A stroke occurs when blood flow to an area of the brain is cut off. The clinical term used for stroke is cerebral vascular accident (CVA). In some cases, lay sources may refer to a stroke as a brain attack. The term stroke originates from the observation that individuals who suffered CVAs often develop very immediate and sudden symptoms as if they were struck down.
The effects of a stroke depend on the area of the brain where the CVA occurs, how extensive the damage is, and other factors, such as an individual’s overall level of health. According to the National Stroke Association:
- Approximately 800,000 people have a new CVA or a repeat CVA every year.
- CVAs are the fifth leading cause of death in the United States.
- CVAs are one of the leading causes of disability in the US.
- Nearly two-thirds of individuals who suffer CVA will have some form of disability.
- As many as 80 percent of CVAs can be prevented.
Types of CVAs (Strokes)
According to the book The Everything Guide to the Human Brain, there are two major forms of CVA.
- A hemorrhagic CVA occurs when there is a weakened vessel that breaks or a leak in a vessel in the brain. This is the least common type of CVA, but the one that is most often fatal. Interestingly, people who survive a hemorrhagic CVA often have a better prognosis than individuals who develop a CVA from the other major cause.
- An ischemic CVA occurs as a result of blockage in a vein or artery (ischemia), and tissue surrounding the main or artery dies. This form of stroke is often a chronic condition that develops over time, resulting in permanent damage. There are two major conditions that can cause an ischemic CVA.
- An embolic CVA occurs when a clot or fragments of plaque formed in another area of the body (most often, in the heart) break, often traveling in the brain. Once they reach the brain, they block the smaller vessels there, and this results in tissue damage and CVA.
- A thrombotic CVA is caused by a blood clot that forms at the site it blocks. Large vein thrombosis occurs in the brain’s larger arteries, and small vein thrombosis occurs in smaller veins and arteries.
Individuals may have also heard the term silent strokes, mini strokes, or TIAs. These terms are often used to refer to the same situation. A TIA (transient ischemic attack) is a result of blockage of blood flow to the brain that only develops for short period of time (typically 24 hours or less) and produces stroke-like symptoms. People who have multiple TIAs are at risk for later having major CVAs.
The effects of the CVA depend on the area of the brain affected and the extent of the damage the stroke has inflicted. In some cases, people may have problems with movement on the side of the body opposite to the side of the brain where the stroke occurred. In other cases, people may have significant problems with thinking, including problems with memory, attention, language, etc., in addition to issues with movement. In some instances, people may have few or no physical problems but significant cognitive issues.
Recovery from a stroke is quite variable from individual to individual, but does depend on the area of the brain where the damage occurs and the extent of the damage. Obviously, strokes that affect numerous areas of the brain and lead to extensive damage have the worst prognosis. Nonetheless, the use of medical treatments and cognitive and physical rehabilitation can be effective in helping an individual recover from a CVA, particularly if these interventions are implemented as quickly as possible after the individual has suffered a stroke. However, the best treatment for a CVA is prevention.
CVA and Alcohol Abuse
According to the National Institute on Alcoholism and Alcohol Abuse (NIAAA), some studies suggest that light to moderate alcohol use may decrease the risk for CVA; however, other studies suggest that light to moderate alcohol use may increase the risk for CVA. Likewise, reports in the media vastly differ, with some saying that alcohol use in moderation is a protective factor and others saying that alcohol use in moderation is a risk factor for the development of a CVA.
Despite the contradictions in research, most medical professionals take the stance that the use of alcohol to prevent cardiovascular problems, such as heart disease, high blood pressure, and the potential for a stroke, is not a sound practice. Per the American Heart Association (AHA), for a very select number of individuals with no significant pre-existing risk factors (e.g., genetic risk factors, metabolic risk factors, etc.), light to moderate alcohol use may decrease their risk of developing a stroke; however, it is far more likely that regular use of alcohol contributes to an increased risk for the development of stroke in the general population. AHA advises against using alcohol is an attempt to decrease the risk of heart attack or stroke. In addition, anyone who already has pre-existing heart disease or has suffered a stroke in the past should abstain from alcohol completely.
Treating Individuals Who Have Experienced a Stroke and Have an Alcohol Use Disorder
Risk factors associated with an increased probability to develop a CVA are the same risk factors that are associated with increased risk to develop any type of cardiovascular disease or disorder. These include dietary factors, lifestyle factors, genetics (family history), substance abuse, and other potential environmental interactions, such as exposure to toxins.
The research is very clear that heavy use of alcohol is a significant risk factor for numerous cardiovascular issues, including the potential to develop a CVA. Any individual who is diagnosed with any level of an alcohol use disorder, according to the specifications designated in the DSM-5, is at an increased risk to develop cardiovascular problems, which include an increased risk to develop a CVA.
The diagnostic criteria used by APA to diagnose alcohol use disorders include several general factors.
- The person’s alcohol use results in significant distress or dysfunction in their daily life.
- The person often demonstrates numerous issues controlling their use of alcohol. These issues are specified by several specific diagnostic criteria within the DSM-5.
- The person continues to use alcohol despite problems associated with such use.
- The person displays the symptoms of physical dependence on alcohol (developing tolerance to alcohol, or both tolerance and withdrawal symptoms).
APA allows for a diagnosis of an alcohol use disorder that is either mild, moderate, or severe, depending on the number of symptoms the person displays within a 12-month period. Even though individuals with a diagnosis of a mild alcohol use disorder have fewer symptoms than those in the other two categories, the diagnosis of a substance use disorder represents a dysfunctional situation and would not qualify under the normal designation of mild to moderate alcohol use. Thus, a person diagnosed with an alcohol use disorder at any level of severity is experiencing significant distress, dysfunction, and an increased potential to develop serious medical issues, including vascular issues that can lead to a CVA.
The approach to treating a person who has experienced a CVA of any type and who has been diagnosed with an alcohol use disorder would include:
- Ensuring that the person attempts to become abstinent from alcohol
- Using standard treatment protocols for addressing the individual’s issues with their CVA
- If possible, attempting to implement dietary and lifestyle changes that can reduce the risk for recurrent CVAs
- Continued monitoring of the individual’s physical and mental health
The person would be treated for both their alcohol use disorder and the CVA concurrently. Individuals who have moderate to severe alcohol use disorders are at significant risk for severe withdrawal symptoms that can exacerbate the symptoms associated with their CVA and even increase the risk that they will develop another CVA. These individuals may develop seizures at a higher rate than individuals who not have a pre-existing history of CVA. Inpatient physician-assisted withdrawal management treatment is necessary as a first step for these individuals.
The protocol to address the alcohol use disorder will typically follow the standard protocol used in the treatment of alcohol use disorders, with the addition of treatment for the individual’s CVA and the implementation of other lifestyle changes, medicines, and therapies associated with recovery from both conditions. Individuals who have alcohol use disorders and use tobacco products are at an even higher risk for the development of stroke than individuals who abuse either of these substances singularly. Treatment approaches for these individuals would attempt to ensure abstinence from both alcohol and tobacco, and incorporate extended treatment protocols for the CVA.
The outlook for individuals with comorbid alcohol use disorders and stroke is quite variable. When there is extensive damage due to the results of a CVA, the prognosis may be guarded at best. In many instances, individuals who experience CVAs begin to also experience significant symptoms of depression or anxiety, which can complicate treatment and result in the need for further interventions. In other instances, there may be significant cognitive dysfunction associated with the person’s CVA that may result in significant alterations to formal treatment protocols.
The primary goal of reducing the potential for recurrent CVAs in an individual who has an alcohol use disorder is to immediately get them to abstain from alcohol use. Because relapse is common in individuals with alcohol use disorders, this puts significant pressure on treatment providers. Using techniques like the Motivational Interviewing approach and other cognitive-behavioral techniques may be useful for individuals with cognitive damage in order to help them understand the severity of their issues; however, cognitive-behavioral approaches become less useful when individuals have significant cognitive impairments that result in substantial difficulties with attention, memory, or understanding language. Instead, strict behavioral approaches, or complete control over the person’s choices by family and medical professionals, are often implemented in treatment of individuals who have severe cognitive dysfunction as a result of their CVA.