Alcoholism can cause neuropsychological deficits, that much is clear. There is much less clarity, however, concerning to what degree recovery may occur with abstinence from alcohol. New findings indicate that long-term abstinence from alcohol can resolve many – but not all – neurocognitive deficits.
Results are published in the September issue of Alcoholism: Clinical & Experimental Research.
"Previous research has shown some but not total recovery with abstinence from alcohol," said George Fein, president of and senior scientist at Neurobehavioral Research, as well as the corresponding author for the study. "The continuing presence of deficits is not a trivial issue as it may interfere with day-to-day functioning."
"The nature of alcoholism as a dynamic condition is largely underappreciated by most people, including clinicians," added Edith Sullivan, a professor in the department of psychiatry and behavioral sciences at Stanford University School of Medicine. "Alcoholics may have periods of abstinence, during which time they give their nervous system time for repair. Thus, longitudinal studies of alcoholics are critical for identifying functional areas that are targeted by alcoholism, those that are relatively spared, and those that can recover with sobriety."
Longitudinal studies in alcoholism, however, are very difficult to conduct, Sullivan added. "Tracking active alcoholics is challenging, finding alcoholics in recovery is also difficult - there is still a stigma associated with the condition. Furthermore, those who are in denial of their condition, by definition, will not avail themselves for study."
In this case, researchers performed a number of neuropsychological assessments on 96 participants, divided into two groups: 48 (25 males, 23 females) long-term abstinent alcoholics, and 48 (25 males, 23 females) age-matched "controls" who either drank lightly or not at all. The alcoholics were abstinent from six months to 13 years, for an average of 6.7 years. Performance was measured in nine domains: abstraction/cognitive flexibility, attention, auditory working memory, immediate memory, delayed memory, psychomotor function, reaction time, spatial processing, and verbal skills. Fein said that the only domain they did not examine was gait and balance, regarding it as separate.
"We found that the cognitive and mental abilities of middle-aged alcoholics who had been abstinent for six months to 13 years are indistinguishable from those of age and gender comparable non-alcoholics," said Fein, "with the possible exception of spatial processing abilities. Recovered functions would include short- and long-term memory, planning, learning, comprehension, etc. In other words, they would be able to support a normal home, work and social life; these people should be able to function cognitively normally."
"These findings further indicate the selectivity of alcoholism's untoward effect on visuospatial processes," added Sullivan, "which are important for many daily activities, including driving. We might also predict that these recovering alcoholics would have difficulties in reading a map, assembling things, and performing tasks that require spatial orientation."
Both Fein and Sullivan noted that these findings provide hope for recovering alcoholics, and can be used to encourage abstinence from alcohol.
However, cautioned Sullivan, "it is important to conduct careful investigation of cognitive and motor functions because they are multifaceted and complex, and component processes and functions can be impaired or recover piece by piece," she said. "It may be that only when enough of the pieces recover to at least some minimum level that we can then observe improved function."
In addition, said Fein, "we cannot definitively say that these individuals had deficits when they stopped drinking. We don't have data on this. Furthermore, these people were middle-aged. We're not saying that you will have full recovery if you stop drinking in your 50s or 60s; we are saying that these people stopped drinking earlier, and they appear to have close-to-full recovery function."
Researchers believe that the older brain may be more vulnerable than the younger and middle-aged brain to the damaging effects of alcohol. Fein and his colleagues are now examining recovery of cognitive functioning among abstinent alcoholics 65 to 85 years of age who stopped drinking before the age of 50, between 50 and 60, and after 60 years of age. This data, said Fein, will address the degree to which alcohol abuse is more damaging to the older brain, as well as the extent of recovery of function with long-term abstinence among older alcoholics.
"Whatever their nature," said Sullivan, "follow-up and/or longitudinal studies are of the utmost importance because of the vast number of factors that can contribute to cognitive and motor abilities, such as pre-existing family history and genetic factors, education, gender differences, age at onset of drinking, drinking pattern, age of drinking, nutrition, non-alcohol substance abuse comorbidity, and psychiatric comorbidity, such as anxiety or depressive disorders."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Cognitive Performance in Long-Term Abstinent Alcoholics," were: Jennifer Torres and Victoria Di Sclafani of Neurobehavioral Research, Inc.; and Leonard J. Price of the Alta Bates Medical Center at Herrick Campus, Berkeley. The study was funded by the National Institute on Alcohol Abuse and Alcoholism.
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