Helping the pickled brain

IF YOU’VE consumed too much alcohol over the years, it is possible to unpickle your brain – but there’s a catch.

Mild pickling can cause subtle impairments that can be difficult for you to recognise, probably because you are already slightly impaired.

To do something about this, you have to be clear-headed enough to recognise that you are not as sharp and as functional as you were and that you could benefit from medical help.

A report from the United Kingdom suggests that 80 per cent of people with alcohol-related brain damage (ARBD) are undiagnosed.

It says three-quarters of them could be helped.

‘‘Usually a person’s intellect will recover over a period of three months of complete alcohol abstinence,’’ the authors say.

But for those who have drunk heavily over the long term, recovery could take up to three years.

Then there are some who never regain what was lost.

The report, Alcohol and Brain Damage in Adults, is the result of a collaboration between the Royal College of Psychiatrists, the Royal College of Physicians, the Royal College of General Practitioners, and the Association of British Neurologists.

It says ARBD is not a defined diagnostic category. Rather, it is an umbrella term that covers a wide variety of conditions that affect the brain and the nervous system.

People who have it are typically active and in their 40s, 50s and 60s. They have structural and chemical changes in the areas of the brain that influence memory and executive function.

Men who consume an average of 50 standard drinks a week for five years are highly likely to have such changes.

But often these changes are not diagnosed because of a lack of awareness among health professionals and because of the stigma associated with long-term alcohol misuse.

The report says scans show the intellect improving through abstinence and treatment.

The evidence shows optimal results can be achieved when withdrawal and the maintenance of withdrawal are managed with medication, together with counselling and support. Vitamins are often necessary too. While vitamin B1 has protective properties and is given during the acute phases of withdrawal, others are used to counter malnutrition.

The report calls for a coordinated approach to managing ARBD. Because there are no established pathways of care, it says people either receive no care or are directed to inappropriate care.

Some eventually land up in nursing homes designed for older people with dementia.

Providing specialist services for people with ARBD can make a dramatic improvement to their quality of life, says Kenneth Wilson, editor of the report and professor of old-age psychiatry at the University of Liverpool.

It can also dramatically reduce hospital admissions.

Australia does not have a comprehensive approach either, says Dan Lubman, director of the Turning Point alcohol and drug centre in Melbourne and Professor of Addiction Studies and Services at Monash University.

Services are under-funded and treatment is episodic, he says.

Although a variety of services supply different forms of support to people with problematic drinking – including online and telephone services – it is not always easy for a person to find a longer-term comprehensive package that offers both medical and psychological care, as exists for many other chronic medical conditions.

‘‘We often fail to understand that alcohol is a drug that affects brain systems, which is why we take it,’’ says Lubman, who is also chairman of the Royal Australian and New Zealand College of Psychiatrists’ Section of Addiction Psychiatry.

‘‘Because it is licit, people fail to recognise it is toxic, particularly if consumed above recommended levels regularly, and can cause problems for both the body and brain.’’

It is estimated 2.5 per cent of the general population of Australia would show some alcohol-related brain changes on post-mortem examination. The degree ranges from mild to severe.

Among heavy drinkers, some 25 per cent would have noticeable changes on autopsy.

Lubman says that the best place to go for anyone concerned about their alcohol consumption is to their general practitioner.

If necessary, from there they can be referred on to an addiction medical specialist or to a specialist alcohol treatment service.