’t. If the person with ARBI is aware of their memory limits, they can learn how to deal with them.

‘Taking in’ information and memory may be improved by:

• planning ahead and allowing adequate time to read and review information
• reducing distractions while memorising information
• learning information with a clear mind – memory difficulties can be made worse by tiredness, stress, anxiety, anger or intoxication.

Communicating with a person with ARBI

People with ARBI often have difficulty focusing on a topic of conversation. They can be easily distracted by less relevant points of discussion and wander off in other directions. You can get them back on track by:

• reminding them of the conversation topic
• redirecting the conversation by repeating a question
• using a pencil and paper to focus discussion
• using concrete and familiar terms
• breaking down information into small important points
• slowing down when you talk
• focusing discussion on one topic at a time.

One of the simplest ways to improve memory and communication is to rehearse information they need to remember. Encourage people with ARBI to:

• Ask for instructions or information to be repeated.
• Rephrase instructions in their own words and check that they have understood properly.
• When introduced to someone, immediately repeat the person’s name and use it as much as possible.

Many people with memory problems related to ARBI respond best to questions with a ‘yes’ or ‘no’ answer. For example, instead of asking ‘What did you do today?’ ask ‘Did you go out today?’. Communication can also be improved by providing cues or prompts to trigger memory.

Using memory aids

Using memory aids helps people with ARBI to make sure things are not forgotten. There is a range of aids available and their effectiveness depends on what best suits each person.

Some useful aids include:

• writing lists for shopping or jobs to do
• keeping a diary and using it as a daily organiser to record appointments, chores and important dates. Many people with an ARBI effectively use their mobile phone for this
• setting alarms and timers as reminders – for example, to take medication
• preparing written reminders, such as posters on the bathroom wall or notes next to the bathroom mirror
• using a whiteboard to clearly display daily routines, appointments and chores. Place it in a prominent position where it will be regularly seen (such as on the fridge door)
• organise set places within the house for important items (such as a bowl on a table near the door for keys and wallet).
  

Behaviours linked with alcohol related brain impairment

People close to someone with ARBI may face a range of behaviours that cause problems. There are a number of possible causes or reasons for these types of behaviour, including medical problems, memory and thinking problems, physical discomfort, the side effects of medication or fatigue from lack of sleep. Alternatively, behaviours of concern may be a reaction to stress, anxiety, or a change or upset to daily routine.

Some common behaviours include:

• aggressive and angry outbursts
• moodiness
• confusion
• withdrawal
• lack of motivation
• untidiness and poor hygiene habits
• sexually inappropriate behaviour
• poor control of emotions.

Dealing with behaviours of concern

Helpful strategies for behaviours of concern include:

• Be prepared to listen – people with ARBI need to feel listened to and understood.
• Reassure the person that you are there to help them.
• Speak in a calm, soothing tone.
• Give praise when the person regains their composure after an outburst.
• Set clear and firm limits, and repeat them as often as possible.
• Reinforce and reward appropriate behaviour
• Ignore the behaviour if it is appropriate to do so and there is no risk of harm to the individual or others.
• Be consistent and ensure others are also.

There are some responses you should try to avoid when dealing with behaviours of concern, including:

• Avoid arguing or reacting to any provocation.
• Avoid using a bossy tone or ordering the person around.
• Ignore negative, critical or aggressive comments.
• Do not take the behaviour personally.
• Avoid adopting defensive postures such as standing with your arms crossed.

Treatment for alcohol related brain impairment

A person with a suspected ARBI should have their health assessed by a doctor. They may benefit from referral for a more specialist assessment by a neuropsychologist or neurologist.

Treatment depends on the person and the type of brain damage sustained.

Good nutrition is really important. Sometimes, doctors will prescribe multivitamins (especially thiamine) to reduce the risk of further severe brain injury.

Alcohol and other drug treatments may need to be modified for a person with an ARBI.

Support for people with alcohol related brain impairment

ARBI may affect the way people think and behave in everyday life. They often experience feelings of anxiety and stress, and an inability to cope.

You can help someone with ARBI with daily routines and by being there to support and guide them. The amount of support and direction they may need will depend on how severe the brain injury is and will work best if it is tailored to their specific needs and goals.

Learning to live with ARBI

An important and often difficult step for people with ARBI is developing self-awareness and insight into their condition so that they can learn to live with it.

They may need professional help with:

• accepting that they have a brain injury
• understanding how this injury affects their memory, thinking and behaviour
• setting realistic goals and making plans that take their condition into account.

Communicating effectively with ARBI

ARBI can affect communication skills and the ability to take in new information and ideas. When you are communicating with someone with ARBI, it may help if you:

• Avoid overloading them with too much information at once.
• Break down information into points or steps.
• Repeat instructions or important points.
• Use familiar language.
• Give the person plenty of time to process information or complete a task at their own pace.
• Give written information, preferably in point form, as well as discussing it.
• Restrict discussions to one topic or issue at a time.

Establishing daily routines

People with ARBI live to their best potential when their life is organised and follows a good structure. Take some time to help establish routines so that all activities follow a predictable pattern.

Aim to build routine into all aspects of their life such as:

• household chores
• personal hygiene
• shopping
• social activities
• employment
• appointments.

Minimise changes to routines or environment

To help reduce feelings of anxiety or stress in people with more severe ARBI, try to:

• Gradually introduce changes in small ways.
• Plan well ahead and allow plenty of time for discussion.
• Surround the person with familiar objects and people as much as possible.

Be available to listen and support

Other simple ways you can help someone with ARBI include:

• Listen – provide a friendly ear and let them talk about problems and frustrations.
• Guide – in stressful times or times of change, be available to help guide them through the decision-making process.
• Give feedback – be honest and helpful about what you think of their choices or decisions.
• Prompt – help them to follow routines by reminding them of activities and appointments planned for the day.

Where to get help

• Your GP (doctor)
• A neuropsychologist, neurologist or alcohol or other drug treatment service
• arbias Tel. (03) 8388 1222 – specialist services for people with acquired brain injury including alcohol and substance related brain impairment
• SHARC Tel. 1300 660 068 – for information and support for people concerned about a relative or friend using drugs