11 Cognitive and behavioural effects of chronic alcohol excess

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Killian is based at the Robert Fergusson Unit, Scotland’s national neurorehabilitation unit, and runs neuropsychiatry clinics at the Department of Clinical Neurosciences, Western General Hospital. His psychiatry training included an endorsement in substance misuse, and his MD examined the impact of alcohol and cannabis use on brain structure in people at high familial risk of schizophrenia. Clinical interests include the delivery of cognitive and behavioural therapies to cognitively impaired patients and treatment of substance misuse post-brain injury.As anyone who has been designated driver can attest, alcohol intoxication is associated with profound effects on cognition and behaviour. The drinker experiences impairments in judgement, inhibition, motor skills and memory while simultaneously imbued with an inflated sense of their own abilities. While intoxication effects are transient, it is now established that detectable cognitive impairments are the rule rather than the exception in habitual heavy drinkers. These impairments exist on a spectrum, from the relatively modest deficits in memory, executive function and visuospatial abilities commonly seen in alcoholics entering treatment, to the potentially persistent dense amnesia associated with Wernicke-Korsakoff syndrome. In reality, the cognitive deficits present in any individual drinker reflect a complex interaction between individual vulnerabilities, the direct neurotoxic effects of alcohol, the consequences of periods of nutritional deficiency and metabolic disturbance, and other pathologies arising from the adverse health behaviours associated with habitual alcohol use. In recent years alcohol-related brain damage, a usefully catch-all concept which acknowledges that significant cognitive impairment in alcoholics extends far beyond the classic amnestic syndrome, has been increasingly acknowledged as a major public health problem.As the prevalence and importance of cognitive impairment associated with heavy alcohol use has been more fully appreciated, so has its potential reversibility. Central to achieving this is abstinence, or at least drastically reducing intake, and this is an exciting time for advances in therapeutic agents for alcohol dependence. The reality is however that alcohol dependence is associated with considerable co-morbidity, an understanding of which can potentially improve outcomes as well as assist identification of an alcohol problem in the first place. Commonly co-occurring problems include anxiety and mood disturbance, pain, sleep disorders and smoking, all of which can have a complex and potentially bidirectional relationship with alcohol dependence.

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