Confabulation, Alcohol Abuse, and Alcohol-Related Dementia

Confabulation breaks trustOne of the lifelong struggles we, as human beings, do – or should be doing – battle with is being consistently honest both with ourselves (I submit this may be the hardest part of this battle because our capacity for self-deception seems to have no limits) and with others.

I have written here before about the interconnected relationship between honesty and trust. When we are dishonest with someone, we break their trust.

Perhaps trust can be rebuilt over time, but if it is rebuilt, it is often a slow and painful process. That’s how precious and fragile trust is.

It seems to me that we don’t value trust or honesty as much as we should. If we did, we wouldn’t break it or abandon it as much as we do.

I have thought a lot recently about King David and whether anyone ever really trusted him again after he sent Uriah the Hittite into the heat of a battle to be killed to cover up the affair that David had with Uriah’s wife that resulted in her becoming pregnant with his child.

Even though David repented, the consequences of the trust he broke – with his family, with his military, and with his subjects – remained.

Joab, one of David’s military commanders, was given the executioner’s letter that David wrote by Uriah himself.

Do you think Joab ever forgot that and wondered when his turn might come if he got on the wrong side of David? There is compelling evidence in some of Joab’s actions after this that he no longer trusted his king, nor, in fact, did he respect him.

And who else did Joab tell? The rest of the military? His friends and family (some of whom were related to David)? Even Absalom, perhaps?

We don’t know the answers to these questions, but we can read the written record and see that David’s life as king, as commander, and as father was a hot mess after this incident of dishonesty and broken trust.

Elderly, Alzheimer's Disease, and alcoholic brainsConfabulation, a common feature of long-term alcohol abuse and alcohol-related dementia, is a form of dishonesty that, unlike King David’s single highlighted incident, is pervasive and progressive.

And it not only completely destroys all trust, but it also tears apart all the relationships that know the lies that are embedded in confabulation.

Confabulation is a very difficult form of dishonesty to live with and to combat, mainly because the person who is confabulating is so sure that they are telling the absolute truth that they can be extremely convincing and believable to people who don’t know their history, their backstory, or any of the information well enough to know the facts, know the reality, and discern between what is true and what is not.

Mosby’s Medical Dictionary, 9th Edition defines confabulation as “the fabrication of experiences or situations, often recounted in a detailed and plausible way to fill in and cover up cognitive impairment or memory loss, which may be caused by alcoholism, especially in people with Korsakoff’s psychosis; head injuries; dementia; or lead poisoning.”

The people closest to those who habitually abuse alcohol or are experiencing stages of alcohol-related dementia are usually the most-targeted subjects of confabulation.

And it’s never in a positive way, but in a way that tears them down and builds the alcohol abuser up. The results, however, can be significant and catastrophic, if the confabulist is believed. It can literally destroy lives.

Part of that is simply the cumulative brain damage that occurs from long-term alcohol abuse and the resulting alcohol-related dementia.

But that’s not always the whole story and those who are the subjects of confabulation often find themselves doing deep historical research of their lives with the person abusing alcohol to determine whether the confabulation was always there and has just worsened with long-term alcohol abuse or whether long-term alcohol abuse created the confabulation.

Sometimes the person abusing alcohol has always been a confabulist – or maybe even a pathological liar.

However, there’s a significant difference because confabulation often has a vengefulness and meanness that is targeted toward people whom the confabulist believes in some way has wronged them (confabulists are also always victims and they play the associated sympathy card to the hilt), while pathological liars, with no hidden agenda or intentional malice, just don’t tell the truth about anything.

And sometimes the confabulation began after the person abusing alcohol journeyed the stretch through time.

Either way, it’s a agonizing process. And it ends in the dissolution of the relationship – the love always remains, but sometimes love means walking away for good from the harm that alcohol abuse and alcohol-related dementia and confabulation produces – with the person abusing alcohol.

Confabulation is not unusual in alcohol abuse. Just yesterday the news broke that David Cassidy says he has dementia and “knew it was coming” because his mother and grandmother had dementia.

This came on the heels of a weekend performance in which Cassidy, who is an alcoholic, was slurring his words, forgetting words to songs he should be able to sing in his sleep, and reportedly fell backwards off of a stage.

Was Cassidy drunk in that performance? Maybe. Does Cassidy have alcohol-related dementia? Most assuredly. Does Cassidy have genetically-inherited dementia (early-onset dementia)? Highly unlikely.

What you’re seeing with Cassidy’s story is confabulation. This a good example of what it looks like in practice. He may not even realize that’s what he’s doing. Most confabulists, because of the damage to the frontal temporal lobe that is characteristic in confabulation, don’t.

Instead they fully believe and are invested in the stories they tell and will until their dying breaths. That is, it seems to me, one of the saddest aspects of confabulation.

Lifestyle dementias such as alcohol-related dementia can be halted through giving up whatever is causing the cognitive impairmentFor those people who have become confabulists as a result of long-term alcohol abuse and who are experiencing signs of alcohol-related dementia, however, there is some promising news.

Because alcohol-related dementia is a lifestyle dementia, there is a change of stopping and even reversing the course of the dementia by sobering up and giving up alcohol for good.

It will, as Alcoholics Anonymous says, be something a person has to choose every day for the rest of their lives.

It won’t always be easy and there may be failures along the way.

But the failures in our lives are not the sum of our lives. Instead, they are places where we have a choice to give up, lie down, and quit, or to muster the courage to endure, stand up, and keep going.

It is in those moments and those choices in which character is forged. And that, my friends, should always be what we build from every failure we experience.

Life and its circumstances can take away everything we have, but the one thing that can never be taken away is our character. Indeed, it is the only thing we take with us when our time here on earth is done.

It’s that important and I hope we value it as such.



3 thoughts on “Confabulation, Alcohol Abuse, and Alcohol-Related Dementia

  1. This was very instructive, and it delved into a type of dementia that isn’t usually addressed in such clear detail. Although I’ve seen instances of confabulation in alcohol-related dementia, I didn’t understand the particular way in which it often manifests itself. This behavior has consequences that are acutely painful to all those involved, and seriously harmful to the targets of abuse. It’s a tragic disease with multiple victims, and very few avenues for recovery. Good article — thanks!

  2. Your article is priceless. We have been dealing with a close family member who years. She has hurt as all in so many ways. This helped me incredibly! Thank you! Thank you! Thank you!

    • I’m glad this article has helped you. I also have intimate knowledge of this subject with a close family member who has caused a lot of hurt among our immediate over the years, so I relate to this subject very personally. Best wishes and many prayers for your family and you as you continue through this painful journey. Answers do help and that’s why I try to share them on this blog.

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