The brain is a delicate and complex organ, which must maintain a careful balance of chemicals called neurotransmitters for a person to function properly. It controls our ability to balance, walk, talk, and eat. It coordinates and regulates our breathing, blood circulation, and heart rate. It is responsible for our ability to speak, process, remember information, make decisions, and feel emotions. Every brain is unique, ever-changing, and extremely sensitive to its environment.

When alcohol enters the body, it travels from the stomach and intestines through the bloodstream to various organs. In the liver, spikes in blood alcohol content caused by heavy drinking overload its ability to process alcohol. Therefore, excess alcohol journeys from the liver to other parts of the body, like the heart and central nervous system. Afterward, alcohol moves through the blood-brain barrier, affecting the brain’s neurons directly. There are over 100 billion interconnected neurons in the brain and central nervous system. As a toxic substance, drinking alcohol can damage, or even kill neurons.

According to Hazelden Betty Ford Foundation, too much exposure to a neurotransmitter can cause neurons to eventually ‘burn out.’ Since neurons make up the pathways between different parts of the brain, when they begin burning out, it can cause a noticeable slowing in the reactions of these pathways. In addition to pathway damage, brain matter itself is also damaged by heavy alcohol use.

People with alcohol dependence often experience ‘brain shrinkage,’ which is a reduced volume of both gray matter (cell bodies) and white matter (cell pathways) over time. There are some subtle differences in how brain damage occurs in men and women, but regardless of gender, loss of brain matter increases with age and the amount of alcohol consumed.

According to the World Health Organization (WHO), there are three million global deaths every year which result from harmful drinking. This represents 5.3% of all deaths. There is a causal relationship between the damaging use of alcohol and a range of mental and behavioral disorders, and other non-communicable conditions and injuries.

Alcohol intoxication is a result of short-term effects on the central nervous system with symptoms which can vary significantly depending on how often someone drinks, their weight, the amount of alcohol they consume, and their unique bodily make-up. Symptoms of alcohol intoxication include mild cognitive and physical impairment which may become more evident after one or two drinks, but heavier use can result in alcohol overdose if someone ingests too much alcohol in one sitting.

The immediate effects of alcohol on the brain are due to its influence on the organ’s communication and information-processing pathways. Unfortunately, drinking too heavily or too rapidly can result in several adverse mental effects, such as confusion, reduced motor coordination, and declined decision-making ability. Continuing drinking despite recognizing signs of this can lead to alcohol overdose, sometimes referred to as alcohol poisoning.
Alcohol poisoning is a dangerous and potentially deadly consequence of drinking large amounts of alcohol in a short amount of time. Alcohol poisoning symptoms include:

• Heart rate slowing
• Vomiting
• Seizure
• Confusion
• Problems with remaining conscious
• Respiratory suppression
• Permanent cognitive disruption or impairment
• Death

Types of alcohol-related brain damage

Wernicke-Korsakoff Syndrome

According to the alcohol rehab guide, this disease consists of two separate but linked forms of dementia. Those with alcohol use disorder (AUD) are commonly malnourished because of a poor diet. AUD is a compulsive, problematic pattern of alcohol use which persists despite negative consequences to a person’s health, job, and personal relationships. This often leads to a Vitamin B1 (thiamine) deficiency because alcohol blocks a person’s ability to absorb or use the vitamin. Almost 80% of people with AUD have a Vitamin B1 deficiency; many will develop brain damage like WKS after years of heavy drinking. Usually, patients develop Wernicke’s encephalopathy and are later diagnosed with Korsakoff as well.

Symptoms of WKS

• Confusion
• Difficulty with muscle coordination
• Forgetfulness
• Paralysis of eye muscles
• Impaired learning ability

For a mental health professional to diagnose someone with an AUD, a person must meet at least two of the following criteria within 12 months:

• Experiencing a craving for alcohol
• Being unable to cut down on drinking
• Spending a significant amount of time trying to obtain alcohol
• Avoiding activities you once enjoyed so you can drink
• Tolerance, or needing higher amounts of alcohol to achieve previous effects
• Using higher or more frequent amounts of alcohol than originally intended
• Experiencing alcohol withdrawal symptoms if you try to stop drinking
• Continuing to drink despite familial and relationship issues caused by alcohol use
• Continuing to drink despite negative physical or mental consequences
• Drinking while in situations where it’s dangerous to do so, such as while driving or operating machinery
• Being unable to fulfill obligations at work, home, or school because of alcohol use

Hepatic encephalopathy

Alcohol hepatitis is inflammation of the liver caused by years of drinking. Because the liver is responsible for filtering out toxins, a dysfunctional liver sends ‘bad’ blood to the brain. The result is hepatic encephalopathy or a build-up of toxins in the brain.

Symptoms of hepatic encephalopathy

• Depression
• Anxiety
• Shortened attention span
• Changing sleep patterns
• Altered mood or personality
• Problems with coordination
• Shaking hands

Foetus alcohol syndrome

Alcohol-related brain damage also presents itself in infants while in the womb. There is no known safe level of alcohol consumption during pregnancy because of the risk of fetal alcohol syndrome (FAS). Alcohol travels through the umbilical cord to the fetus, where the undeveloped body is unable to process the substance properly. The risk of developing FAS is higher in women who drink without using effective forms of contraception. This means most pregnancies are unplanned, especially in the US where women may not know they are pregnant until weeks four to six.

FAS can cause miscarriage, stillbirth, and several developmental disorders, such as:

• Low IQ
• Hyperactivity
• Distinct facial features
• Sleep and sucking problems during infancy
• Shorter than average height and weight
• Small head size

Several factors influence how and to what extent alcohol affects the brain. These include:

• The persons’ age, level of education, gender, genetic background, and family history of alcoholism
• How much and how often the person drinks
• The age at which he/she began drinking, and how long he/she has been drinking
• Whether he/she is at risk as a result of prenatal alcohol exposure
• His/her general health status

Patients may receive either preventative, restorative, or end-of-life supportive medical care depending on the severity of brain damage. Alcohol-related brain damage has no cure, but for those with WKS, thiamine and vitamin supplements can improve brain function. Early diagnosis of alcohol-related dementia, hepatic encephalopathy, and FAS can stop alcohol-related brain damage, and lifestyle changes may even reverse the deterioration. However, for all forms of alcohol-related brain damage, quitting drinking is the best first step.

All treatment for AUDs and alcohol-related diseases starts with a complete detox to free the body of harmful substances. Proper detoxing shows some effects of heavy drinking can be undone. Alcohol treatment medications like acamprosate and naltrexone may be prescribed to block the effects of relapse or reduce alcohol cravings.

For most people, the brain can heal, if started in time, and abstinence from alcohol can reverse much of the physical damage caused by heavy drinking. According to the Hazelden Ford Betty Foundation, magnetic resonance imaging (MRI), studies show that lost gray matter volume due to chronic alcohol abuse begins to redevelop in as little as two weeks of abstinence.

Just as brain damage leads to cognitive impairment, healed brain tissue leads to improved cognitive performance. Improvements result from healed brain tissue, some cognitive improvement comes as a result of the brain adapting to the damage and creating new pathways to complete tasks impacted by neuron pathways damaged by alcohol abuse. The most noticeable improvement in cognitive function begins after one year of abstinence from alcohol, although longer periods of abstinence result in greater improvements.

Alcohol use, especially excessive alcohol use, can aggravate pre-existing comorbid psychiatric disorders, such as depression and anxiety. In others, alcohol may induce depression and anxiety. Cognitive effects of alcohol may include memory loss, problems with learning, dementia, and severely hindered mental functioning in the most severe cases.

Since men and women have biological differences in the makeup of the brain tissue, there have been numerous debates on whether alcohol affects men and women differently and whether their brains recover differently. Studies have shown age and alcoholism affect both genders similarly and there are no significant differences between genders in the cognitive benefits of long-term sobriety.

Long-term abstinence over many years can allow the brain to heal enough to recover most cognitive functions, but there are still some lasting effects on certain areas, such as spatial processing. Chronic alcohol-related diseases such as alcohol-related dementia are permanent.

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