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Sober, But Not Thinking Straight

May 04, 2021
Photo of Timothy Conley; Sober but not thinking straight on image background

By Timothy B. Conley, Ph.D., LCSW
Certified Addiction Specialist

According to studies published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), damage to the brain from drinking is a common and potentially severe consequence of long-term, heavy alcohol use. The ability to think, remember and reason, referred to as “cognitive functioning,” is adversely affected by even mild-to-moderate drinking. A smaller though significant number of heavy drinkers may develop devastating, irreversible brain-damage, such as Wernicke-Korsakoff syndrome, a disorder characterized by the inability to remember new information for more than a brief period.

In this article, the obstacles to recovery from alcoholism for those suffering cognitive impairment will be explored and discussed. Some strategies for coping, which have been used by others successfully, will be presented.

Research studies have found that impaired cognition is often more severe during the first weeks of abstinence, making it difficult for some with alcohol use disorders to get their recovery off the ground and benefit from treatment activities. Most treatment programs—inpatient or outpatient—rely heavily on psychological education (called “psycho-ed” for short) as a treatment strategy. But what is the point if the alcoholic is unable to recall what they are being taught? It can take from several months to a year before the brain is fully recovered from its assault by alcohol; what is the recovering person to do in the meantime?

A client I will call Roland came to me for alcoholism treatment with a personal history marked by multi-year periods of abstinence and relapse. He had just completed two weeks of inpatient treatment following a three-year relapse which had included continuous as well as binge drinking. When I asked him how his treatment had gone he replied sarcastically “I don’t know—you would have to ask them.” Something in my experience told me he was not just being flip. When queried specifically about what treatment films he had seen, what the name of his counselor was and who else he was in treatment with, he drew blanks. He expressed concern about this saying that “I know I have lost a lot off the ball this time out—I can’t remember crap.” He also indicated that he remembered more from the two treatment programs he attended over five years ago than about the one he was just in. This baffled him.

I was able to explain to him the difference between long-term memory and recent memory, though I knew too that this information would most likely need to be repeated. His big problem was remembering new information. So, for treatment purposes we started with what he already knew: slogans from AA, the first three steps and even some meeting locations near where he lived. I knew that as time goes by cognitive functioning often improves and that eventually he may be able to make better use of the information presented to him in individual and group therapy, educational programs, and 12-step programs. Fortunately, I was seeing him in an Employee Assistance Program (EAP) office at his work location, so finding the office and keeping appointments could be ensured. It has been more of a challenge when outpatient participants forgot their appointment time, lost the card or could not find the office.

Steps to address cognitive functioning

One strategy which has proved helpful in working with the cognitively impaired recovering alcoholic is the shirt-pocket-sized spiral notepad. Making lists, crossing off what is done, copying over slogans and basic advice, writing directions and phone numbers—all can be accomplished in this simple way. This has advantages over an electronic device because the physical act of writing assists with memory. Another basic tactic is repetition and effort. Most people take their memory for granted and just go about life’s business. If something is important you remember it, if not, no big deal. How often do we say “I forgot...it must not be that important!” Helping the alcoholic decide what is important and what is not and putting effort into remembering what is important by writing it down and repeating it has proven helpful.

Another strategy is relying on others. Family, friends and even employers are often willing to help the newly recovering alcoholic stay on track. Joining Alcoholics Anonymous often means getting a “sponsor,” an established AA member who will help the newcomer make it to meetings and learn the slogans and steps so crucial to many for recovery.

The question may arise: Is this problem strictly alcohol related? Other types of brain damage not related to alcohol can also produce symptoms very similar to those associated with chronic alcoholism. Alcohol use disordered individuals are at a much greater risk for traumatic injury, including head injury, than non-drinkers. It is an important question to ask: Is there a history of brain injury? Good history taking and medical testing can answer this question.

Step 2 of the Alcoholics Anonymous program suggests that the recovering person believes that a power greater than themselves could restore them to sanity. What is the pre-drinking soundness of mind being referred to here? It may be that an individual has struggled with brain functioning or neurological issues all their life and the drinking was an adaptation to that. This is important to know when setting expectations for recovery, for while much alcohol-related brain impairment will reverse with time and abstinence, some other damage (and certainly pre-existing conditions) may not.

By remaining abstinent, however, persons with an alcohol use disorder will usually continue to recover brain function over a period of several months to one year with observable improvements in memory, attention span and reasoning. Time and patience answers a lot of questions. As often heard in AA: “You spent a long time walking into the woods, it will take a long time to walk back out.” May the view grow clearer with every step.

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Facts and information for this article were taken directly from the National Institute on Alcohol Abuse and Alcoholism Alcohol Alert # 53, July 2001

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