The National Council on Alcoholism and Drug Dependence fights the stigma and the disease of alcoholism and other drug addictions.

Ask Dr. Bob

QUESTION
A Massachusetts woman in her early thirties inquires, "What are the effects of alcohol on the brain? Is there permanent brain damage? Is it treatable?"


ANSWER
This question is much more complex today than it was just a dozen years ago. Within the last decade, much has been clarified about brain effects in alcoholism and drug addiction. For example, we now know about many of the neurotransmitter (brain chemical) changes which occur as one becomes alcoholic. The "pleasure center," deep in the mid-brain (also known as the nucleus accumbens), is effected by alcohol and many transmitters are activated. These include dopamine, serotonin, endorphin, and GABA. Although not truly "brain damage," these are basically abnormal changes in the biological functioning of the brain.

Impaired cognitive functioning (poor memory and disturbed thinking) occurs in many alcoholic persons during and after detoxification. Imaging studies suggest that 50% or more of chronic alcoholics may show brain shrinkage at that time. Since these patients are not regularly followed-up, we don't know how many return to normal. However, studies suggest that, if drinking stops, the shrinkage improves over several months. The only "treatment" for alcoholism and drug addiction is abstinence or detoxification.

Complicated detoxification may result in hallucinosis (a state of repeated hallucinations, but otherwise seeming to have normal thinking), epileptic seizures, or DTs (delirium tremens: confusion, hallucinations, agitation). All of which are types of temporary brain damage, usually self-limited and treated with sedatives or tranquilizers. There seems to be a continuum of brain damage with continued heavy drinking in many, but not, all alcoholics. Cognitive changes may include mild forgetfulness and poor concentration; or coordination may be poor with staggering gait, even while sober. Dementia, which mimics Alzheimer's Disease in all ways, may occur, and is permanent, and does not improve even after sobriety is achieved. A relatively rare condition, Wernicke-Korsakoff Syndrome, is particularly devastating. The patient seems sociable but has virtually no ongoing memory or ability to learn so that conversations are not recalled even a few minutes later. Treatment for all these conditions is abstinence from alcohol. Thiamine (a vitamin) may offer limited help in some cases, but, unfortunately, there is no other helpful treatment.

Finally, we now know more about brain damage to the developing fetus when exposed to alcohol during pregnancy. When the fetus is exposed to alcohol at vulnerable times, certain brain structures simply fail to develop. Necessary brain cells fail to migrate to areas where they are required for normal development. And CT or MRI imaging show reduced overall brain size. This condition, Fetal Alcohol Syndrome (FAS), is diagnosed after birth and the damage will last throughout life.

So much evidence exists to warn us about the potential brain damaging effects of alcohol use and abuse. There should be no doubt in anyone's mind that this does occur, and that it is one of the devastating effects of this all-to-common disease!



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Disclaimer

Dr. Bob does not provide specific medical advice or a medical diagnosis for any particular condition described, nor verify the authenticity of any information described in the questions presented. Patients should always consult their physician to discuss any specific symptoms, conditions, or modes of therapy for any particular mental or physical difficulties, diseases or conditions.

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