Dan Mushens examines whether it is correct to use the term alcohol related brain damage
Declaring "I support people with ARBD" is my stock answer when asked what I do for a living. Naturally, I then need to elaborate on the abbreviation which involves speaking about the medical diagnosis of alcohol related brain damage and how it manifests itself.
The more I say and hear those four words mentioned, the more I consider the potential impact it could have on sufferers of the illness. A certain stigma has long been attached to the self-inflicted nature of addiction to alcohol and it often feels as if it’s hardwired into society’s mindset and perpetuated by media.
Depending on your point of view, you may believe that alcoholism is self-inflicted, unworthy of sympathy; funding or resources, and completely preventable. Without wanting to generalise, the same rationale could be applied to obesity, lung cancer and self harming, but personal attitudes may differ.
Our attitudes, beliefs and values invariably change over time and so does the names we use to describe and label people. Referring to someone as an 'alcy’ isn’t so common these days, with many services also choosing not to use the term alcoholic, preferring to describe people as being alcohol dependant instead.
For the last four years I have worked for Penumbra, a Scottish mental health charity that supports around 1600 people every week. We believe that people can and do recover from mental ill health and I work for the Glasgow ARBD Supported Living Service, helping people to live independently in their own homes.
Over those four years, I’ve probably worked alongside 40 people with an ARBD diagnosis and I’ve begun to question if alcohol dependence is actually the cause or the effect of a person’s situation. The general societal view is that addiction to alcohol is the effect of drinking too much over a sustained period of time, and physiologically speaking, this may be true.
However, out of the 40 ARBD sufferers I’ve had the privilege to work alongside, I’d estimate that 95% of them have been exposed to the toxic trio of domestic abuse, mental ill health and substance misuse at sometime during their formative years either directly or indirectly via parents, during childhood.
Therefore, from my own viewpoint I don’t think it would be extreme to suggest that this common theme could be the cause of a person’s life path, thus leading to alcohol misuse, addiction and then alcohol related brain damage.
Incredibly, in 2004 the World Health Organisation estimated that 76.3 million people worldwide are affected by alcohol use disorders - that’s more than the entire population of the United Kingdom. Governments often have initiatives to tackle the detrimental impact of alcohol use such as taxation, minimum unit pricing and advertising restrictions.
However, to my knowledge, no real commitment has been made by governments to tackle the stigma that those experiencing substance abuse experience, although admittedly I’m no expert in this field.
With that in mind, I’ve been trying to initiate some discussion within local ARBD circles about an issue that the people I work with often highlight, the terminology of alcohol related brain damage and whether it’s fit for purpose in 2018.
Firstly, why is the cause of the illness mentioned in the medical diagnosis? Alcohol related seems to be slightly discriminatory in the sense that we don’t refer to smoking related lung cancer or junk food related obesity. I also think it could be seen to perpetuate the perceived self-inflicted nature of the illness.
However, consultant psychiatrist and expert advisor to the Drink Wise Age Well project Dr Tony Rao says, "by keeping the term alcohol related in the diagnosis, it helps to address the problem and defines a unique constellation of problems".
In relation to the brain damage part of the diagnosis, this is another area that to me, seems to be slightly discriminatory, with other countries such as Ireland and Australia commonly referring to ARBD as ARBI - alcohol related brain injury or impairment.
By having some colloquial conversation with various stakeholders such as service users and employees from various multi agency organisations, it seems apparent that there is an appetite to replace damage with injury, as damage suggests a definitive outcome – the brain has been damaged and that is absolute.
To use the word injury or impairment however tends to imply that recovery is possible and a person can indeed recover from this form of mental illness, something which Penumbra promote wholeheartedly in the way we deliver our services each and every day.
With ARBD thought to be massively under diagnosed, I can’t imagine people with suspected symptoms willingly asking to receive such a diagnosis. I believe that the condition is often hidden within families due to a sense of shame, fear or embarrassment which is perpetuated by this mentioned stigma.
By writing this very article, I hope that it can act as a small contribution to changing societal attitudes towards what we now call ARBD, but may one day call ARBI.
Dan Mushens is a recovery practitioner with Scottish mental health charity Penumbra. He can be found on twitter @DanielMushens
