Aim: To understand the issues around alcohol and brain injury including dependence, withdrawal, alcohol related cognitive impairment, the impact of ongoing alcohol use on recovery post brain injury and how to encourage behavioural change.

Alcohol problems are common in the general population but are even more common in people who experience head injuries. Around half of those who experience head injuries are intoxicated at the time of the injury, and nearly 40% of people suffering from a head injury have a chronic problem with excessive alcohol consumption (Parry-Jones, Corrigan 2006). It is not surprising that alcohol use increases the risk of having a head injury: it affects balance and co-ordination and people are more likely to do risky or dangerous things following alcohol consumption. It is likely that one of the most effective ways to reduce the occurrence of brain injuries would be to reduce the amount of alcohol people consume.

Alcohol Dependence
‘Problem drinking’ is a broad term encompassing people not dependent on alcohol but whose consumption is causing harm (physical, psychological or social) through to the severely physiologically dependent. A diagnosis of alcohol dependence is made when three from the following six symptoms are present:

  • Craving.
  • Impaired ability to control use.
  • Withdrawal symptoms.
  • Tolerance (reduced sensitivity to the effects of alcohol).
  • Neglect of alternative pleasures/ interests.
  • Continued use despite harmful consequences.

It is alcohol craving rather than withdrawal which is the central feature of the syndrome. Alcohol dependence is the most severe form of alcohol misuse and is fairly common: it is estimated that 9% of men in the UK are alcohol dependent.

It is clear that people who are alcohol dependent would benefit from stopping consumption. However, if they are severely dependent and simply suddenly stop consuming alcohol, this can be dangerous. In these people the habitual use of alcohol will have caused compensatory changes in their brain, meaning that if they suddenly stop they can develop seizures or confusion with hallucinations (delirium tremens). They may also be at significant risk of developing Wernicke’s Encephalopathy. People at risk of seizures or delirium tremens will often be drinking large amounts of alcohol every day and generally experience shakes and sweats in the morning before they have their first drink.

Alcohol Withdrawal and Alcohol Related Cognitive Impairment
Alcohol Use and Recovery Following Brain Injury
Alcohol Consumption: How to Foster Behavioural Change

 

Reference
Parry-Jones BL, Vaughan FL, Cox WM. Traumatic brain injury and substance misuse: A systematic review of prevalence and outcomes research (1994–2004). Neuropsychological rehabilitation. 2006;16(5):537-60.