Dr Helen McMonagle: Alcohol-Related Brain Injury in the Irish Context - Individual, Service & Policy...
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Transcript of Dr Helen McMonagle: Alcohol-Related Brain Injury in the Irish Context - Individual, Service & Policy...
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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
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Alcohol-RelatedBrain Injury
in the Irish Context
Individual, Service & Policy Considerations
Dr Helen McMonagle, ARBI Rehabilitation Coordinator
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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”
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The Alcohol Trap
Increasing alcohol use
Cognitive deterioration
Reduced capacity to
seek or utilise
supports
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“ A man with no memories is a man with no foresight”
The Luminaries by Eleanor Catton
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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.
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Up to 80% of people with ARBI are diagnostically missed
by attending medical practitioners and allied professionals
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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
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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
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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
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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.
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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
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Whole System Approach to ARBI: Suspected Disorder
• Inconsistent implementation of detox protocols
• Undertreating is a false economy
• Agreed discharge pathways
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Discharge Care Pathway
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Whole System Approach to ARBI: Established Disorder
• Phased Rehabilitation
• Multidisciplinary input
• Optimising independence and community reintegration whilst managing risk.
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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
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