Effects of Alcohol on the Brain Brain Impairments and Strategies for Recovery

One function of the brain is to motivate you to repeat pleasurable behaviors and to reduce uncomfortable emotional or physical situations. Alcohol can temporarily provide relief for negative feelings and create pleasurable feelings. This is a powerful, dual-reinforcing effect that can show why some people struggle with excessive drinking. The following is an overview of how the brain responds to alcohol and alcohol’s impact on the brain’s structure and circuitry:[2] 

Alcohol and Pleasure

Alcohol produces pleasure by increasing the brain’s activity in reward processing.[3] Opioid receptors are activated by alcohol in the basal ganglia, resulting in feeling pleasure when intoxicated. The brain’s ventral tegmental area releases dopamine, increasing pleasurable feelings. Your brain quickly begins to associate alcohol with the reward of pleasure. For other people, the pleasure may be that alcohol alleviates their emotional or physical pain.   

Habit Formation

Once drinking alcohol becomes a habit, it makes it even harder to stop drinking. When you have a pattern of behavior, your brain shifts control from the conscious prefrontal cortex to the habit-forming control of the basal ganglia.[4] This change in the brain circuitry makes it easy to continue your drinking patterns and harder to stop the now habitual drinking. 

Emotional and Physical Pain 

Alcohol initially reduces negative emotional states or emotional pain by diminishing activity in the amygdala. The amygdala manages the fight-or-flight stress response and helps you learn what cues to associate with danger. It also releases stress-related neurotransmitters that impact other brain areas, including the hypothalamus and the brain stem. 

While alcohol initially suppresses the amygdala and stress response activity, long-term alcohol use can result in tolerance and needing to drink more to have the same results. When you stop drinking after long-term use of alcohol, many people experience withdrawal, which is partly due to your amygdala becoming hyperactive. This results in hyperkatifeia, which increases your negative emotional state.[5] Symptoms include anxiety, irritability, difficulty sleeping, and emotional pain. This is an extremely uncomfortable state to be in and causes many people to return to drinking.  

Alcohol can also temporarily ease physical pain. Physical pain relief occurs at binge drinking levels, meaning having a blood alcohol concentration at or above 0.08%. As your blood alcohol concentration decreases, the pain returns, but at a more intense level. This reinforces the cycle of drinking to relieve the pain when, in actuality, it is making the pain worse. 

Motivation

Over time, the brain is motivated to continue to drink as the negative emotional states of withdrawal are so unpleasant. The brain attaches a strong incentive to alcohol, which can be from environmental stimuli or memories. These connections are made between the prefrontal cortex and the basal ganglia. Cravings can be particularly strong when the thought of alcohol is combined with negative emotional or physical states and associated with relief from those negative feelings. 

Executive Functioning

Alcohol impairs functioning in the prefrontal cortex, which controls executive function, impulse control, decision-making, and emotional regulation. When functioning is impaired, it makes it harder to resist urges and refrain from behavior that perpetuates alcohol use. This is made even more difficult if you are experiencing stress, emotional discomfort, or physical pain. Prefrontal cortex functioning can be impaired for months to years after alcohol consumption is stopped. 

Higher alcohol use is linked to several structural brain issues, including reduced grey matter density, hippocampal atrophy, and reduced white matter microstructural integrity.[6] While these deficits are most pronounced in people who are heavy drinkers, consuming over 30 drinks per week, there was still atrophy present among moderate drinkers (7-14 drinks per week) when compared to those who abstain from using alcohol. 

Higher alcohol consumption was also linked to a decline in cognitive function. It is important to note that the abnormal brain structure and decline in cognitive function were present in men and women who drank moderately, which is the current recommendation of drinks per week according to the U.S. Dietary Guidelines of 1 drink or less per day for women and 2 drinks for less per day for men.[7] 

Alcohol-induced blackouts occur when you become intoxicated to the level your brain temporarily can not transfer memories from short-term memory to long-term memory, leading to gaps in your memory.[8]  This function is called memory consolidation and happens in the brain’s hippocampus. 

If you continue to drink beyond intoxication, an alcohol overdose can occur.[9]  When this happens, there is such an excess of alcohol in your bloodstream that your brain is no longer able to control life-supporting functions (breathing, heart rate, and temperature control). The consequences of this can result in permanent brain damage and can even be fatal. 

Heavy drinking is linked to Wernicke-Korsakoff syndrome, dementia, and brain atrophy.[10]  The potential risks and harms outweigh the protective factors linked to small amounts of alcohol use.