Martin Jackson 2002 © TWO MAJOR ALCOHOL RELATED BRAIN INJURY SYNDROMES Memory impairment Executive dysfunction

Martin Jackson 2002 © MAIN FEATURES OF THE AMNESIC SYNDROME Immediate memory is not affected Difficulty remembering recent events or recently learned information Achronogenesis - loss of time tags Retrieving information stored in memory Confabulation - a tendency to make up memories Preserved learned behaviour

Martin Jackson 2002 © STEPS TO PROBLEM SOLVING Perceive incoming information Form intentions Create plans, programs Inspect the performance Regulate the behaviour Verify conscious activity Resultant behaviour or outcome

Martin Jackson 2002 © EXECUTIVE DYSFUNCTION: ADAPTIVE BEHAVIOUR SYNDROME Difficulties with: Attention and concentration Planning, organisation, problem solving Complex, abstract and flexible thinking Initiative Emotional and behavioural change Self awareness and insight

Martin Jackson 2002 © THINGS ARBI DOES NOT AFFECT Vocabulary and language Long term memory Any well learned skills Knowledge of facts and understanding of the world Knowledge of the social world ARBI is sometimes called the invisible disability because the person is still good at many things

Martin Jackson 2002 © HOW MUCH IS TOO MUCH? Research into these factors has been plagued by problematic experimental subject groups Research shows that drinking more than eight drinks per day is likely to cause ARBI Less than four drinks per day is unlikely to produce ARBI Between four an eight drinks is a grey area

Martin Jackson 2002 © HOW MUCH IS TOO MUCH? (CONT) The person will need to drink at hazardous levels for ten to fifteen years before the damage begins There are similarities to ARBI and chronic subacute exposure to solvents There is a high correlation between the presence of neurological symptoms and the degree of ARBI

Martin Jackson 2002 ©

FACTORS RELATED TO RECOVERY No determination regarding the presence of a brain injury can be made until the effects of recent use or withdrawal are resolved Recovery from ARBI is related to –the severity of ARBI –the presence of neurological signs –the presence of other forms of acquired brain injury Recovery is similar to other forms of brain injury

Martin Jackson 2002 © WHAT DON’T WE KNOW? The effect of drinking alcohol heavily from an early age The effect of binge drinking

Martin Jackson 2002 © Brain Development The majority of adults that suffer a brain injury (from any cause) do so on the basis of a fully developed brain and cognitive skills. Therefore, problems are generally related to “functions that were once there are now lost”. However, in adolescents, brain injury does not always take the form of “functions that were once there are now lost”, but often takes the form of “functions that were not there, now can’t develop”.

Martin Jackson 2002 © Brain Development (cont) This is particularly so for executive functions. The frontal lobes and executive functions experience rapid development between the ages of eight and eighteen Studies have shown that most ‘ normal’ fourteen or fifteen year olds think more like eight year olds than they do adults.

Martin Jackson 2002 © Brain Development (cont) Paediatric head injury studies show that damage to a brain at an early age can hinder development of higher brain functions later in life Therefore, adolescents who begin abusing alcohol from an early age, whilst having the same risks as adults for structural brain impairment, have the additional risk of perhaps not developing particular cognitive functions later in life, nor having other well developed skills to “fall back on” as support.

Martin Jackson 2002 © Brain Development (cont) If there is a developmental ABI effect, then it is also quite likely that similar effect is seen in the personality development and development of other skills (such as coping). It is not known whether the same factors apply to adolescents as do to adults, in terms of level of drinking and length of drinking

Martin Jackson 2002 © BINGE DRINKING There is very little known from a cognitive perspective what the effects of heavy binge drinking are Yet, this is the most common form of drinking amongst younger drinkers

Martin Jackson 2002 © PREVENTION This is still the most difficult area with respect to alcohol related brain injury Alcohol consumption is a major part in the lives of the majority of Australian. Statistics still indicate that about 10% of Australians drink at levels likely to produce ARBI at some point in the future

Martin Jackson 2002 © PREVENTION (cont) In the majority of cases, the onset and progress of ARBI is subtle. People with ARBI usually do not present in the health system until they are ‘sick’ By this time, it is usually too late, as ARBI has already commenced and the social and occupational disintegration is under way

Martin Jackson 2002 © PREVENTION (cont) The best method of preventing the development of ARBI would be to contain alcohol consumption to levels that are not hazardous This is a very difficult task to do