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Alcohol Related Brain Injury - Fact Sheet
 ARBI is a term used to describe the physical injury to the brain sustained as a result of excessive alcohol consumption. Having ARBI is not the same as having an intellectual disability, nor is it the same as having dementia.
Alcohol has a toxic effect on the central nervous system. It results in changes to metabolism, heart functioning and blood supply. It interferes with the absorption of thiamine (Vitamin B1 - an important brain nutrient). Alcohol is commonly associated with poor nutrition. It can cause dehydration which may lead to wastage of brain cells. It can lead to falls and accidents that injure the brain.
Disorders Associated With ARBI
The degree of brain injury resulting from excessive alcohol consumption depends on many factors, including the amount and pattern of consumption, age, sex, nutrition and individual differences. ARBI may be mild, moderate, severe or very severe. ARBI is associated with changes in cognition (memory and thinking abilities), difficulties with balance and coordination and a range of medical and neurological disorders. The following description of common disorders related to ARBI aims to help workers become familiar with some of the medical terms encountered in the field.
Cerebellar Atrophy
Injury to the part of the brain called the  Cerebellum causes balance and coordination difficulties which typically Affect the lower limbs and results in a wide-based gait (walking with the legs wide apart). Ataxia is the term used to describe the gait disorder.
Peripheral Neuropathy
Peripheral neuropathy is a sensory disturbance affecting the hands, feet and legs. It usually begins in the feet with numbness, pins and needles, burning sensations and pain, and may progress to loss of knee and ankle reflexes and muscle wasting.
Hepatic Encephalopathy
Hepatic encephalopathy is the neuropsychiatric syndrome seen in patients with liver disease. It can present with striking neurological and psychiatric changes and is characterised by acute exacerbations and remissions. The syndrome features changes in sleep, mood and personality. Impairment and fluctuation of consciousness is accompanied by confusion, delirium and hallucinations and in the latter stages will progress to Coma.
Frontal Lobe Dysfunction
Injury to the Frontal Lobes of the brain results in changes in thinking patterns, behaviour and personality. Frontal lobe dysfunction makes it difficult for people to plan and organise, to monitor and control behaviour, to think flexibly, and to adapt to change or unfamiliar situations.
Wernicke’s Encephalopathy
Wernicke’s encephalopathy is the acute neurological reaction to severe thiamine deficiency and causes multiple disturbances of vision, ataxia, and confusion. It may be reversed by administration of large doses of thiamine, but left untreated may progress to coma and death.
Korsakoff’s Amnesic Syndrome
Korsakoff’s amnesic syndrome is a profound impairment of short term memory that results in an almost complete inability to acquire any new information. An associated feature is confabulation, or tendency to fabricate missing memories.
Is ARBI Permanent?
The severity of thinking and behavioural problems resulting from ARBI varies from person to person, as does the potential for recovery. Restitution of cellular function is dependent on age. Younger sufferers have a better chance of recovery. Some improvement may be expected when a person stops using alcohol and maintains a balanced diet. When a person with ARBI shows improved skills and behaviours, it is not always clear whether this improvement results from a restoration of brain cells or from the person’s ability to compensate for the impairment.
Assisting People with ARBI
A central principle in assisting people with ARBI is ‘compensation’. This means reducing demands on impaired thinking and memory ( Cognitive) skills and tapping a person’s strengths and preserved cognitive functions.
Reducing the Demands on Cognitive Functioning
This is an important step in reducing anxiety and depression that may be associated with feelings of inadequacy. The ways by which demands on cognitive functions can be reduced are outlined as follows:
- Avoid overloading people
- Break down information and present one idea at a time
- Discuss one point at a time
- Tackle one problem at a time, one step at a time
- Allow sufficient time for people to work at their own pace
- Minimise distractions and stressors in the environment
- Allow frequent breaks or rest periods
Structure the environment
- Assist to develop a routine that is predictable and that encompasses all aspects of life (for example, personal hygiene, chores, meals, work, social activities, exercise, appointments)
- Ensure all activities follow a predictable pattern, for example chores and appointments can be organised to occur at precisely the same time each day or week
- Display prominent prompts in the environment to remind and to help initiate activities
- Help carers understand the person’s need for predictability and structure.
Note: People with severe ARBI benefit from a rigid timetable that is displayed predominately (for example on a whiteboard beside their bed).
Minimise change in the environment
- Minimise change to routines
- If change is inevitable, plan ahead and allow sufficient time to discuss the plans
- Change needs to be tackled in small increments, and incorporated gradually
- Explain clearly what is occurring before initiating any activity as surprises may be distressing
- In times of change surround the person with familiar objects and people
- Use imaginative approaches to retaining some stability and continuity during change.
Be available to the person with ARBI
When tackling new problems, or during times of stress or change, you can act as the person’s ‘frontal lobes’:
- Generate ideas and alternatives (written)
- Develop a plan of action to tackle problems (written)
- Prioritise steps
- Follow through with plans by prompting people at each step
- Provide encouragement and reinforcement at each stage
- Help the person to focus on relevant discussion by gently redirecting their attention if they become stuck on an idea, or re-focus them if their conversation becomes tangential.
People with severe ARBI will need similar assistance for any tasks that involve multiple steps and that they are not familiar with.
Tap strengths and preserved skills
The aim of assisting people compensate for impairment is to increase feelings of coping and competency. An important step in increasing feelings of coping is identifying and making use of preserved skills and talents.
People with severe ARBI can talk of the past with greater ease than recent events in their lives. A useful distraction technique (for agitation or depression) can be to initiate conversation about the past.
Use familiar language. Many people with ARBI respond well to prompts or cues to trigger their memory, and respond better to specific, closed ended questions than open questions.
For example, when asked what was discussed at the doctor’s appointment John was unable to remember. When however he was asked if he was put on medication, he pulled a prescription out of his pocket.
Where practical encourage people to pursue old interests and hobbies, and in doing so increase their experience of success.
Getting Help
ARBIAS is a Melbourne based specialist disability service which works together with families, support networks, employers and service providers to assist people with acquired brain injury to live and function to their full potential in community. It is not an alcohol treatment service, but has a close working relationship with established alcohol and drug counselling, treatment and rehabilitation agencies. You can visit their website at:
http://home.vicnet.net.au/~arbias/.
To reach relevant services in other States contact your local Brain Injury Association for further information.
The information in this fact sheet is © Copyright to ARBIAS. For permission to use and adapt information from this fact sheet you must contact ARBIAS directly - their website http://www.arbias.org.au/.
For further information see the fact sheet “Alcohol and drug use ” on our website at: www.braininjury.org.au
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Alcohol related brain injury 
