The Mental Welfare Commission has published a good practice guide to help clinicians recognise and treat the condition. 

Alcohol-related brain damage (ARBD) is caused by heavy alcohol use over a long period that causes changes in the brain and can lead to memory loss, problems with judgement and the ability to live independently. Almost 30% of individuals who are alcohol dependent have ARBD.

The Mental Welfare Commission has warned there are significant barriers to recognising and treating the disease.

Some individuals exhibit confabulation, where they create vivid memories to fill the blanks of their memory and make sense of their situation without any intent to deceive.

Alongside the fact that verbal and communication skills are often unaffected, clinicians can be ‘taken in’ by these characteristics and fail to spot the condition, the guide warns.

The report recommends healthcare professionals build up a more accurate assessment of an individual’s cognitive abilities by speaking to friends and families but cautions those with the condition often have narrowed social circles.

Healthcare professionals also have to grapple with the conflict between respecting a person’s right to choose how they live and the need to protect a potentially vulnerable person in need of help that could improve their quality of life.

In the most serious cases, compulsory intervention under incapacity or mental health law is deemed appropriate.

Clinicians must rule out all other causes of cognitive impairment to be certain of ARBD, the report states, which can be further complicated by an individual continuing to consume alcohol or suffering from withdrawal.

The guide recommends a five-stage treatment model running from stabilisation in a hospital setting to rehabilitation and long-term support provided by a multi-disciplinary team including doctors, social workers and occupational therapists.

The guidelines note, however, that “this model requires specialist services which are not available in many areas of Scotland”.

They also highlight inadequacies in the supply of housing types appropriate for patients recovering from ABRD, with most care homes designed to care for older people.

A final barrier identified by the Mental Welfare Commission is stigma among the wider public, which can lead to sufferers being excluded from services and wider society, and pessimism among health workers who may see their patients relapse.

Colin McKay, chief executive of the Mental Welfare Commission, said: "Working with specialists in this condition, we produced this guide because we know that diagnosing and treating people with ARBD can be a complex process.”

"The guide discusses these issues and also addresses the assessment of a person's capacity to make their own decisions, once they have a diagnosis. It also reviews the legal powers available in Scotland, and the use of those powers in particular settings and situations, using case studies.”

Dr Roger Smyth, consultant liaison psychiatrist at the Edinburgh Royal Infirmary, added:

"ARBD is a condition which can have devastating effects on the lives of sufferers and their families. We know that medical practitioners can find it a challenging condition to diagnose and, even after diagnosis, professionals can be unsure whether and how to intervene. We hope this guidance will offer useful help to professionals working with sufferers and their families."