Recovery of Function after Chronic Alcohol Abuse

2014

The importance of abstinence for the recovery of functions in chronic alcohol abusers cannot be more strongly emphasized, given the severity of the risk for permanent brain damage associated with long-term, protracted abuse and given recent studies that show some recovery of neuropsychological functioning is possible in abstinent chronic alcohol abusers who have not suffered Korsakoff ‘s syndrome, cerebellar degeneration, or irreversibly damaging encephalopathic conditions. Rourke and Grant found that chronic male alcoholics who maintained interim abstinence for a period of two years following initial detoxification showed improvement on neuropsychological tests of abstracting ability compared with a group of chronic male alcoholics who resumed drinking during the two-year post-detoxification period, and compared with a control group of long-term abstinent alcoholics and a control group of nonalcoholics. The latter two groups were comparable in their neuropsychological performances on measures of abstracting ability, complex perceptual-motor integration, and simple motor skills. The group of relapsed chronic male alcoholics showed deterioration in their performance on the motor tests.

In another study that looked at perfusion images in frontal brain systems of abstinent long-term alcoholics using single photon emission computerized tomography (SPECT), Gansler et al. found an increased level of perfusion in the left inferior frontal brain region associated with greater years of sobriety in recovering alcoholics. Alcoholics with less than four years of sobriety showed a significantly reduced left inferior-frontal perfusion when compared with a group of nonalcoholic controls and a group of recovering alcoholics who had been abstinent for a longer period of time. These findings not only support the hypothesis of the negative impact of chronic alcohol intake on frontal-limbic-diencephalic brain systems, but also the possibility for some recovery of function in these brain systems with prolonged abstinence.

Studies which have looked at the recovery of cognitive functions have found that maintaining prolonged abstinence is a crucial requirement for any recovery of cognitive functions. Even with abstinence, however, not all cognitive functions show recovery or recover to levels equal to the control subjects. Age at onset of drinking, premorbid intellectual status, history of head injury, and age at which abstinence begins appear to be important modifying factors in determining cognitive function recovery.

Despite evidence that chronic alcohol abuse, even in the absence of an amnesic syndrome, is associated with neuropsychological deficits that are indicative of moderate to severe cerebral dysfunction, few treatment programs for recovering alcoholics routinely include neuropsychological evaluation and consultation as a standard treatment modality or offer rehabilitation for cognitive deficits as an integral part of their treatment program. Such deficits can present a significant obstacle to an individual’s ability to fully participate and benefit from various aspects of the prescribed treatment program. The need for further research into the efficacy of such an integrated treatment program for recovering alcoholics has been recently called for.