1. Cognitive impairment and recovery associated with episodic and chronic alcohol use amongst Aboriginal Australians, and the factors that influence continued use after treatment Kylie Dingwall & Dr Sheree Cairney

2. Neurological impacts – Chronic use -Brain atrophy, ventricular enlargement, widened sulci -Learning, memory, visual spatial, executive impairments Rosenbloom, Sullivan and Pfefferbaum, 2003

3. Neurological impacts Chronic use – Consumption of large amounts of alcohol on a daily or near daily basis Episodic use or ‘binge’ use - consumption of large amounts of alcohol in one sitting on an irregular or episodic basis

4. Catalyst Full video available from www.abc.net.au/catalyst/stories/s2019179

5. Computerised, non-verbal assessment intended for the repeated assessment of cognitive function in diverse groups A number of subtests measuring: −Visual motor function −Executive function −Psychomotor function −Visual Attention −Visual Learning and Memory

6. Our studies Detect cognitive impairments associated with episodic alcohol use among Aboriginal people. Monitor cognition longitudinally for Aboriginal people attending rehab Identify and compare impairment and recovery profiles of chronic and episodic alcohol users Examine the factors contributing to continued alcohol use post-treatment

7. Non-drinkers vs Heavy Episodic

8. Rehabilitation Study Baseline4 weeks8 weeks Setting: Residential alcohol treatment programs in Northern Territory. Participants: 41 chronic alcohol users, 40 episodic users and 24 healthy controls (M age = 34.24; SD = 9.73). Measurements: CogState at baseline (start of treatment), then 4 weeks and 8 weeks later.

9. Baseline: Impaired visual-motor, learning, memory and executive functions Within 4 weeks: All except visual-motor function had recovered No significant difference between Chronic and Episodic users Results

10. Conclusions Episodic and chronic alcohol users presented a comparable profile of cognitive deficit and recovery Cognitive performance may improve rapidly with abstinence (i.e. within 1 month) Persisting visual-motor impairments. The majority of alcohol related cognitive impairments may arise from the residual biochemical effects of alcohol which ameliorate following detoxification

11. Community Follow up Participants: 37 alcohol users assessed at baseline upon entry to treatment Method: Re-interviewed and re-assessed after an average of 11 months (SD = 4.4) after treatment 6-12 months

12. Outcomes: 6 (16%) abstained 31 (84%) continued using Of continued users: 3 (10%) reduced their alcohol intake 23 (74%) continued using at the same level (change in use was unknown for 5 individuals). Improved users (abstained or reduced their use; n = 9) were compared to relapsed users (continued heavy use; n = 23) Community Follow up

13. Findings Relapsed users: Poorer paired associate learning at baseline Poorer paired associate learning, visual attention, executive function, learning and memory at follow up Less likely to return to a community with restricted alcohol access More likely to experience the psychological symptom of worry at follow up

14. Summary Alcohol affects frontal, hippocampal, cerebellar brain regions Impairments in executive functions, memory, learning, psychomotor function. Chronic and Episodic users present similar profiles of impairment and recovery Cognitive and impairment and accessibility were important factors in relapse

15. Flipcharts Available From: www.menzies.edu.au/brainstories

16. Australian Bureau of Statistics. (2006a). National Aboriginal and Torres Strait Islander Health Survey 2004-05. [Cat. No. 4715.0]. Canberra: Australian Government Publishing Service Vos, T., Barker, B., Stanley, L., & Lopez, A. D. (2007). The burden of disease and injury in Aboriginal and Torres Strait Islander peoples 2003. Brisbane: School of Population Health, The University of Queensland Australian Bureau of Statistics. (2008). The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples, 2008 [Cat. No. 4704.0]. Canberra: Australian Government Publishing Service Carlen, P. L., Wortzman, G., Holgate, R. C., Wilkinson, D. A., & Rankin, J. G. (1978). Reversible cerebral atrophy in recently abstinent chronic alcoholics measured by computed tomography scans. Science 200(4345), 1076-7078 Cairney, S., Clough, A. R., Jaragba, M. J., & Maruff, P. (2007). Cognitive impairment in Aboriginal people with heavy episodic patterns of alcohol use. Addiction, 102, 909-915 References