Treatment Options
Where severe cognitive impairment is present:
- Abstinence (or substantial reduction in alcohol intake) should be encouraged.
- Nutritional support should be considered including extended use of thiamine supplementation.
- Treatment should be provided in a structured and routine manner that limits need for complex decision-making skills (e.g. consider need for inpatient treatment).
- Treatment elements that require significant cognitive processing should be reconsidered as they may be ineffective.
- Information presented to patients should be adapted according to the type of impairment they have (e.g., concrete and provided in more than one modality, that is, written and spoken).
- Patients should be given opportunities to practice behaviours taught, in various settings, with and without prompting.
- Treatment interventions may focus more on linking the individual with enhanced external supports (e.g. community activities, National Disability Insurance Scheme) or assisting with protective interventions (e.g. guardianship) rather than on strengthening the individual’s personal motivation to change.
Although clinicians have for some time recognised that many people with AUD also have CI, little evidence has been produced about which treatments are most effective. Nevertheless, level of cognitive functioning should be used to guide treatment planning. Even subtle cognitive deficits could affect treatment effectiveness in a number of ways.
People with AUD may have little insight into the nature and extent of their cognitive deficits. Due to concrete and rigid thought processes that can occur secondary to AUD-induced cognitive impairment, patients with CI may have difficulty processing all of the relevant information about their problem, and may be inflexible about changing their behaviour. They also may be impulsive and have difficulty generating new ways of solving problems when they arise. Clinicians must be aware therefore that this inflexibility results from an inability to understand the need to change, or from difficulties shifting existing ways of behaviour, rather than denial of a problem or refusal to change behaviour. In these situations, particularly where cognitive deficits are temporary, clinicians should try different treatment approaches (see next section) to engage the person in treatment.