What are the Effects of Alcohol Addiction?

Alcohol is astoundingly ubiquitous in our society; it’s hard to walk within a few-block radius without finding a liquor store or bar; even the 7-11s in Colorado sell it. While some people can drink infrequently or in social settings and not become dependent on alcohol, many others eventually cross the threshold into dependency or addiction.

Alcohol affects the brain on a number of levels, and by the time alcohol addiction becomes a problem for someone, the effects have had far-reaching consequences, infinitely more than the effects of a single episode of drinking. Difficulty walking, blurred vision, slurred speech, slowed reaction times, impaired memory, and impaired judgment are consequences of drinking too much in a single setting, and quickly resolve when the person stops drinking. However, people who drink heavily over a long period of time and who develop alcohol addiction may have brain deficits that persist long after they achieve sobriety.

Chronic over-reliance on alcohol resulting from alcohol addiction may have extensive and effects on the brain. Such effects range in severity from brief lapses in memory to permanent and debilitating conditions, such as Wernicke-Korsakoff Syndrome (also known as “wet brain”) that require lifetime custodial care.

BLACKOUTS AND MEMORY LAPSES

Alcohol can produce detectable impairments in memory after only a few drinks and, as the amount of alcohol increases, so does the degree of impairment. Large quantities of alcohol, especially when consumed quickly and on an empty stomach, can produce a blackout, or an interval of time for which the intoxicated person cannot recall key details of events, or even entire events; forgetting entire events refers to a state of “blackout.” While alcohol-addicted individuals may have frequent blackouts, they are also more common among social drinkers than previously assumed and should be viewed as a potential consequence of acute intoxication regardless of age or whether the drinker is clinically dependent on alcohol. Behaviors that people may engage in during a blackout period include a wide range of potentially dangerous events they may not remember, including vandalism, unprotected sex, and driving. If you or someone you know has experienced blackouts while drinking, this is a troubling sign. Another problematic behavior is binge drinking, which is defined by drinking five or more drinks (equivalent to 1.5 ounces of hard liquor, 12 ounces of beer, or 5 ounces of wine) within a two-hour period for men, or four or more drinks within a two-hour period if you are a woman.

PERSISTENT CHANGES TO THE BRAIN

For people who are addicted to alcohol – those who have been steadily or compulsively drinking alcohol for long periods of time and have not been able to stop, even if they want to – there is a significant risk of developing serious and persistent changes in the brain. Damage may be a result of the direct effects of alcohol on the brain or may indirectly develop in the context of poor general health status or severe liver disease. For example, a deficiency in vitamin B1 – also known as thiamine – is a common occurrence in people who are addicted to alcohol; this results from poor overall nutrition, often a byproduct of long-term drinking. Thiamine is an essential nutrient required by all tissues, including the brain. Thiamine is found in foods such as meat and poultry; whole grain cereals; nuts; and dried beans, peas, and soybeans. Many foods in the United States commonly are fortified with thiamine, including breads and cereals. As a result, most people consume sufficient amounts of thiamine in their diets. The typical intake for most Americans is 2 mg/day; the Recommended Daily Allowance is 1.2 mg/day for men and 1.1 mg/day for women (14).

Wernicke–Korsakoff Syndrome

Up to 80 percent of alcoholics develop a thiamine deficiency at some point – and some of these people will go on to develop serious brain disorders, such as Wernicke–Korsakoff syndrome (WKS). WKS is a disease that consists of two separate syndromes: a short–lived and severe condition called Wernicke’s encephalopathy and a pervasive, long-lasting condition known as Korsakoff’s psychosis.

The symptoms of Wernicke’s encephalopathy include mental confusion, paralysis of the nerves that move the eyes, and difficulty with muscle coordination. People struggling with alcohol addiction who develop Wernicke’s encephalopathy may be too confused to find their way out of a room or may not even be able to walk. Many Wernicke’s encephalopathy patients, however, do not exhibit all three of these signs and symptoms, and clinicians working with alcoholics must be aware that this disorder may be present even if the patient shows only one or two of them. In fact, studies performed after death indicate that many cases of thiamine deficiency–related encephalopathy may not be diagnosed in life because not all the “classic” signs and symptoms were present or recognized.

Approximately 80-90% of alcoholics with Wernicke’s encephalopathy also develop Korsakoff’s psychosis, a chronic and debilitating syndrome characterized by persistent learning and memory problems. Patients with Korsakoff’s psychosis are forgetful and quickly frustrated and have difficulty with walking and coordination (17). Although these patients have problems remembering old information (i.e., retrograde amnesia), it is their difficulty in “laying down” new information (i.e., anterograde amnesia) that is the most striking. For example, these patients can discuss in detail an event in their lives, but an hour later might not remember ever having the conversation. It can be a devastating experience to live with or watch a family member struggle with Wernicke-Korsakoff Syndrome, and tends to have a poor prognosis if not treated.

LIVER DISEASE

The liver is the organ that is chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body. Prolonged liver dysfunction, such as liver cirrhosis resulting from alcohol addiction, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy.

Hepatic encephalopathy can cause changes in sleep patterns, mood, and personality; psychiatric conditions such as anxiety and depression; severe cognitive effects such as shortened attention span; and problems with coordination such as a flapping or shaking of the hands (called asterixis). In the most serious cases, patients may slip into a coma (i.e., hepatic coma), which can be fatal.

New imaging techniques have enabled researchers to study specific brain regions in patients with alcoholic liver disease, giving them a better understanding of how hepatic encephalopathy develops. These studies have confirmed that at least two toxic substances, ammonia and maganese, have a role in the development of hepatic encephalopathy. Alcohol–damaged liver cells allow excess amounts of these harmful byproducts to enter the brain, thus harming brain cells.

GROWING NEW BRAIN CELLS

For decades scientists believed that the number of nerve cells in the adult brain was fixed early in life. If brain damage occurred, then, the best way to treat it was by strengthening the existing neurons, as new ones could not be added. In the 1960s, however, researchers found that new neurons are indeed generated in adulthood—a process called neurogenesis. These new cells originate from stem cells, which are cells that can divide indefinitely, renew themselves, and give rise to a variety of cell types. The discovery of brain stem cells and adult neurogenesis provides a new way of approaching the problem of alcohol–related changes in the brain and may lead to a clearer understanding of how best to treat and cure alcoholism.

RECOVERY IS POSSIBLE

People who struggle with alcohol individuals are unique individuals and have vastly different experiences, personality traits, genes, sociocultural influences, educations, races, and ethnicities. They experience different degrees of impairment, and the disease has different origins for each person. Consequently, researchers know that there is no one particular thing that is solely responsible for the brain deficits found in alcoholics. Characterizing what makes some alcoholics vulnerable to brain damage whereas others are not is the focus of much research these days.

While alcoholism can often seem like a hopeless and devastating disease, many people who struggle with alcohol addiction make completely full recoveries – no matter if they’ve been to treatment one time or 20 times. While many alcoholics, even those who are young, show some cognitive impairment or other signs of brain damage, most do show some improvements in brain structure and function within one year of becoming abstinent. Other alcoholics may take longer time to show such improvements.

At Flatirons Recovery, we emphasize and utilize a variety of evidence-based therapeutic approaches – including cognitive-behavioral therapies and other forms of therapy that involve physiological training in anxiety reduction and increased impulse control (which can lead to enhanced decision-making skills); psychological and behavioral strategies to practice interpersonal communication skills and develop the ability to tolerate distressing situations; and, of course, mindfulness training, which is a neuroscientifically-based modality being used to address conditions ranging from addiction to chronic pain to cancer.