Alcohol-Related Brain Damage (ARBD) - What is it?

Alcohol-related brain damage (ARBD) is an umbrella term used to describe the damage that can happen to the brain as a result of long-term heavy drinking.

What is ARBD?

Alcohol-related brain damage (ARBD), or alcohol-related brain injury (ARBI), is an umbrella term for the damage that can happen to the brain as a result of long-term heavy drinking. Over time, drinking too much alcohol can change the way the brain works and its physical shape and structure. This can bring some very serious consequences, including changes in personality, as well problems with thinking, mood, memory and learning.

The different forms of ARBD

The human brain is a complex organ, and alcohol can affect it in many ways. Because of this there are a number of different types of ARBD and they show themselves in different ways:

  • Alcohol-Related Dementia: The symptoms of this are similar to Alzheimer’s Disease.
  • Alcohol Amnesic Syndrome: This involves short-term memory loss, difficulty concentrating, and confabulation (filling gaps in memories with irrelevant or inaccurate information).
  • Wernicke-Korsakoff’s Syndrome (WKS): One the most serious types of ARBD, this is made up of a brain swelling known as Wernicke’s Encephalopathy, and a severe confusion known as Korsakoff’s Psychosis.
  • Damage to the frontal lobe: the brain’s control centre: leading to problems controlling impulses, making decisions, setting goals, planning, problem-solving, assessing risk and prioritising activities. The frontal lobe also controls our personality and moral conscience.
  • Hepatic encephalopathy: Damage to the brain may also be a result of hepatic encephalopathy (HE). This occurs when the liver has been severely damaged (often by alcohol) and can no longer do its job of getting rid of harmful substances from the blood. These chemicals, such as ammonia, build up in the blood and damage the brain. The symptoms of HE can range from mild to severe and can include confusion, forgetfulness, sleeplessness and personality changes. There are a number of medications available to treat HE but the most important thing to first of all is to get a diagnosis from your doctor. To find out more, go to the British Liver Trust’s guide to hepatic encephalopathy.

What causes ARBD?

ARBD occurs for a number of different reasons:

  • Alcohol itself is toxic in large doses: Long-term heavy drinking damages brain cells.
  • Alcohol is diuretic (it makes you pass too much urine): It causes the body to lose too much water, which can cause brain cells to shrink and die.
  • Alcohol makes it hard to absorb some vitamins: Particularly important is vitamin B1 (thiamine), which is a building block of the brain.
  • Heavy drinkers often don’t eat very well: They may lose their appetite, and so may not be taking in enough nutrients, including vitamin B1 and other nutrients the brain needs. Alcohol can also cause inflammation of the guts (gastritis) and vomiting, both of which mean that heavy drinkers may not be able to absorb the nutrients from their food.
  • Heavy drinking causes changes to the metabolism (the chemical reactions inside our bodies), heart function and blood supply: This can lead to high blood pressure and high cholesterol levels, increasing the risk of heart attacks and stroke, all of which can also damage the brain.
  • Drunkenness can lead to falls and fights: Some heavy drinkers suffer injury to the brain in these ways. The effects of alcohol itself can be worsened in those who have frequent falls or other head injuries. The medical term for this is traumatic brain injury, and around 25% of people with ARBD have this kind of injury.
  • Alcohol withdrawal can also damage the brain: If someone is dependent on alcohol and they suddenly stop drinking without medical supervision, this can cause damage to the brain as the body’s chemistry tries to re-adjust to not having alcohol.

What level of drinking can cause ARBD?

Everyone is different and alcohol affects people in different ways, so there’s no specific amount or length of time of drinking that will determine whether a person does or doesn’t have ARBD. On the other hand, the more someone drinks and the longer the period of time they drink for, the more likely they are to have some form of ARBD.

Research shows that in some cases, men who regularly drink more than 50 units of alcohol a week and women who drink more than 35 units of alcohol a week for a period of five years or more are likely to experience changes in the brain that adversely affect memory or other cognitive (thinking) processes. In terms of drinks, that equates to 5 bottles of wine or 20 pints of lager in a week for a man, and just less than 3½ bottles of wine or about 14 pints of lager per week for a woman.

The recommended maximum alcohol use for adults (men or women) in the UK is 14 units per week, ideally spread over three or more days and with at least two alcohol-free days each week.

Who gets ARBD?

Most people with ARBD are in their 50s and 60s, but more and more people in their 30s and 40s are being seen with symptoms. Typically, women develop ARBD at a younger age than men, and women are more vulnerable to ARBD after drinking heavily for a shorter length of time than are men. This is true not only for brain damage, but also for damage to the heart, liver and nerves. People who start drinking at a young age and continue to drink heavily as adults are also at risk.

Here are some of the key factors that put someone at risk of ARBD:

  • Heavy alcohol consumption (generally more than 50 units of alcohol a week for men and 35 units for women) over a period of years is the most obvious risk factor for ARBD, and particularly alcohol dependence – where the body has become so used to alcohol, the drinker feels unwell without it.
  • Poor nutrition/low vitamin intake.
  • Head injuries.
  • Alcohol-related damage to other organs.
  • Alcohol withdrawal without medical supervision.

How common is ARBD?

There are various statistics on how common ARBD is in the UK, although it is hard to get a totally clear picture:

  • Around 10 million people in the UK regularly drink at above low-risk levels – that is, they drink more than 2 to 3 units a day or 14 units a week.
  • Around 0.5% of the UK population have some changes in their brain as a result of their alcohol use.
  • Around 35% of the very heaviest drinkers are thought to have some form of ARBD.
  • Current research suggests that ARBD accounts for 10-24% of all cases of dementia.
  • One of the most extreme forms of ARBD, Wernicke-Korsakoff’s Syndrome, is seen in around 12% of dependent drinkers.

0.5%

have changes in their brain as a result of alcohol use

35%

of the very heaviest drinkers are thought to have some form of ARBD

24%

research suggests that ARBD accounts for 10-24% of all cases of dementia.

Is there a cure for ARBD?

ARBD is often mistaken for conditions like Alzheimer’s Disease, but one of the key differences is that, with the right treatment, symptoms of ARBD can improve greatly. Unlike Alzheimer’s, ARBD is not progressive – it doesn’t inevitably get worse over time. Recovery is possible and the outcomes for people who stop drinking can be very good, with much of the damage to the brain being reversed. To find out more, see our fact sheet ARBD – Diagnosis and Treatment.

There are also support services for carers, family members and friends of people with ARBD. To find out more read our guide to family support services.

Recovery is possible and the outcomes for people who stop drinking can be very good, with much of the damage to the brain being reversed.

For advice on living with someone with ARBD, see our handbook for carers: Road to Recovery.

If you’re a professional working with people with ARBD, see our Quick Guide for Professionals.

For more detailed information on all aspects of ARBD, go to Alcohol Concern’s report All in the mind – Meeting the challenge of alcohol-related brain damage.

Please note: Our publications do not look at the damage to the brain caused in the womb by heavy drinking during pregnancy, known as Foetal Alcohol Spectrum Disorder or Foetal Alcohol Syndrome. More information on these conditions can be found on the website of the National Organisation for Foetal Alcohol Syndrome: www.nofas-uk.org.

This fact sheet was written by our predecessor organisation Alcohol Concern with the support of Garfield Weston Foundation.

Other fact sheets in this series:

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