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Published by Castle Craig Hospital
Professionals with drug and alcohol problems
Drug & alcohol problems at work
Addiction and the professional brain
Executive functioning: The series of higher processes carried out by the prefrontal cortex in the brain including planning, decision making, control of impulsive actions and problem solving.
The prefrontal cortex is the part of our brain located just behind the forehead and it plays a crucial role in many of the processes involved in professional life. It governs all decision-making: quick, impulsive decisions and longer drawn-out thought processes. It also supports self-monitoring, planning, reasoning and judgement.
Alcohol and drugs directly affect the functioning of the prefrontal cortex, both acutely and when used over long periods of time.
Drinking and the brain
Alcohol directly damages the brain, affecting the structure of the prefrontal cortex which controls executive functioning. Even a small amount of alcohol in the blood (as low as 0.05 g%) can lead to the following:
- Reduced hand-eye coordination
- Lower precision in manipulation
- Impaired vision
- Slow reaction time
- Impaired cognitive processing: poor concentration, difficulties in judgement, lack of perseverance, impaired problem-solving, poor memory, increased risk-taking.(1)
Many of these symptoms are also present during a hangover the next day, even after a normal night’s drinking.
MRI scans have shown the physical long-term effects of alcohol on the brain. This includes destruction of brain cells and brain shrinkage. Many of these changes are seen in the geriatric brain suggesting that essentially alcohol ages the brain prematurely.
It is estimated that around 20% of alcoholics are "high-functioning alcoholics". They maintain a seemingly flawless addiction, almost fitting it into their lifestyle with ease, continuing to maintain a professional front of stability and confidence. They hold down their job and have a great family life despite relying on drugs or alcohol in ever-increasing amounts. The fact is that the damage will continue until one day it catches up with them. No one's brain is immune to the damaging effects of alcohol.
Employers often do not recognise or ignore these problems in high-functioning alcoholics because it is well hidden and when the cracks begin to show alcohol addiction may be confused with burnout, stress and anxiety.
Cocaine and the brain
Cocaine users often feel euphoric, energetic, mentally alert and indestructible. However people who regularly use cocaine have been found to perform worse in concentration tests compared to non-users.
A study by Goldstein et al., used modern brain scanning technology to assess how active the brain is. The researchers found that cocaine users had reduced activity in brain areas associated with attention and concentration which correlated with worse performance in concentration tests. The memories of cocaine users were significantly worse than those who didn’t use the drug. Decision-making was also found to be significantly impaired in cocaine users and this again was backed up by brain imaging studies. (2)
A study by Kaufman et al., using fMRI, which measures brain activity by looking at the amount of oxygen used, found decreased brain activity in the anterior cingulate region of cocaine users who also performed significantly worse than non-users in the decision-making task. (3)
"Cocaine is an extremely addictive drug and this addiction harms not only the employees but also the company management. We are talking about millions of Euros lost in, for example, financial institutions”, said Dr. Etienne Olivier, Medical Director of Castle Craig Netherlands. “It can be difficult to recognise a cocaine addiction. Side-effects, including fatigue, insomnia, anxiety and depression are not always recognised as a cocaine problem”.
Can executives repair their brains?
Recently there have been exciting advances in the understanding of neurogenesis, the process whereby the brain repairs itself with the help of stem cells. Stem cells, sometimes described as 'mother cells' or 'blank cells', are cells that can multiply, renew themselves, and can develop into a variety of cell types e.g. brain cells, blood cells, bone cells, heart cells etc. Stem cells can be used to regenerate and repair damaged or diseased tissues in people.
How can we encourage neurogenesis in our brains?
For executives and professionals with alcohol and drugs problems, who want to get their brain back into optimal condition this requires:
- Abstinence from toxic substances e.g. alcohol and drugs,
- Regular exercise,
- Good nutrition,
- Healthy sleep patterns,
- Psycho-education and rehab treatment,
- Hyperbaric oxygen therapy - an adjunctive treatment at Castle Craig which stimulates the natural stem cell production and directs these cells to the brain where the damage is. This together with added oxygen flow and regeneration of blood vessels speeds up brain cell growth.
These are the conditions under which the brain can heal and decision-making can improve.
The best way to kick-start this is through an abstinence-based residential rehab treatment programme which combines all of the above elements, such as that provided at Castle Craig and Smarmore Castle. Residential rehab gives alcoholics the perfect chance to repair the damage done to the brain and establish full brain function again.
“Don’t expect a ‘quick fix”, says Frances Beek, Director of Castle Craig Netherlands. “It takes time to recover from an addiction, to let the brain recover and function well again”.
(1). McCann, M Harker Burnhams, N Albertyn, C Bhoola, U. Alcohol, Drugs & Employment. 2011. 2nd Ed. p. 83(2). Goldstein R.Z, et al. Severity of neuropsychological impairment in cocaine and alcohol addiction: association with metabolism in the prefrontal cortex. Neuropsychologia. 2004;42:1447–1458.doi:10.1016/j.neuropsychologia.2004.04.002 [PubMed] (3). Kaufman J.N, et al. Cingulate hypoactivity in cocaine users during a GO/NO-GO task as revealed by event-related functional magnetic resonance imaging. J. Neurosci.2003;23:7839–7843. [PubMed]