Alcohol-Related Brain Injury: Impact on Family and Society Dr Helen McMonagle BSc. MSc. PGDip. DCounsPsych

ARBI Rehabilitation Coordinator

What is an Alcohol-Related Brain Injury?

• Is a term used to describe the injury or damage caused to the brain as a result of excessive alcohol intake and related nutritional deficiencies.

• A spectrum of psycho-neurological/cognitive conditions.

Structural Changes

Sullivan E V , and Pfefferbaum A Alcohol and Alcoholism 2009;44:155-165

Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved

Functional Changes

Key cognitive skills affected by ARBI:

• Memory

• Executive functions

• Balance & Coordination

These can range from mild to severe.

Who’s at Risk?

• Men drinking 35 standard drinks per week or women drinking 28 standard drinks per week for 5-10 or more years.

• Admitted to acute hospital in the past year due to drinking. • Those neglecting their nutrition. • Those with Alcohol-Related liver damage. • Multiple detoxifications. • Has a close relative who has a suspected ARBI

• Oslin, D., Aktinson, R.M., Smith, D.M. and Hendrie, H. (1998) Alcohol-Related Dementia: Proposed Clinical Criteria. International Journal of Geriatric Psychiatry 13, 203-212.

National Prevalence

Autopsy Studies: 0.4% - 2.8%

Irish Estimate: 18,320 - 128,240

Harper C, Fornes P, Duyckaerts C, Lecomte D, Hauw JJ. An international perspective on the prevalence of the Wernicke-Korsakoff syndrome. Metabolic Brain Disease 1995;10:17–24.

Acute Hospitals in Ireland

• 17% of alcohol-related hospital admissions will feature varying degrees of cognitive impairment

• 84 days= Average length of stay per person in acute hospitals.

• 16 = Lost bed days at acute hospital per person.

Popoola A, Keating A, Cassidy E (2008); Alcohol, cognitive impairment and hard to discharge acute hospital inpatients. Ir J Med Sci 2008; 177:141–5.

Homelessness Population

21% of homeless hostel dwellers.

Gilchrist, G, and Morrishon, DS (2005) Prevalence of alcohol related brain damage among homeless hostel dwellers in Glasgow. European Journal of Public Health, 15 (6). Pp. 587-588

Prison Population

15-42% of prison population

“male impairment profile more resembled that seen in alcohol related brain injury- alcohol use was the main cause of brain injury among prisoners, while in the general community traumatic head injury is the most common cause”

Arbias: Acquired Brain Injury in the Victorian Prison System & Famularo-Doyle, Jo. "Homelessness, Acquired Brain Injury and Corrections Victoria." Parity 23.1 (2010): 18.

Dementia Population

10% of Dementia population = 4170 of Irish Dementia Population

12.5% of dementias in under 65's

MacRae, Rhoda, and Sylvia Cox. Meeting the needs of people with alcohol related brain damage: a literature review on the existing and recommended service provision and models of care. Dementia Services Development Centre, 2003.

Key Challenges

Two Tier Service Response

ARBI Service-

user

Addictions Team

Acute Services

Homelessness Services

ABI Services

Voluntary Sector

Psychology

CMHT

P.C.C.C – G.P and

P.H.N

Case Study

• Matthew – Aged 48

• Longstanding Alcohol-Dependence

• Observations of deterioration in cognitive/functional abilities over 3 years.

• Admitted to LGH

• Structured routine of activities including placement in community gardening project – 4 days per week

• Introduction of P.A

• Graduated discharge.

• Living successfully in the community. Remains abstinent

Impact on Family

• The hidden patient of ARBI

• Caregiver ambivalence

• Ambiguous loss

• Repeated difficulties accessing services

Impact on Family

• Caring for someone with ARBI is a hugely challenging process.

• But, if well supported can be mutually beneficial.

• Families need attention, education, guidance and support if they are to survive, regroup and rebuild their lives.

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