Alcohol-Related Brain Damage

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Brain damage from alcohol is a serious concern, especially in heavy and long-term users. It is well known that alcohol intoxication affects many aspects of human cognition and behavior. Alcohol can slow reaction time, slur speech, blur vision, impair muscle coordination, compromise judgment and reasoning, reduce inhibitions, induce euphoria, and may cause bouts of amnesia called “blackouts” where users cannot remember events that occur while they were drinking.^1,2,3 Over time, alcohol use can lead to alcohol-related brain damage, including a serious condition known as Wernicke-Korsakoff Syndrome, as well as other harmful effects.

How Does Alcohol Affect the Brain?

Alcohol reaches your brain within five minutes of consumption and starts to affect cognition and behavior within 10 minutes.2 While alcohol can initially appear to be a stimulant because it reduces inhibitions, it is actually a central nervous system (CNS) depressant.⁴

Alcohol damages most organs in the body, but it especially takes a toll on the brain. It interferes with your brain’s communication pathways and disrupts how it processes information. Alcohol brain damage can cause adverse effects to many parts of the brain including:^2,3,4,5,6

• Cerebral cortex: Alcohol slows down the function of the cerebral cortex, affecting thought processes, impairing judgment, and depressing inhibitions. It also blunts the senses and increases the pain threshold, which can increase the risk of injury.
• Frontal lobe: The frontal lobe is responsible for cognition, decision making, and self-control. Alcohol can impair these abilities, making it difficult for you to control your emotions and impulses. Some people may even become violent. Heavy, long-term drinking can cause permanent damage to the frontal lobe.
• Cerebellum: The cerebellum plays an important role in balance and coordination. Drinking alcohol impairs fine motor skills and causes loss of coordination and balance. Some people may become so shaky that they are unable to touch things normally.
• Occipital lobe: The occipital lobe is the part of your brain that governs vision. In the short-term, alcohol use can cause blurred vision. In the long-term, it can lead to vision problems such as abnormal eye movements, double vision, and eyelid drooping.
• Temporal lobe: Alcohol can impair the function of the temporal lobe, causing slurred speech and hearing problems.
• Parietal lobe: The parietal lobe is important for processing sensory information. Alcohol slows down the function of the parietal lobe, which slows down your reaction time.
• Hippocampus: When it comes to alcohol brain damage, the hippocampus is one of the most vulnerable parts of the brain. The hippocampus plays a major role in learning and memory. Higher doses of alcohol (usually blood alcohol concentrations (BACs) of 0.16 or higher) can prevent the hippocampus from transferring short-term memories to long-term memories. This experience is often referred to as a blackout when you have no recollection of events that occurred while you were drinking. Long-term alcohol use can damage the hippocampus and affect your ability to learn and retain new information.
• Hypothalamus: Alcohol disrupts the normal function of the hypothalamus, increasing blood pressure, hunger, thirst, and the urge to urinate while decreasing heart rate and body temperature.
• Medulla: The medulla regulates the body’s autonomic processes like heart rate and body temperature. Alcohol lowers body temperature and chills the body. The effects of alcohol on the medulla can be fatal in excessive amounts.
• Central nervous system (CNS): Alcohol slows down the function of the central nervous system, which slows reaction time, thought processes, and speech.
• Opioid receptors: Alcohol releases endorphins that bind to opioid receptors in the brain, inducing feelings of euphoria. Because alcohol affects the brain’s pleasure and reward systems, it can be psychologically and physiologically addictive.

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How Does Alcohol-Related Brain Damage Happen?

Serious brain damage can occur from heavy or long-term use. It can change the way neurons function, damage nerve cells, and even kill brain cells over time. This can lead to physical abnormalities, such as loss of brain volume. Drinking alcohol also damages the brain’s blood vessels, elevating blood pressure, and increasing the risk of a stroke.^1-7

Drinking alcohol causes brain damage even in moderate amounts. While excessive drinking is linked to an increased risk of dementia, moderate drinking (defined as one drink or less per day for women and two drinks or less for men) has generally been thought to be relatively safe. However, recent research has indicated that even moderate drinking is associated with shrinkage in several areas of the brain involved in learning and cognition.⁵

Alcohol shrinks the hippocampus, a part of the brain responsible for memory and reasoning. The amount of shrinkage that occurs depends on the amount of alcohol you consume, with heavy drinkers having six times the risk of shrinkage compared to non-drinkers, whereas moderate drinkers only had three times the risk. Researchers have also found that overall brain volume shrinks in proportion to alcohol consumption and that shrinkage occurs even in light drinkers.⁵

Drinking alcohol also damages the brain indirectly through malnutrition. Alcohol inhibits the absorption of Vitamin B1 (thiamine), and the liver damage from alcohol use reduces the body’s ability to store thiamine, which can lead to a serious brain disorder called Wernicke-Korsakoff syndrome.⁸

Symptoms of Alcohol-Related Brain Damage

Alcohol-related brain damage (ARBD) refers to a spectrum of disorders caused by chronic or binge drinking that occurs over many years. Some people may have a mild cognitive impairment, others may have alcohol-related dementia, and some may develop a more serious condition known as Wernicke-Korsakoff Syndrome (WKS).^7,9

Wernicke-Korsakoff Syndrome is a degenerative brain disorder caused by Vitamin B1 (Thiamine) deficiency. This deficiency often occurs as a result of alcohol use. The condition starts as Wernicke encephalopathy and often progresses to Korsakoff syndrome. Wernicke encephalopathy damages lower parts of the brain like the thalamus and hypothalamus. Korsakoff syndrome occurs when there has been permanent damage to the brain’s memory centers.^2,6,7,10

Symptoms of Wernicke encephalopathy include:^2,6

• Loss of muscle coordination that may cause leg tremors
• Vision changes (double vision, abnormal eye movements, or eyelid drooping)
• Alcohol withdrawal symptoms
• Confusion and loss of mental activity that can lead to coma or death

Symptoms of Korsakoff syndrome include:^2,6

• Hallucinations
• Amnesia or memory loss
• Inability to form new memories
• Making up stories

Other symptoms of Wernicke-Korsakoff syndrome include:^6,10

• Rapid pulse
• Low blood pressure
• Low body temperature/hypothermia
• Abnormal reflexes
• Muscle weakness and atrophy
• Coordination problems

If you start to notice any signs or symptoms of alcohol-related brain damage in yourself or a loved one, it is important to see a doctor immediately for an examination.

Who is at Risk for Alcohol-Related Brain Damage?

Anyone who consumes alcohol regularly is at risk of brain damage, even if their use is moderate. Those who misuse alcohol are at even higher risk of alcohol-related brain damage (ARBD); 50%-70% of people with alcohol use disorder (AUD) will suffer from some level of cognitive impairment.⁸

People who develop ARBD are usually between the ages of 40-50 years old. More men are diagnosed with ARBD than women, but women who get it tend to develop it earlier in life and after fewer years of alcohol misuse.⁷ Research has shown that alcohol-related brain shrinkage and cognitive decline tend to develop more quickly for women than for men. However, no conclusion has been drawn as to why this is. The speculation is that because women have smaller body sizes than men, brain damage can occur in a shorter period.¹¹

Can You Reverse Brain Damage from Alcohol?

Fortunately, most alcohol brain damage can be reversed or significantly reduced, especially when caught early. Symptoms may improve if you stop drinking alcohol and take a multivitamin along with a magnesium supplement. Research has shown that when alcoholics refrain from drinking for just a few weeks, brain atrophy shows significant improvement.⁵

As little as one year of alcohol abstinence can reverse or improve most cognitive damage.² You may regain your memory function, thinking skills, and ability to do things independently.⁷ However, restoration of memory function is often slow, and many patients do not make a full recovery and will have permanent brain damage from alcohol in the form of lingering memory problems.¹⁰

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Treatment for Alcohol-Related Brain Damage (ARBD)

Those with symptoms of alcohol-related brain damage must seek treatment as soon as possible. Even mild cases of ARBD can worsen and lead to serious symptoms if not treated. Without treatment, the symptoms of Wernicke-Korsakoff syndrome will progress and can be life-threatening.⁶

Typically, people suffering from ARBD have a co-occurring alcohol use disorder. This makes it much more difficult to treat the symptoms of ARBD because you need to stop drinking to restore your health and repair the damage caused by alcohol. You may need substance use treatment and detox support to obtain abstinence before you can begin to recover from ARBD.⁷

Treatment for severe cases of ARBD like Wernicke-Korsakoff syndrome usually begins with thiamine replacement therapy to restore the body’s Vitamin B1 levels. Vitamin B1 is usually given by injection into a vein or muscle and may help improve the following symptoms:^6,7

• Vision and eye movement problems
• Lack of muscle coordination
• Delirium or confusion

Thiamine therapy can begin while you are still drinking, but refraining from drinking will prevent further nerve and brain damage and offers you a greater chance of making a partial or full recovery. Well-balanced nutrition can also help, but it is not a substitute for quitting drinking.^6,7

Depending on the severity of alcohol brain damage, patients may receive one of three types of care: preventative, restorative, or end-of-life. Ultimately, wherever the patient is in their progression of the disease, the goal is to ease suffering, control symptoms, and prevent the condition from worsening.⁶

A hospital stay with monitoring and special care may be needed if the person is:⁶

• Lethargic
• Comatose
• Unconscious

Seeking Treatment

If you are struggling to control your alcohol use, you may want to consider seeking a professional assessment. Being unable to control use is one of the clinical criteria for a diagnosis of alcohol use disorder (AUD). To learn more about treatment options for AUD, call 800-948-8417 Who Answers? to speak with a treatment specialist.

Resources

1. Northwestern Medicine. (March 2021). How Alcohol Impacts the Brain.
2. Offrede, T., Jacobi, J, Rebernik, T, Jong, L., Keulen, S.,Veenstra, P,, Noiray, A., & Weiling, A.. (August 2020). The Impact of Alcohol on L1 versus L2. Sage Journal, 64(3).
3. National Institute on Alcohol Abuse and Alcoholism. (March 2021). Interrupted Memories: Alcohol Induced Blackouts.
4. New York State Government. (August 2019). How Alcohol Affects the Brain.
5. Merz, B. (July 2017). This is Your Brain on Alcohol. Harvard Medical Publishing.
6. U.S. National Library of Medicine. (February 2020). Wernicke-Korsakoff Syndrome.
7. Alzheimers Society. Alcohol-related brain damage: What is it and who gets it?
8. Thomson, A., Guerrini, I., Bell, C., Drummond, T., Field, M., Kopelman, M., Lingford-Hughes, A., SMith, I., Wilson, K., & Marshall, E. (April 2012). Alcohol-Related Brain Damage: Report from a Medical Council on Alcohol Symposium. Alcohol and Alcoholism, 27(2): 84-91.
9. U.S. National Library of Medicine. (May 2021). VR Assessment for Alcohol-Related Brain Damage.
10. National Institute of Neurological Disorders and Stroke. (March 2019). Wernicke-Korsakoff Syndrome Information Page.
11. Centers for Disease Control and Prevention. (October 2020). Excessive Alcohol Use is a Risk to Women’s Health.