Research Update (2006 November): Cognitive Improvement and Alcoholism Recovery

2006·0.27 MB·English

by  Butler Center for Research

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HazeLDeN
Research Update is published bythe Butler Center
- — - for Research toshare significantscientific findings
from thefield ofaddiction treatment research.
RESEARCH U PDATE
BUTLER CENTER FOR RESEARCH NOVEMBER 2006
Cognitive Improvement
and Alcoholism Recovery
i\lost alcoholics are aware that alcohol use causes at least THEHAZELDEN EXPERIENCE
immediate shor-term memory problems. Vhile drinking they All patientsarescreenedtorcognitivedeficitsuponentry
totreatmentatHazelden,andwhen necessary,referred
may easily forget new information, such as people’s names or
forfurthertesting. Individualtreatmentplansaccommodate
directions. After a drinking episode, they may be frustrated deficitsso patientscan benefitmaximallyfromtheir
by their occasional inability to remember an entire conversation treatmentexperience.
or event, a phenomenon know’n as a blackout. But what AttheButlerCenterforResearch, a studyis underwayto
examinecognitivechangesovertimeamongmiddleaged
happens in recover\’? How resilient is the brain?
andolderadultswithalcohol dependence.Wehopetouse
thisinformationtoassistcliniciansin betterservingthe
How Does Alcohol Affect the Brain?
needsofthosewithcognitivedeficits.
Over halfof people enteringtreatmentforalcohol or otherdrugdependence have some brain
mpairrnerit.The impairment might reveal itself in the following areas Workingmemory: CONTROVERSIES& QUESTIONS
holding numbers orfacts in one’s head for use in the immediatefuture, e.g. for balancinga Howdoesalcoholcoonparewit/iotherdrugsinterms
checkbook orconsidering several options. ofrecoveryofcognitiveimpairment?
Performanceon memorytests attreatmententry
While new information may be learned In mostcasesthereis nooveralldifferencein
and six-weekfollow-up
it maytake more review and repetition 12 cognitive improvementbasedontypeofdrug
than it normallywould. Executive control used. Mostsubstancesofabusecausesimilar
10
functions:these are higher level cognitive typesofimpairmentsandthe brain recoversin
functionsthatare called upon in new similarways.
or unexpected situations that involve
6 Aresomepeopletooimpairedtorecovertheir
atteiition, planning, abstract reasoning,
fullcognitivefunctioning?
problem solving, judgment and sensitivity
Almostallpeoplecanrecovercognitivefunctioning.
tothe consequences ofone’s behavior.
Improvementdependson abstinenceandtime,
Visuospatialperception: abilityto grasp
noton severityofinitial impairment.Thereis
newand complex information visually;
CaliforniaVerbal ProductRecallTest DigitSymbnl asmall subsetofindividualswhomayhavea
recognition and recall ofvisual images; the Learningtest Substitutionrecall
specifictypeofneurologicaldisorderassociated
•
skillsto learn new routes through buildings • TreatmentEntry 6-weekfallow-up
with longterm alcohol useandthiamine
ortowork a puzzle. <.05Note:Thememorytestsarenatbasedanthesamenumber deficiency(Wernicke-Korsakoff’s syndromes)
ofpossibleresponses.Source:Batesetal.,2005.
There are recentadvances in understanding which is notreversible:
wtiat has happened in the brain to cause these deficits. (1) Structuralchanges: Magnetic
HOWTOUSETHIS INFORMATION
Resonance Imagery (MRI) studies consistentlyshow shrinkage ofthe brain amongalcoholics.
Clinicians:Assesspatients’ levelofcognitivefunctioning
Both the grey matter (nerve cells) and thewhite matter (transmission routes) lose volume,
andtargetinterventionsaccordingly. Heavyemphaseson
especially in the piefrontal region.’’ Loss of brain mattercorrelates with age and quantity
educational methodsearlyintreatment maynotbeeffective,
ofalcohol consumed.(2) Neurotoxirify: Alcohol causes new nerve cellsto die. Throughout
even ifa patienthasa high level ofeducationorintellectual
life (though more slowlyas we age) new brain cellsare created, a process known as
ability. Usenovelwaystorepeat material.
neurogenesis;°alcohol interferes with neurogenesis. (3) Circuitry: Recent research suggests
that it may be the degradation ofthe brain’s circuitry, or nerve transmission, that is responsible NewlyRecoveringPeople: Ifyoufeelyouarehaving
for cognitive deficits. This may result in what is called ‘processing inefficiency.” As the brain difficLiltyremembering,learning,orunderstanding,ask
reorganizes how it processes information, itcompensates for deficits and uses higher level forhelp.This isa normal partofearlyrecoveryand nothing
functions for lower level tasks. This meansthe brain needstowork harderto performthe tobeashamedof.Stayingabstinentand givingyourself
>CONTINUEDONBACK timein recoveryarethebesthealers.
<CONTINUEDFROMFRONT
Cognitive Improvement and Alcoholism Recovery
HZLDN
samefunctions:: Some people may be more susceptibleto alcohol’s effects. Women typically
experiencethe negative physical consequences ofalcoholism soonerthan men, given the
same numberofyears ofdrinking. This phenomenon, known as ‘telescoping,” has long been
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