It’s estimated that between 20-80% of people seeking help for alcohol and other drug use will experience some level of cognitive impairment.
Alcohol related brain damage, a consequence of excessive alcohol use, can lead to a spectrum of alcohol-related brain disorders including alcohol-related dementia and Wernicke-Korsakoff Syndrome.
These disorders give rise to impairments in several cognitive functions which can vary in type and severity across populations and even in individuals over time. Additionally, people who use methamphetamine have been shown to experience deficits in several cognitive functions including impulsivity, working memory and executive function – involved in decision making behavioural control and regulation of goal-oriented thinking.
Mechanisms of cognitive impairment with substance use
Structural changes in the brain during alcohol and other drug dependence are linked to reduced cognition.
Around 78% of people who experience alcohol dependency show significant brain changes. Those who experience alcohol dependence are also at high risk of thiamine deficiency due to reduce intake of nutrients and alcohol’s ability to block thiamine absorption. Thiamine deficiency further increases the risk and extent of brain damage. Both alcohol exposure and thiamine deficiency cause loss of grey and white matter in the brain and particularly affect the frontal cortex and cerebellum.
These structures are responsible for functions like reasoning, judgement, flexibility and planning, and are shown to be impaired in people experiencing alcohol dependency. Similarly, memory deficits in people experiencing methamphetamine dependency are associated with reduced cortical thickness.
How might cognitive impairment influence treatment for substance use?
People with cognitive impairment are less likely to complete treatment and cognitive deficits are a predictor of relapse among patients with substance use. Current methods to treat alcohol and drug use, such as cognitive behavioural therapy, heavily rely on the capacity of a person to recognise their own behaviours, recall the mechanisms they have been taught, and apply them to their personal situation.
Given that impairments to working memory occur in people experiencing alcohol and drug dependence, these tasks come with an added layer of complexity. Impaired executive functioning introduces additional challenges, where decision-making and behaviour control are impaired.
How can we support people with cognitive impairments seeking treatment?
Treatment programs that are more inclusive of people with cognitive impairment can provide support for those experiencing cognitive deficits to reach a similar level of treatment retention and completion as those without cognitive impairment. These programs offer the advantage of ‘person-centred’ treatment, provide space to practice skills through repetition and role play, and offer simplified written materials along with verbal instructions.
Enhance your understanding of AOD use and the brain!
Better understand the brain, the impact of drugs, and how it affects treatment by coming to our online, interactive ‘Brain Workshop‘ on 25 February 2021!
In this workshop, you will:
- Understand cognitive impairment related to alcohol and other drug use
- Gain skills in assessment of impairment of cognition and daily functioning
- Learn how to adapt treatment to take account of cognitive impairments