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.
