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Edith Sullivan, Ph.D.

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One finding that surprised me when comparing level of impairment across domains of cognitive functions was the profound problem that even persons in long-term recovery from alcoholism exhibited in their ability to stand still. We found that, on average, the deficit in quiet standing was substantially greater than the significant deficits observed in cognitive functions. In our longitudinal studies, we have found this balance may improve, that improvement is correlated with signs of improvement in brain structure (notably, ventricular shrinkage), and that the time to recovery is longer in alcoholic women than men.

Our research often uses a force platform, capable of recording tiny movements in subtle sway made while trying to stand still. Sometimes during quiet standing, study participants are permitted to use stabilizing factors, such as keeping their eyes open, touching a non-weight-bearing post rather than keeping arms at their side, or standing with feet apart rather than with feet together. Balance TestWe have found that without the advantage of visual, tactile, or stance aids, individuals with AUDs wobble significantly more than healthy individuals on the force platform. With cues, however, individuals with AUDs are able to quell their sway almost to the level of healthy persons. The points I wish to note here are that 1) individuals with AUDs are still at a heightened risk of falling even long into sobriety, and should be warned of this risk; and 2) problems with balance can be reduced with simple aids from touch, vision, and stance.

We combined these studies of postural stability with examining the brain structures of both the individuals with AUDs and the group of healthy individuals used as the study control group. We found that the longer sway paths of those people suffering from alcoholism correlated with the size of their cerebellar vermis, a structure in the back of the brain known to be important for gait and balance and affected by chronic alcoholism. This led us to the next step: maybe the cerebellar vermis – traditionally considered supportive of motor control only, but recently gaining support as a cognitive control center as well – contributes to the cognitive impairment signature of alcoholism. This is our current research focus, with a focus on brain circuitry.

SW: What direction do you anticipate your research will take?

Our functional magnetic resonance imaging (fMRI) studies indicate that certain cognitive and motor functions require activity of neural systems that far-reaching across the brain. In particular, these fMRI studies have revealed that individuals with alcoholism can at times perform certain cognitive tasks as well as nonalcoholic individuals, but to do so may need to recruit different brain systems from nonalcoholic men and women to accomplish a test task at normal levels.
Furthermore, by using diffusion tensor imaging – a neuroimaging method that can provide information about the microstructure and quality of tissue, especially white matter tracts that connect far-reaching structures of the brain – we have found that white matter fiber tracts can be affected by alcoholism. However, there is the possibility that white matter degradation can undergo repair. Perhaps some of the functional recovery we see in alcoholics who remain sober over prolonged periods may be attributable to repair of white matter microstructure.

SW: What are the day-to-day applications of your research?

There are several facts I strongly believe that therapists, families of persons suffering from alcoholism, and society at large should appreciate:

  • One, even mild impairments can hamper everyday functioning and rehabilitation efforts.
  • Two, alcohol dependence changes the brain and those brain changes can themselves help maintain dependency.
  • Three, neurological recovery takes time, from months to years.

There are both dangerous and mild impairments. The dangerous ones include postural instability while standing; these can be especially troublesome in the dark and without stabilizing factors, such a stable surface to touch while walking. Yet, even though mild impairments such as cognitive and motor problems are subtle and require specialized testing to detect, they are clinically relevant because they reduce capacity for multi-tasking.

Families and individuals with AUDs both are often unaware of the severity of the drinking problem. Everyone should know about the 1-2 drinks a day limit, with a day-a-week holiday; that is, no more than 1 drink a day for women, and 2 drinks a day for men, and everyone needs a day a week off from drinking.

SW: What would you like to see happen in the addiction-research field?

We should know more about the beneficial effects of alcohol and who can benefit and who remains at risk for further harm. What are the scope and limits of brain-function recovery? What neurological and neuropsychological functions recover and which ones remain impaired or sub-standard? What is the course of recovery and what are the neural mechanisms of recovery?

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