The Blue Light Approach: Identifying and addressing cognitive impairment in dependent drinkers

6 April 2023

This guide aims to identify and address cognitive impairment in dependent drinkers.

Executive summary

Cognitive impairment is very common in dependent drinkers.

  • People are more likely to drink problematically because of traumatic brain injuries (TBI) or other brain damage experienced before birth, in childhood or in early adult life.
  • As a drinking career progresses brain damage caused by alcohol and poor nutrition and vitamin deficiency accumulates.
  • Physical damage to the brain from falls, fights, fits and impulsive self-harm accumulates to similar effect.
  • This damage impairs memory but also impulse control, executive function and the ability to regulate cognition, emotion, and behaviour, therefore, making it harder to engage with recovery.
  • The drinking lifestyle may generate other forms of cognitive impairment e.g. the damage from strokes, poor sleeping patterns or the ‘brain fog’ associated with hepatitis C.

This accumulating damage generates a downward spiral. As the cognitive impairment increases, impulse control decreases, consequently drinking and the risk of further head injury may also increase. Those head injuries then further impair impulse control leading to the risk of more drinking.

Therefore, anyone working with dependent drinkers needs to be aware of the impact of cognitive impairment.

However, most practitioners will not meet dependent drinkers with a diagnosis of cognitive impairment; they will meet dependent drinkers who are confused, impulsive and possibly self-destructive and who they suspect may have a cognitive impairment. The problem is that the next steps can be very difficult.

Securing a diagnosis may be a challenge. Memory and brain injury services may require someone to be alcohol-free for three months before they can be assessed. The dependent drinkers themselves may be hard to engage into constructive interventions and may struggle to engage in traditional ways of assessing cognitive impairment. Their behaviour may be dismissed as a ‘lifestyle choice’ or attributed to intoxication rather than brain damage.

It is this situation that is the focus of this guidance. Its target audience is the practitioner struggling with an individual who finds it difficult to move forward because of cognitive impairments or the challenging requirements of other services.

How this guidance was developed

Alcohol Change UK have developed this guidance as part of a national, multi-partner initiative to develop accessible national practice guidance and training on the assessment and management of cognitive impairment in dependent drinkers.

The project was led by Mike Ward and Jane Gardiner from Alcohol Change UK and the project partners were:

  • Bath & North East Somerset Council
  • London Borough of Bexley
  • Bournemouth, Christchurch & Poole (BCP) Council
  • Buckinghamshire County Council
  • Cambridgeshire County Council
  • Cheshire West and Chester Council
  • Cornwall Council
  • Cranstoun
  • Crisis' Housing First Team
  • Devon County Council
  • London Borough of Ealing
  • Gloucestershire County Council
  • Kent County Council
  • Luton Council
  • Medway Council
  • London Borough of Newham
  • Sandwell Council
  • Shropshire Council
  • Staffordshire County Council
  • Sunderland City Council
  • Surrey County Council
  • London Borough of Tower Hamlets
  • Turning Point
  • West Sussex County Council
  • Wigan Council
  • We are With You Cornwall

Please see the appendices of the guidance document for full details of members of the expert steering group and interviewees.

Cognitive Impairment Training

We have developed training as part of this project which is now available for delivery by members of our consultancy and training team who formed part of the expert steering group for this project. Please contact our training department on [email protected] and visit here to enquire about booking this training for your organisation.

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