More about ARBD & Korsakoff Syndrome
The current problem is complex
Acute excess intake of alcohol can cause drunkenness (intoxication) or even death, and chronic or long-term abuse leads to potentially irreversible damage to virtually any level of the nervous system. However, how much an individual is affected by alcohol will depend upon their genes, how well nourished they are and other environmental factors.
Other effects of alcohol-related brain disease include cerebella degeneration, a slowly progressive condition affecting the anterior and superior cerebella vermis portions of the brain, causing wide-based gait, leg co-ordination and walking difficulties. Alcoholic myopathy, or muscle weakness, affects four times as many males as females. In its severest form, alcoholic myopathy is associated with the sudden onset of muscle pain, swelling, and weakness.
Alcohol-related brain damage (ARBD) is an illness that has been around, I suppose, as long as the population has been drinking alcohol: unrecognised, undiagnosed and definitely untreated. It has led in the past to many relatively young adults being left on long stay wards in the old asylums, or being placed in nursing homes for the elderly. They would live out the rest of their lives in environments that were inappropriate to their needs: living for a long time, but unhappy, bored and withdrawn.
The current problem is the complexity of the illness and the individuals' needs. The diversity of services that these clients may come under, and which service will accept them, has become a challenge for us.
Multi-agency working may be the answer
At present we have excellent social workers and health service workers who are committed to the needs of this group, but no single service provider. With this client group perhaps multi-agency working may be the answer: their memory problems could be understood and cared for by the older adults team; the alcohol team could manage their alcohol problems; anxiety and depression come under the remit of a mental health team; the young physically disabled team and the physiotherapy department could best deal with the mobility problems; the acquired brain injury team would have the advice and expertise we require to understand the brain trauma.
The geography of where a person with ARBD is resident is becoming more relevant , and the need to develop services has become more apparent. These are areas in the UK that are seeing increased numbers of clients with ARBD admitted to hospital, and thus requiring specialised follow-up care. Increasing numbers of individuals are being noticed in older adult facilities. Generally, it is social workers who are reviewing care packages and looking for alternative settings to better serve their ARBD clients.
Each individual can have different problems and variable levels of damage to their brain. However, as long as someone with ARBD continues to drink alcohol, the damage will increase. If they stop drinking the damage will not get any worse and, in fact, there is a significant possibility of recovery. Carers, out of lack of knowledge, can sometimes think that the damage has already been done, so allow the drinking behaviour to continue.
The damage sustained can be on a continuum ranging from mild to very severe. Further brain damage can be avoided if the sufferer abstains from alcohol and maintains a healthy diet. Recovery outcome can be split into quarters:
- 25% make a complete recovery
- 25% make a significant recovery
- 25% make a slight recovery
- 25% make no recovery
Recovery is also dependent on rehabilitative care and a supportive environment to maintain the required abstinence from alcohol. We need to look at facilities available and the development of services to provide the ARBD client with appropriate care during the two-year window of opportunity they are said to have before they reach their optimum recovery.
How does ARBD affect people we work with?
People may lose the ability to plan and organise, become unable to see the consequences of their own behaviour, and do not remember recent events and occurrences. Their emotional reactions may include loss of self-esteem and self-confidence, leading to anxiety and depression. These effects may lead to an increase in alcohol use. If we are to learn how to help and deal with the problems of ARBD it is important for us to consider the effect the syndrome has on individual's feelings as well as on other areas of their lives.
