Mental Disorders
Caused by Addiction
Instructor: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs.com, Counselor Education and Training
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery
Objectives
~ Define Alcohol Related Brain Damage
~ Explore how an awareness of ARBD is vital for mental health as well as addiction counselors
~ Learn about the symptoms of ARBDs including alcoholic dementia and vascular dementia
~ Learn about Fetal Alcohol Spectrum Disorders
Alcohol Related Brain Damage
~ Damage directly caused to the person by exposure to alcohol or other drugs
~ Alcohol Related Dementia (Wernicke-Korsakoff’s syndrome)
~ Vascular Dementia
~ Fetal Alcohol Spectrum Disorders
~ According to the CDC
~ Most excessive drinkers do not meet the criteria for dependence (meaning they may present in mental health clinics for treatment of mood disorder)
~ About 17% of the adult population reported binge drinking, and 6% reported heavy drinking
Alcohol Related Brain Disorders
~ Caused by regularly drinking too much alcohol over several years.
~ Covers several different conditions which are similar to, but not actually dementia, including:
~ Wernicke-Korsakoff syndrome
~ alcoholic dementia.
~ In contrast to dementia (i.e.Alzheimer's disease), most people with ARBD who receive good support and remain alcohol-free
~ Make a full or partial recovery
~ Will not experience a worsening of their condition
Alcohol Related Brain Disorders
~ ARBD is greatly undiagnosed.
~ Post-mortem findings indicate it affects about 1 in 200 of the general adult population.
~ Among those with alcoholism, this figure rises to as high as one in three
~ People with ARBD tend to in their 40s or 50s
~ Alcohol-related brain damage is thought to cause more than 10% of ‘dementia' in people under 65.
Alcohol Related Brain Disorders
~ Drinking more than the recommended limit for alcohol increases a person's risk of developing common types of dementia such as Alzheimer's disease and vascular dementia.
~ Recommended limits are now a maximum of 14 drinks each week, with a maximum of 2 per day
~ Repeated binge drinking – heavy drinking in one session is particularly harmful
~ Increased risk of dementia is greatest at higher levels of alcohol consumption
~ But you do not need to be an alcoholic or get drunk often to be at increased risk of developing dementia.
~ Regularly drinking even a little above recommended levels increases your risk
ARBD
~ Alcohol-related brain damage causes a range of conditions
~ Alcoholic dementia/alcohol-related dementia
~ Korsakoff's syndrome/ Korsakoff's psychosis.
~ ARBD is defined as long-term decline in memory or thinking caused by excessive alcohol use and a lack of vitamin B1 (thiamine)
~ Regular heavy (>14/week) drinking over time can cause:
~ Damages nerve cells because alcohol
~ Causes chemical changes in the brain
~ Shrinkage of brain tissue
~ Intestinal damage poor nutrient absorption
~ Poor handling of thiamine
~ Damaged blood vessels
~ High blood pressure
~ Increased risk of heart attacks and strokes
Alcohol Related Dementia
~ Symptoms largely reflect the areas in the person's brain that are damaged.
~ Poor planning and organizational skills, and problems with decision-making, judgement and risk assessment
~ Problems with impulsivity (eg rash financial decisions) and difficulty controlling emotions (eg irritability or outbursts)
~ Problems with attention and slower reasoning
~ Lack of sensitivity to the feelings of other people
~ Behavior which is socially inappropriate.
~ Unlike Korsakoff's syndrome, however, not everyone with alcoholic dementia has loss of day-to-day memory.
Alcohol Dementia Diagnosis
~ Person must have stopped drinking alcohol for several weeks, to enable the symptoms of alcohol intoxication/withdrawal to resolve.
~ Full physical examination
~ A detailed history from the person and someone who knows them well if possible. Includes:
~ How their symptoms started and affecting the person's life.
~ The person's history of alcohol use (how much, how often, and for how long).
~ Tests of the person's mental abilities (eg memory, thinking)
~ Tests for depression.
Alcohol Dementia cont…
~ A brain scan may also be required to:
~ Rule out other possible causes of symptoms (eg stroke, bleed, tumor).
~ Show changes such as shrinkage of the cerebellum at the back of the brain, which supports a diagnosis of ARBD rather than dementia.
~ ARBD should be diagnosed if:
~ The person has impaired memory, thinking or reasoning which is bad enough to affect daily life, and
~ A recent history of several years of alcohol misuse, and
Alcohol Dementia cont…
~ ARBD should be diagnosed cont…
~ Other physiological causes have been ruled out
~ Stroke
~ Brain bleed
~ Chronic fatigue
~ Lupus
~ Hypothyroid
~ Medication side effects (i.e. benzos in the elderly)
Korsakoff's syndrome
~ Is a form of ARBD caused by lack of thiamine.
~ Is much less common than other forms of ARBD such as alcoholic dementia.
~ Is diagnosed in about one in eight people with alcoholism
~ Develops as part of a condition known as Wernicke-Korsakoff syndrome.
~ Consists of two separate but related stages: Wernicke's encephalopathy followed by Korsakoff's syndrome.
~ Not everyone has a clear case of Wernicke's encephalopathy before Korsakoff's syndrome develops
~ No specific lab tests or brain scan procedures to confirm diagnosis
Korsakoff's syndrome
~ Wernicke's encephalopathy usually develops suddenly, often after abrupt and untreated withdrawal from alcohol.
~ Symptoms of Wernicke's encephalopathy can include:
~ Disorientation, confusion or mild memory loss
~ Malnutrition
~ Involuntary, jerky eye movements or paralysis of the muscles that move the eyes
~ Poor balance or unsteadiness, staggering and stumbling, lack of coordination
~ If Wernicke's encephalopathy is suspected, immediate medical treatment is essential to prevent permanent brain damage.
Korsakoff's syndrome
~ Where Wernicke's encephalopathy is untreated, or is not treated soon enough, Korsakoff's syndrome gradually develops
~ Damage occurs in several regions of the brain
~ Symptoms
~ Severe loss of short-term, day-to-day memory
~ Problems learning new information (including new routines/life skills)
~ Inability to remember recent events
~ Gaps in long term memory
~ Memory problems may be severe while other thinking and social skills are relatively unaffected. For example, individuals may carry on a coherent conversation, but moments later be unable to recall that the conversation took place or to whom they spoke.
Korsakoff's syndrome
~ Those with Korsakoff’s syndrome may “confabulate,” or make up, information they can't remember.
~ They are not “lying” but may actually believe their invented explanations.
Treatment
~ There is a good chance of stabilization or improvement if the person:
~ Is given high doses of thiamine
~ Remains free from alcohol and adopts a healthy diet with vitamin supplements.
~ Brain scans show that, with abstinence, some of the damage caused by excessive drinking can be reversed.
Vascular Dementia
~ Caused when blood supply to the brain is interrupted
~ Stroke
~ During the second stage of alcohol withdrawal (24-72 hours post drink) people experience high blood pressure, increased body temperature, unusual heart rate, and confusion
~ Vein collapse (IV drug use)
~ Stimulant use causing high blood pressure
~ Bradycardia
~ Severe hypothyroid
~ Opiate overdose
~ Heavy alcohol use arrhythmias, hypertension
~ Alcohol poisoning
Vascular Dementia
~ The most common cognitive symptoms are:
~ Problems with planning or organizing, making decisions or solving problems
~ Difficulties following a series of steps (i.e. cooking a meal)
~ Slower speed of thought
~ Problems concentrating, including short periods of sudden confusion.
~ A person in the early stages of vascular dementia may also have difficulties with:
~ Memory – problems recalling recent events (often mild)
~ Language – i.e. speech may become less fluent
~ Visuospatial skills – problems perceiving objects in three dimensions.
Vascular Dementia
~ Many patients who use substances, even recreationally, may experience strokes or mini-strokes while under the influence and not realize they had one.
~ HBP + Alcohol or stimulant use increase chances of a stroke.
~ Clinicians must
~ Be aware of the symptoms of dementia
~ Differentiate it from intoxication
~ Encourage clients to seek immediate medical assistance
~ Be additionally attentive if a patient reports self-detoxing from alcohol
Fetal Alcohol Spectrum Disorders
~ Caused by fetal exposure to alcohol
~ Along a spectrum
~ Facial features
~ Are not always present
~ Tend to disappear with age
~ Intellect may not be impaired
~ People with FASD have many neurobehavioral problems which inter-relate to produce profound problems with accurately processing information and relating to the world around them.
FASD
~ Skill/Characteristic Developmental Age Equivalent
~ Chronological Age ————————————————————–18
~ Physical Maturity—————————————————————18
~ Developmental Level of Functioning——————–9
~ Daily Living Skills———————————————11
~ Expressive Language————————————————————————23
~ Receptive Language——————————–7
~ Artistic Ability (or other strength)———————————————–29
~ Reading: Decoding———————————————————16
~ Reading Comprehension———————–6
~ Money and Time Concepts————————–8
Fetal Alcohol Spectrum Disorders
~ Diagnostic features
~ 3 distinct facial features:
~ Smooth ridge between the nose and upper lip
~ Thin upper lip
~ Short distance between the inner and outer corners of the eyes, giving the eyes a wide-spaced appearance
~ Children have a height, weight, or both at or below the 10th percentile
~ Smaller-than-normal head size for the person’s overall height and weight (at or below the 10th percentile).
~ Significant changes in the structure of the brain as seen on brain scans such as MRIs or CT scans.
Fetal Alcohol Spectrum Disorders
~ Diagnostic features cont…
~ Poor coordination, poor muscle control
~ Cognitive deficits including SLDs
~ Executive functioning deficits (ADLs)
~ Attention problems or hyperactivity
~ Poor social skills
~ Difficulty interpreting nonverbal behavior
Issues for Clients with a FASD
~ Problems with cause and effect relationships and impulse control
~ Problems with the ability to conceptualize, internalize and structure time
~ Problems with the ability to generalize information
~ Problems with understanding concepts and abstract thought
~ Problems with perseverative behavior
~ Perseveration is commonly described and thought of as some form of repetitive behavior – i.e. tapping toes, drumming fingers, knocking, pacing, etc.
~ it can also manifest as a particularly rigid way of looking at things, a refusal to let go of an idea {rigid tenacity which can border on fanaticism}; and/or a certain way of feeling or interpreting a feeling and refusal to consider any other explanation.
Issues for Clients with a FASD cont…
~ Problems in all areas of processing information, particularly auditory
~ Problems with short term memory
~ Difficulty anticipating consequences
~ Good expression, but poor comprehension
~ Good at reading, poor writing skills
Issues in Treatment of Someone with FASD
~ Will likely not benefit from “standard” treatments requiring conformance, motivation and follow-through on multiple tasks
~ Have clients write out their own weekly goals
~ Cannot accurately anticipate consequences, and repeatedly make the same mistake
~ Often seem to “shoot themselves in the foot”
~ May be unable to demonstrate remorse and get incorrectly labeled as anti-social
~ Have a right to specialized treatment and accommodations
~ May not have an alcohol or drug issue
Issues in Treatment of Someone with FASD
~ See themselves each time as making a single mistake– unable to conceptualize the past
~ Are easily manipulated and often “take the fall”
~ Often have gaps in their personal history account, including important facts
~ Tend to be quite impulsive and comedic
~ May not follow through with appointments due to inability, not lack of interest or motivation
More Strategies
~ Use as few words as possible.
~ Always clearly state what you want to happen—the desired behavior.
~ Don’t argue, debate, or negotiate.
~ Being direct is good, but don’t become too authoritarian or they will shut down
~ Don’t expect the person to be reasonable or to act their age.
~ Go for a few “Yes” responses first. Use short questions you think the person will answer “Yes” to, just to get them out of being stuck in the “No” loop.
~ Be nonjudgmental.
~ Start with a clean slate each day.
~ Don’t get frustrated that you just dealt with this same type of issue yesterday.
Summary
~ Mental health clinicians are likely to see clients who present with depression and/or anxiety who are misusing or excessively using substances
~ ARBD can be caused by:
~ Use of the substance increasing blood pressure, causing a stroke, slowing the heart, collapsing veins
~ Withdrawal from the substance (alcohol)
~ Heavy use is defined as more than 14 drinks per week or 2 per day.
~ Many clients with ARBD are NOT alcoholics
~ FASD is brain damage caused by fetal exposure to alcohol
~ Those with a FASD experience deficits in interpersonal and executive functioning which make it difficult to comply with “traditional” treatment
~ Special approaches are required for persons with a FASD