What is ARBD?

There are several terms that are used to describe the potentially damaging effects of alcohol and related vitamin deficiencies on the brain.

The terms intoxication or drunkenness are well recognised and usually do not imply any long-standing damage. However, when there is a history of longer term, heavy drinking, sudden cessation of alcohol can result in unpleasant withdrawal problems. Multiple withdrawals, over a period of time have been associated with longer term brain damage and changes in intellect (cognitive damage).

Long term alcohol dependency is frequently associated with vitamin deficiency (particularly thiamine deficiency). Withdrawal associated with thiamine deficiency may result in a life-threatening condition known as Wernicke’s encephalopathy. This condition requires immediate hospital treatment. The person presents as confused, hallucinating and experiencing serious neurological changes. When this is not treated (and the person survives) it may be followed by permanent cognitive impairment and neurological problems. This is called Korsakoff’s Syndrome. Korsakoff’s Syndrome is characterised by disabling long term memory loss and the inability to learn new information (short term memory loss). It is often associated with the person experiencing false memories (confabulations). There are usually significant neurological problems including unsteadiness and changes in eye co-ordination and double vision. Someone who has suffered brain damage as a result of thiamine deficiency is often referred to as having Wernicke-Korsakoff’s Syndrome (WKS).

Thiamine deficiency and WKS is not the only way in which alcohol misuse can damage the brain. For most people, cognitive damage may be much more gradual and subtle in onset. The commonest problems encountered involve changes in the front part of the brain. These include problems in complex reasoning, planning and working things out. Other features include progressive changes in social understanding, anticipating risk, impulse control and making complex decisions. These are often associated with problems in mood including difficulty in initiating things, flattening of mood (lack of reaction in mood to events) or excessive outbursts. These features may be associated with changes in memory, both long term and short term. This more subtle and gradual presentation may last a few months and spontaneously improve if the individual remains abstinent. In more severe cases the brain needs time to regrow, and this can take three or four years of abstinence. Some cases will be left with permanent cognitive problems that will deteriorate if drinking continues.