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