Background: Initiatives are required to identify and provide rehabilitation for individuals with Alcohol Related Brain Injury (ARBI). However, there is very little evidence as regards the outcomes and lived experiences of the patients who often have a myriad of corollary problems including alcohol dependency, homelessness, family dysfunction, poor health, and contact with the criminal justice system. Leonard Cheshire has developed a specialist residential rehabilitation facility for people in Northern Ireland with Alcohol Related Brain Injury. This service is the first of its kind on the island of Ireland and is one element in the network of services required to support people with ARBI.

Objectives and main outcomes: This mixed methods study explored the effectiveness of an ARBI rehabilitation treatment modality available for patients in Northern Ireland on an inpatient basis. In particular, the study sought to ascertain whether the ARBI treatment service improved outcomes for patients(psychological, functional, social and relational) and to determine what is required to sustain and/or improve implementation of the service. The quantitative element focused on measuring the impact of the intervention on psychological well-being, functional ability, familial and social relationships/ community participation/ cognitive ability and maintaining abstinence.

Design: A mixed method design was employed, with individuals with ARBI who were recruited through Leonard Cheshire ARBI service using purposive sampling over a 16-month period. A range of psychometric measures were used to assess psychological well-being, functional ability, familial and social relationships/community participation/cognitive ability and maintaining abstinence at base line and at five junctures throughout the project time frame. Qualitative data was collected over 4 timepoints: baseline (n=20), 6 months (n=15), 12 months (n=6) and at discharge (n=8). Remote interviews were conducted with family members (n=10) in order to capture their lived experience and views. Staff interviews (n=6) captured views on the implementation of the model as well as their perceptions of strengths, weakness and benefits of the service and external influences that might impact on its implementation and effectiveness.

Findings: Quantitative findings for service users showed significant positive differences across T1 and other junctures for physical and cognitive functioning, anxiety, occupational performance and satisfaction, quality of life and societal participation, there were no significant differences between all time points at baseline and at the three-month juncture for psychological well-being and depression. Qualitative findings for residents across 4 timepoints from baseline to time of discharge indicated an overall improvement in all outcomes. Staff from within the unit felt that the ARBI multidisciplinary holistic approach had a positive impact on residents’ outcomes and was also cost effective in that these individuals were no longer frequenting A&E departments and the judicial system and instead were now able to live stable lives without relentless chaos whilst residing in the unit.

Conclusions: Overall, the ARBI holistic intervention significantly improved psychological wellbeing, social relationships/community participation, functioning abilities and abstinence from alcohol, particularly when residents were residing in the unit. Whilst the residential unit provided structure and a protective environment, residents required ongoing support post discharge for their addictive behaviours. An outreach intervention for these individuals is currently being piloted.