An individual is considered ‘at risk’ of developing ARBD if they consume 35 units a week or more over a period of 5 years. Current guidelines in the UK recommend consuming no more than 14 units a week for males and females. This is roughly 6 pints of beer or 6 medium glasses of wine spread evenly across the week with a couple of alcohol-free days in between the days that an individual drinks alcohol. 35 units a week is roughly equivalent to 15 pints of beer or medium glasses of wine.
Individuals that are affected by ARBD often experience impairments in cognitive functioning that include but are not limited to:
- Memory (particularly in forming and retaining new memories)
- Attention and concentration
- Reasoning/judgement
- Information processing, planning and decision making
- Visuospatial abilities (identifying and interpreting visual information e.g. map reading, judging distances)
- Confusion
In some cases, additional indicators of ARBD can include changes in personality and behaviour (e.g. aggression, apathy), confabulation and ataxia. Confabulation refers to the process whereby individuals fill in gaps in their memory by producing fabricated or distorted “memories” although the individual does not realise that these memories are false and they are not intentionally being deceptive. Ataxia is a term used to describe a cluster of disorders that affect speech, balance and coordination, leading to difficulties with walking, swallowing, writing, eating and vision.
How Alcohol Affects the Brain
The principle component of alcoholic drinks is ethanol, and this chemical has substantial direct effects on the complex brain processes in a number of ways. Firstly, this chemical results in changes to the ways that neurotransmitters (the brain’s messengers) sends signals between brain cells. The signals can become blocked meaning that these messages are not transmitted through the brain which results in some of the short-term effects that are experienced during intoxication, such as delayed processing, impulsivity and memory loss. This is because alcohol temporarily inhibits glutamate (an excitatory transmitters) which helps control the brain’s overall level of activity. In response to this, the neurons produce more glutamate receptors and when the effects of alcohol wear off, the neurons are able to fire faster which can contribute to feelings of anxiety and/or stress.
Subtypes of ARBD
There are a number of subtypes of ARBD which were initially believed to be different conditions, however, as suggested by Jacques and Stevenson (2000) ARBD is best viewed as a spectrum of conditions which range in severity and overlap with one another.
The most notable type of ARBD is Wernicke-Korsakoff syndrome (WKS) which was originally viewed as two separate conditions characterised by severe difficulties with memory and the inability to learn new information. Korsakoff’s syndrome (KS) and Wernicke’s Encephalopathy (WE) are now viewed as two expressions of the same disorder, however, some people may receive a single diagnosis of Korsakoff’s syndrome which is viewed as a more severe disorder and the outcomes are less positive. Wernicke’s Encephalopathy is sometimes viewed as a triad of symptoms (although only 16.5% present with all 3 symptoms) which are:
- Ophthalmalgia and Nystagmus (weakness of eye muscles/involuntary eye movements)
- Ataxia (impaired speech, balance and coordination)
- Confusion
Thiamine (Vitamin B1) is a crucial nutrient that is required by the body for cell development and functioning. Those who misuse alcohol are at a substantial risk of developing a thiamine deficiency which may be responsible for, or contribute to the damage that is caused to the brain.
Thiamine plays a crucial role in cell functions and is an essential nutrient required, especially for the brain. A deficiency in this key nutrient leads to damage to the brain in several ways and it is deficient in individuals who abuse alcohol.
The body cannot produce thiamine by itself, so it must be absorbed through a suitable diet. Those who consume large amounts of alcohol are at risk of developing a deficiency due to a reduction in absorption, a poor diet and replacing meals with alcohol. Foods containing thiamine include meat (especially pork), nuts, bread, vegetables and breakfast cereals (especially those with oats).