Alcohol-related brain injury (ARBI)

• Regularly consuming alcohol at risky levels can cause alcohol-related brain injury (ARBI), which can affect your thinking, memory, personality and movement.

• Anyone can get ARBI, but men over 45 with a long history of alcohol abuse are the most common group.

• You can recover at least some of the damage of ARBI if you get treatment as soon as possible.

About alcohol-related brain injury

Alcohol-related brain injury (ARBI) is damage to the brain caused by consuming alcohol at risky levels for many years.

ARBI causes damage to your brain. It can affect your memory, learning, thinking, personality, mood and social skills.

You might read or hear the term “alcohol-related dementia.” This term is outdated. Most doctors now refer to “alcohol-related brain injury”, although you may also hear “alcohol-related brain impairment” or “alcohol-related brain damage”.

Wernicke’s encephalopathy, Korsakoff’s syndrome and Wernicke-Korsakoff syndrome are types of alcohol-related brain injury.

The longer and more regularly someone consumes risky levels of alcohol, the more likely they are to develop ARBI. However, if you get treatment early and stop drinking alcohol, you can slow the damage and stop more damage happening. You may be able to recover at least some of the losses.

Support is available if you want to stop drinking alcohol, or have alcohol-related brain injury.

Causes of alcohol-related brain injury

Regularly consuming alcohol at risky levels over time can:

• cause your brain to shrink
• damage your heart, reducing the blood supply to your brain and damaging brain cells
• cause a lack of thiamine (vitamin B1).

If you regularly consume alcohol at risky levels, you are at risk of alcohol-related brain injury (ARBI). Men over 45 with a long history of alcohol abuse are the most likely to develop it.

What is a risky level of alcohol consumption?

There is no safe level of drinking alcohol. Following the Australian alcohol guidelines is the best way to avoid alcohol-related health problems.

We don’t know why some people who regularly consume alcohol at risky levels develop alcohol-related brain injury (ARBI), and others don’t. Most people who regularly consume alcohol at risky levels over time don’t develop ARBI.

However, we know that thiamine (vitamin B1) is involved.

Thiamine and alcohol-related brain injury

Thiamine is also known as vitamin B1. Thiamine helps turn the food you eat into energy, so it’s very important for your brain health. You usually get thiamine from the food you eat.

If you regularly consume alcohol at risky levels over time, you don’t get enough thiamine, because:

• alcohol makes your body worse at absorbing thiamine
• you may not be eating a healthy, balanced diet.

If you don’t get enough thiamine, your brain cells can become damaged and die. This is alcohol-related brain injury.

Types and symptoms of alcohol-related brain injury

Alcohol-related brain injury (ARBI) is also often linked with:

Wernicke’s encephalopathy

Wernicke’s encephalopathy is an intense swelling of your brain caused by a severe lack of thiamine. It usually develops suddenly.

Someone with Wernicke’s encephalopathy may experience:

• jerky eye movements, double vision and trouble moving muscles
• loss of muscle coordination, poor balance, staggering or inability to walk
• confusion or memory problems
• signs of malnutrition, including unplanned weight loss, tiredness, weakness and vitamin deficiency.

The symptoms of Wernicke’s encephalopathy can be different from person to person. If you’re concerned about yourself or someone else, talk to your doctor.

If it isn’t treated, Wernicke’s encephalopathy can cause permanent brain damage and lead to Korsakoff’s syndrome.

Korsakoff’s syndrome

Korsakoff’s syndrome is caused by damage deep in your brain that affects your ability to:

• form new memories
• learn new things.

Korsakoff’s syndrome often develops if you don’t get treatment for Wernicke’s encephalopathy. But it can also develop on its own if you use alcohol at risky levels over time. Korsakoff’s syndrome usually develops gradually.

Someone with Korsakoff’s syndrome may experience:

• trouble forming new memories and learning new things
• more rarely, loss of older memories
• personality changes
• making up stories to fill gaps in memory (confabulation)
• seeing or hearing things that aren’t there (hallucinations)
• not understanding or not believing you have Korsakoff’s syndrome.

If you have Korsakoff’s syndrome, what happens next depends on:

• how soon you get treatment
• how much brain damage you already have.

If you experience both Wernicke’s encephalopathy and Korsakoff’s syndrome at once, it’s called Wernicke-Korsakoff Syndrome (WKS).

Treatment and management of alcohol-related brain injury

Without treatment, the damage and symptoms of alcohol-related brain injury will get worse over time. It can become permanent and may lead to death.

But it is possible to slow or stop the progress of alcohol-related brain injury. You may also be able to recover from at least some of the damage.

Treatments for alcohol-related brain injury include:

• High doses of thiamine (vitamin B1) for Wernicke’s encephalopathy
• stopping drinking alcohol
• taking vitamin supplements
• eating a healthier diet.

Always talk to your doctor before starting any treatment.

Recovery can take up to two years after you stop drinking. Some symptoms, especially memory loss and thinking skills, might be permanent.

If you’re struggling to stop drinking, there is help. Talk to your doctor or see below.

Get support

There is good support and treatment for alcohol addiction and alcohol-related brain injury.

• Talk to your doctor. They can start treatment and provide advice and referrals.
• Alcoholics Anonymous: A peer-support organisation for people affected by alcohol abuse. Call 1300 222 222.
• Al-Anon Family Groups: A self-help group that provides support to people affected by someone else’s drinking.
• Australian Drug Foundation: The foundation is committed to preventative initiatives and credible information. Contact their Drug Info and Advice Line on 1300 85 85 84. 
• Arbias: provides specialist services for people with alcohol and drug-related brain injury. Call 03 8388 1222 in Victoria and 02 9708 0027 in New South Wales.

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