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Excessive use of alcohol and other substances can contribute to Alzheimer’s. Alternatively, any form of dementia (of which Alzheimer’s is the most common) can contribute to addiction. In cases where both are present, clinicians may question if rehab is then a suitable place for treatment. At Castle Craig Hospital, we have successfully treated patients with symptoms of both conditions simultaneously.
Understanding Substance Misuse Dementia
When a person suffers from co-occurring substance misuse and Alzheimer’s1 then each condition will affect the other. Substance misuse may increase in response to Alzheimer’s or it may have been a contributing factor to its onset. The person affected is likely to be highly anxious and confused as to the causes and severity of their dual condition. Symptoms such as poor cognition, uncontrolled emotions, and erratic behaviour may be pronounced, making both diagnosis and treatment especially challenging.
Alzheimer’s and Rehab Treatment
Recovery from addiction to drugs or alcohol dependency is never easy and co-morbid conditions such as dementia have to be carefully assessed. But despite the challenges, the situation is not hopeless—many drug and alcohol treatment facilities have developed adaptable treatment programs to meet the unique needs of people with dementia. These programs have produced successful results in many instances.
What Is Alzheimer’s Disease?
Alzheimer’s is the most common form of dementia, a disease that is disabling and difficult to treat. It affects a large proportion of people over the age of 65 although it can affect younger people too. Dementia is known as a degenerative neurological disorder that negatively and progressively impacts brain functions such as memory, cognitive abilities, perception, and practical and emotional control. There is much that is not yet understood as to how these changes in the brain begin to happen, but genetics, lifestyle, and environment are known to be factors. In particular, prolonged use of alcohol or other drugs can hasten the onset of dementia of all kinds.
Diagnosis of Alzheimer’s
A diagnosis of Alzheimer’s disease will consider the following (source –The Diagnostic and Statistical Manual of Mental Disorders, DSM 5)
Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains:
- Learning and memory
- Language
- Executive function
- Complex attention
- Perceptual-motor
- Social cognition
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In practice, these will show up as behavioural warning signs such as:
Forgetfulness – relationships, and events
- The decline in listening abilities
- Reduced problem-solving ability
- Poor concentration
- Struggles with communication including speech
- Difficulties learning new ideas and techniques
- Loss of physical strength and coordination
- Getting lost in familiar locations
- Mood and personality changes
- Poor appreciation of time
- Inappropriate or hostile reactions to family, friends, and caregivers
- Poor self-care – hygiene, meal preparation, tidiness, etc.
Diagnosis of Substance Misuse When Alzheimer’s Is Present
Diagnostic criteria for substance misuse including alcoholism are contained in the DSM 5 and are well known. They come under the four main headings of physical dependence, inappropriate use regardless of the dangers, serious social consequences, and loss of control.
An addicted person suffering from any form of dementia as well may experience symptoms that are more severe than for most people due to their impaired perception of what is happening and their brains’ inability to control their actions. Even those in the early stages of Alzheimer’s will struggle to regulate their drinking and drug use habits, hampered by memory problems and a lack of self-awareness. They can easily consume far more drugs or alcohol than they realized or intended, and their diminished interpersonal functioning may prevent them from asking for the assistance they need.
Special Considerations When Assessing Suitability for Residential Treatment
A co-morbidity of dementia and addiction presents special challenges at the assessment stage. Both cognitive, emotional, and laboratory tests are likely to be needed. Points to be considered are:
- Physical health: both diseases (addiction and dementia) lead to severe physical and mental deterioration and eventual loss of control of basic bodily functions. A careful assessment to establish a person’s capability, however, limited is the first step.
- Mental health: although a person on admission to rehab may often be in severe mental and emotional distress or depression, they need to be capable of attaining a degree of peace of mind if treatment is to be worthwhile. An assessment to establish this will always be made.
- Assessing co-morbidity: it will be necessary, although difficult, to differentiate between symptoms relating to dementia and those relating to addiction – some symptoms (loss of control, acute anxiety for example)are present in both conditions. This is important in planning appropriate treatment – some dementia conditions respond to drugs whereas some addiction conditions respond to behavioral changes.
- Risk assessment: we will carry out a risk assessment in order to make sure that the patient will be safe and properly cared for, having regard to their individual needs.
- Treatment Goals: it will be important to establish achievable treatment goals for each individual based on an assessment of their ability to respond to a programme of rehabilitation in a way that will improve their quality of life. It may be that some people, in the early stages of dementia will have the potential for good progress while for others, the likely benefit may be limited to the process of detoxification only.
Treatment Considerations Where Dementia Is Present
At Castle Craig, our addiction recovery programme is flexible enough to accommodate people suffering from a range of co-morbid conditions including Alzheimer’s, provided that the patient is assessed to be capable of responding at a level that would make the process beneficial. Factors such as the level of medical and nursing attention required, degree of participation in the daily activities, and length of stay would all be carefully discussed and planned in advance.
Detoxification – Special Considerations
People suffering from Alzheimer’s and substance misuse generally have less control and less awareness of their addictive behaviour. This puts them at greater risk of overdose and also can make detox more problematic. Thus the detox process requires special levels of care and monitoring. This process, which can last from a day or two to several weeks, depending on the substances that have been used, will be followed with the utmost care in order to keep any discomfort or anxiety to a minimum.
Family Involvement
Wherever possible, family involvement is encouraged. Both addiction and Alzheimer’s can have profound effects on families – emotional as well as practical. Family sessions will be arranged wherever possible to increase understanding of the disease, the treatment, and future plans.
Aftercare
Any form of dementia is likely to lead to a reduced capacity to handle personal affairs and therefore a good and workable aftercare plan is essential for lasting benefit from treatment.
If an improved quality of life is to be sustained after discharge, it may well require the involvement of family members as well as caregivers and healthcare professionals. Follow-up sessions can also be arranged.
