“It is likely that many people who are suffering from ARBD are not diagnosed. One symptom of ARBD is a lack of insight into the problems that it causes, which means that many patients do not recognise that there is anything wrong and do not seek medical help”.
Carol Mochan – MSP for South Scotland (04 March 2025)
What is ARBD?
Alcohol-Related Brain Damage (ARBD) – also sometimes referred to as Alcohol-Related Brain Injury (ARBI) – is an umbrella term for psychoneurological / cognitive conditions caused by long-term, heavy alcohol consumption and related vitamin deficiencies. ARBD is not a single condition, but rather a range of conditions with varying symptoms and is thought to affect ‘around 0.5% of the UK population’(~350,000 people). In the homeless population, this figure is thought to be far higher, with a recent study suggesting this figure could be as high as 70%.
The causes of ARBD
Prolonged excessive alcohol consumption can change the way the brain works, affecting its physical shape and structure. Alcohol can disrupt communication between brain cells, destroy brain cells, lead to structural changes and – in some cases – cause shrinkage of the brain. According to a report by The Royal College of Psychiatrists:
“Women who drink more than 28 units a week, and men who drink more than 35 units a week for 5 years or longer are likely to experience some changes in their intellect, even though many will not be aware of it”.
Because ARBD will typically develop over a of number years, most people with the condition are in their 50s and 60s, but increasingly ‘people in their 30s and 40s are being seen with symptoms’.
Symptoms of ARBD will vary depending on the type and severity of psychoneurological / cognitive conditions but can include:
-
- Problems with memory and learning
- Difficulty concentrating
- Confusion and disorientation
- Changes in personality and behaviour
- Problems with coordination and balance
- Impaired judgment and decision-making
- Difficulties with planning and problem-solving
- Visual disturbances
The challenge of addressing ARBD
One of the key challenges of tackling ARBD is ‘diagnosis overshadowing’ – this can occur where symptoms of cognitive impairment or neurological damage can be misdiagnosed and attributed to intoxication or alcohol withdrawal.
In addition, there is a general lack of awareness amongst healthcare providers who may misinterpret ARBD symptoms as being indicators of Alzheimer’s, which, in turn, can lead to delays in accessing appropriate treatment.
Assessing for ARBD in community settings also presents specific challenges, especially for individuals that continue to drink and/or are difficult to engage (e.g. due to homelessness). Whilst screening tools are available – for example the ACES-III and the Montreal Cognitive Assessment (MoCA) – these are not routinely used within drug and alcohol treatment settings, although both of these have been developed as online self-assessment tools.
Types of ARBD
The term ‘ARBD’ covers a wide variety of conditions including:
-
- Alcohol-related dementia: This is characterised by personality changes and a deteriorating ability in planning, decision making and assessment of risk. In addition, an individual may experience problems with attention, concentration and memory.
-
- Memory problems (Alcohol Amnesic Syndrome): characterised by short-term memory loss, difficulty concentrating and confabulation (filling gaps in memories with inaccurate information).
-
- Wernicke’s Encephalopathy: A potentially life-threatening condition whereby the individual presents as confused, often hallucinating and experiencing serious neurological changes. If left untreated, the individual may go on to develop Korsakoff’s Syndrome and have permanent cognitive impairment, memory loss and long-term neurological problems.
It is important to note that ARBD is treatable, especially where it has been identified early, and ‘around 75% of people with ARBD who receive treatment do make some recovery’. As not all individuals with ARBD will present at hospital, it is important that cognitive screening – where appropriate – forms part of the general assessment process for alcohol treatment services. Alongside this, having robust referral pathways into specialist clinics will help ensure that ‘every patient has a designated keyworker who has expertise in assessing and treating adults with cognitive deficits’.
How can ILLY help?
At ILLY our mission is to make a meaningful impact across our communities through technology, and raising awareness of ARBD and supporting those affected by it is one area where we can help.
On Tuesday 17th June ILLY will be hosting an ‘Understanding and Addressing Co-Occurring Conditions’ webinar. This free webinar is open to all and will cover many of the issues raised in this article, including:
-
- The challenges of identifying and treating Alcohol Related Brain Damage
-
- Supporting Rough Sleepers with Co-Occurring Mental Health, Alcohol and Drugs (COMHAD)
-
- The Importance of collaboration and COMHAD
If you would like to know more information – or would like to attend this event – then please contact our Client Services Team and we’ll be happy to help.
020 4566 5727 
clientservices@illycorp.com