dr helen mcmonagle: alcohol-related brain injury in the irish context - individual, service &...

Dr Helen McMonagle: Alcohol-Related Brain Injury Rehabilitation Coordinator

Alcohol-Related Brain Injury in the Irish Context: Individual, Service & Policy Considerations

ARBI: A Best Practice Seminar: Royal College of Physicians, 20th April 2015

Alcohol-RelatedBrain Injury

in the Irish Context

Individual, Service & Policy Considerations

Dr Helen McMonagle, ARBI Rehabilitation Coordinator

Sound Familiar…?

“They’re not motivated to stop drinking”

“Unless they stop drinking, I can’t help them”

“Unless they come into see me themselves and say they want help, I can’t do anything”

The Alcohol Trap

Increasing alcohol use

Cognitive deterioration

Reduced capacity to

seek or utilise

supports

“ A man with no memories is a man with no foresight”

The Luminaries by Eleanor Catton

National Prevalence of ARBI

Autopsy Studies: 0.4% - 2.8%

Irish Estimate: 18,320 - 128,240

Harper C, Fornes P, Duyckaerts C, Lecomte D, Hauw JJ. An international perspective on the prevalence of the Wernicke-Korsakoff syndrome. Metabolic Brain Disease 1995;10:17–24.

163 = people admitted to acute hospitals across Donegal, Sligo, Leitrim and Roscommon over a 5 year period.

Up to 80% of people with ARBI are diagnostically missed

by attending medical practitioners and allied professionals

Primary Care

Acute Care

Detoxification

Assessment and Diagnosis

Case CoordinationCommunity based services

Residential

Rehabilitation

NeuropsychologyOccupational Therapy

Discharge Destination

1

9 7 10

65

4

3

2

8

Blocks/Gaps in Service Provision

Prognosis and Recovery

• Acute Hospital bed day usage can be reduced by 85%

• 75% can be supported successfully in community settings

• 10% relapse rateWilson, K., Halsey, A., Macpherson, H., Billington, J., Hill, S., Johnson, G., ... & Abbott, P. (2012). The psycho-social rehabilitation of patients with alcohol-related brain damage in the community. Alcohol and Alcoholism, 47(3), 304-311.

Smith, I., & Hillman, A. (1999). Management of alcohol Korsakoffs Syndrome. Advances in Psychiatric Treatment, 5(4), 271-278

A Whole System Approach to ARBI

Get better at preventing the disorder

Get better at identifying the disorder

Get better at treating the disorder

Get better at rehabilitating the disorder

Whole System Approach to ARBI: Primary Prevention

• Best to work on what is causing or supporting difficulties to occur, rather than simply responding to the problem itself at a later stage.

• Alcohol presents a more significant cost burden on Irish society than smoking and obesity combined.

Whole System Approach to ARBI: Secondary Prevention

• Redefine ARBI across of trajectory of risk

• Increase preclinical detection rates

• Training for professionals working with people with AUD’s

Whole System Approach to ARBI: Suspected Disorder

• Inconsistent implementation of detox protocols

• Undertreating is a false economy

• Agreed discharge pathways

Discharge Care Pathway

Whole System Approach to ARBI: Established Disorder

• Phased Rehabilitation

• Multidisciplinary input

• Optimising independence and community reintegration whilst managing risk.

Primary Care

Acute Care

Detoxification

Assessment and Diagnosis

Case CoordinationCommunity based services

Residential

Rehabilitation

NeuropsychologyOccupational Therapy

Discharge Destination

1

9 7 10

65

4

3

2

8

Blocks/Gaps in Service Provision

Available now from: www.alcoholforum.org