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Alcohol Damages the Brain

Updated: Sep 28, 2022

It is often said that one glass of red wine a day is good for you, and this may be true for your heart because of the antioxidants available in red #wine, but a neurologist will tell you it isn't worth the sacrifice your brain suffers.


More recently I've been working on creating a program to address the challenges of #alcoholism and it's been on my mind so much that last night, I had several dreams about it. One was specific to how the alcoholic often struggles with memory loss and decision making. We acknowledge the damage alcohol can do to the liver, so for those who seem to have livers worthy of superman, the threat goes unappreciated. When you drink more chronically and especially if you binge drink, have a foggy memory after drinking, or black out, this is clear indication your brain cells are so toxic they are being starved of oxygen. Do this enough and you will suffer significant and long term brain damage.


It really doesn't require as much as one may believe. Drinking 8 glasses of wine, 8 beers, or 8 shots or more for men, and 6 for women is enough to cause damaging effects. Many hit the golf course with cold six-pack and are still eager to see the cart girl by the back end of the course, yet haven't any difficulty hitting par. If you're drinking more than 25 units per week, your ability to think and function will be compromised, although drinking more in short periods of time is much more risky with far more damaging effects.


For many though, drinking again masks these symptoms and your bias causes you to believe alcohol is the cure of this foggy mind. Keep this cycle up though and your brain will suffer irreversible damage and you may eventually struggle to accomplish even simple daily tasks, similar to Alzheimer's. Interestingly too, for those who work to recover their addiction, they may not even recognize the damage their brain has suffered until they spend some time sober.



Alcoholism is an addictive disorder with many underlying causes and consequences. The neurological consequences include hepatic encephalopathy, Wernicke encephalopathy (WE), Korsakoff syndrome (KS), Marchiafava-Bignami disease (MBD) and central pontine myelionlysis (CPM). Each of these relatively well-characterized alcohol-related CNS disorders is associated with a unique clinical presentation and a discrete neuropathological and neuroradiological signature, but when chronic alcohol consumption can leads to structural changes to the brain and functional consequences that don't quite fit into one of these diagnosis, we as clinicians will identify this as "alcohol-related brain damage" or ARBD.


Alcohol-Related Brain Damage


People who get ARBD are generally aged between about 40 and 50 years. It doesn't have to get worse with time, unlike other causes of dementia such as Alzheimer's disease. If a person with ARBD stops drinking alcohol and receives good support, they may be able to make a partial or even full recovery. They may regain much of their memory and thinking skills, and if they previously required assistance for daily tasks, even this can be recovered to complete independence.


Some people with ARBD or ARBI (injury) will only have small changes to their thinking and memory, known as mild cognitive impairment. They are at risk of more serious brain damage if they continue drinking. Others will suffer more serious problems with memory and thinking. This is a sort of alcohol related dementia or Wernicke-Korakoff syndrome, which will challenge their ability to even do day-to-day tasks, similar to Alzheimer's disease.


In my dream last night, a friend of mine who struggles with alcohol was given a random MRI and to everyone's surprise, he had significant brain damage to his amygdala - the fight or flight center of the brain. He also had issues with his frontal lobe causing significant issues with his memory and decision making, so that I was often saying to him, "that doesn't even make sense." These weren't super ominous statements of confusion though, because until the MRI offered revelation, I thought I was the one confused and questioned my own state of reality. He would also confuse timelines so he would think things were more common than they were, or confuse his memories of events. He even confused who he was talking to at times.


Maybe though as one becomes sober their underlying psychiatric disorder becomes more apparent, whether #depression or even #anxiety, and this appears similar to how one may present with neurologic deficit initially. Complex Post-Traumatic Stress syndrome can certainly mimic neurologic dysfunction at times. The first approach may be an evaluation with a #neuropsych to assess for underlying psychiatric conditions.


My practice works heavily in #epigenetics, so I also like to evaluate certain genotypes which can not only create a greater predisposition to alcoholism, but also neurological conditions. When one has MAO-A SNPs, an enzyme important for the normal functioning of the serotonergic system, then we often find correlation with an increase in antisocial behavior, an antecedent of alcohol addiction. Iron accumulation in the brain is another explanation for why even moderate drinking is linked to compromised cognitive function.


This damage though is significant. If a person regularly drinks too much alcohol, it can be toxic to their nerve cells. Over time, this can cause brain cells to die, and their brain to shrink. This means there are fewer cells to carry the messages to the brain required for accomplishing basic tasks. Regular drinking can also damage blood vessels and lead to high blood pressure, which increases risk of stroke.


Brain damage also occurs because alcohol prevents the body from getting its necessary amounts of thiamine, vitamin B1. I talk about this much more thoroughly in my Holistic Healing for Alcoholism course, and offer a regimen for treatment, but when you get the bulk of your energy from the carbohydrates in alcohol and not from nourishing foods, vitamins plummet. Alcohol itself puts greater demand on the body to detox, which utilizes these vitamins and minerals at a higher rate. The B-vitamins in particular are especially important and most often the nutritional component most at threat.


Drinking heavily and more often also increases the risk of head injuries, and when drunk, it seems these people are somewhat invisible. They can fall and have blood on their face, but seemingly walk away unharmed. They are numb to the pain that would warn a sober person they likely suffered a concussion, which can cause long lasting brain damage just in itself, if not properly managed. I no longer ask if my alcoholic clients have suffered a head injury, but how many times.


A person with ARBD may experience all of these types of damage. Wernicke-Korsakoff syndrome is most closely linked with low levels of thiamine, vitamin B1, and supplementation can help. Our clinic offers intravenous nutrition therapy so we can speed recovery. While I relate these brain injuries from alcohol to dementia, they really aren't one in the same, because one doesn't really recover from dementia, although if identified in earlier states, alcohol related brain injury can be reversed. One in ten people with dementia though, do have some form of ARBD and if under 65 years of age, that statistic is even higher.


Men do tend to suffer ARBD more than women, but women who do get it younger and with less alcohol abuse. If you find you have difficulty staying focused on a task without becoming distracted; struggle with solving problems, planning or organizing; setting goals, making judgments, or making decisions, you may be in the earlier stages of ARBD. Lack of motivation is also indicative, or difficulty controlling your emotions, easily irritable or having outbursts. This may look like fight-or-flight responses. Also indicative of ARBD is the inability to understand how other people are thinking or feeling, so you may come off as insensitive or uncaring, or even fail to recognize the difference between someone who is hurt and someone who is mad. These symptoms vary a great deal from person to person, so a brain scan can be helpful. This can identify which areas of the brain have shrunk more than others. Alcohol affects the frontal lobe of the brain rather prominently.


This can be difficult to diagnose, even identifying the alcoholic as a clinician can be a real challenge, but if you aren't talking to your clients about it, you are certainly missing it. Keep in mind, with support and treatment, recovery is possible or at least there will be no further progression. While it can be a challenge to help the #addict recover, those working through sobriety and also dealing with alcohol-related 'dementia' may feel very scared, confused, and unsure of themselves and have no idea why. This may also challenge their logic for why it is important to stop drinking and cause them to forget they haven't the ability to control their quantity of drinks. They may even become more confident in their drunken state that they are sober and can handle even more, potentially even getting behind the wheel. Remember, losing motivation is also a symptom of dementia, which further challenges the effort to remain sober.


A comprehensive rehabilitation program will address the addiction, the buried emotions through talk therapy, rewiring of the brain through changing thought patterns, movement, and thiamine replacement. It will also address memory skills and a plethora of life-style habits. If you feel you are struggling with alcohol, come talk to me. I can offer a no-judgment zone, a safe place. We have a variety of options and you will remain in control of that journey. Sustaining from alcohol doesn't have to be the first step. Tools can be offered first, but if you are already sober and finding yourself facing challenges maybe you haven't even related to your alcohol, know that we have support for you and you aren't crazy. This isn't your fault. You can overcome.


References

Zahr, N. M., Kaufman, K. L., & Harper, C. G. (2011). Clinical and pathological features of alcohol-related brain damage. Nat Rev Neurol, 7(5), 284-294.

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