De-boozing the brain

Welcome back to Georgia's Grey Area! As we celebrate the end of dry January, perhaps with a well-deserved drink, I'd like to explore what actually happens in our brains when we consume alcohol and why taking breaks can be so beneficial. Having recently graduated university, I've seen first hand how alcohol becomes woven into the fabric of celebrations, social events, and stress relief – but what impact do these casual drinks have on our brains over time? This isn't about inducing guilt, but rather empowering you to make informed decisions about your health journey, whether you're fresh off Dry January, cutting back long-term, or simply reconsidering your habits. Remember, even small changes can make a meaningful difference in strengthening your brain and building a healthier future.

The Dance Between Alcohol and Your Brain

Immediate effects:

When we consume alcohol, it absorbs first through the stomach lining and into the bloodstream, affecting your body rapidly. Within only 5 minutes it reaches your brain and after just 10 minutes you start to feel its effects (as we likely all know from personal experience or observing others). While our whole body absorbs alcohol, it takes a significant toll on the brain, swiftly interacting with multiple different systems from communication networks to how your brain processes information. Unlike other substances that typically target specific brain regions or receptors, alcohol is what scientists term a "dirty drug", affecting multiple neural systems simultaneously [1].

Here is a breakdown of its immediate effect on neurotransmitter systems specifically:

• The GABA Effect: Alcohol enhances the effects of your brain's primary inhibitory neurotransmitter, GABA [2]. Think of GABA as your brain's brake pedal – when alcohol amplifies it, everything slows down. This is why you might feel relaxed, sleepy or struggling with slurring your words after drinking.

• The Glutamate Block: Simultaneously, alcohol can block the neurotransmitter glutamate, your brain's main excitatory neurotransmitter. This doubling up of increased inhibition and decreasing excitation leads to the classic symptoms of intoxication: slurred speech, slower reactions, and impaired memory formation [3].

• The Dopamine Surge: Perhaps the most dangerous effect, alcohol triggers the release of dopamine in your brain's reward system, pleasure and reinforcing drinking behavior. This is one of the main reasons moderate drinking can escalate to problematic use and addiction over time [4].

Long-term Effects: The Sobering Truth

While the immediate effects of alcohol may seem fleeting—perhaps nothing more than a hangover or fuzzy memory the next day—its long-term impact can be profound and is not to be underestimated. Chronic alcohol intake doesn’t just temporarily alter function; it can lead to permanent structural changes. You may have noticed that if you look up nearly any major disease/disorder both physical and mental, alcohol is a common presence on the list of risk factors [5].

Heavy drinking over extended periods significantly increases the risk of complications from heart disease to liver damage to digestive issues to weakened immunity, to even cancer. Beyond physical health, chronic alcohol use is linked to sleep disturbances, mood disorders, and heightened risks for depression and anxiety. To give you some perspective here are some of the lasting impacts that this beverage can have inside our head:

Brain Volume changes: Yes, you read that correctly- alcohol can actually make your brain SMALLER. Studies using MRI scans have revealed that chronic alcohol use can lead to a significant reduction in brain volume, particularly in regions essential for cognitive functions like learning, memory, and decision-making. The frontal lobe, often referred to as the brain's executive control centre responsible for managing higher-order processes such as reasoning, impulse control, and planning, is particularly vulnerable [6]. Over time, the shrinkage of this critical region can impair decision-making abilities, making it harder to regulate behavior. These changes underscore the structural toll alcohol takes on the brain, beyond its immediate effects.

Memory System Malfunction: The hippocampus, a region of the brain vital for forming and retaining new memories, is particularly affected by long-term alcohol use [7, 8]. Chronic drinking can cause the hippocampus to shrink by up to 10%, leading to difficulties in learning new information and recalling recent events. This damage explains why heavy drinkers often experience memory lapses and struggle with retaining day-to-day details. The loss of hippocampal volume also contributes to a heightened risk of cognitive decline as individuals age, further demonstrating how alcohol use can have lasting impacts on brain function.

Neurotransmitter Imbalances: Regular alcohol consumption forces the brain to adapt to the constant presence of the substance, disrupting the delicate balance of the neurotransmitters discussed above. Over time, the brain compensates by reducing its natural production of GABA and increasing glutamate activity, creating a state of dependence. When alcohol is removed, this imbalance can result in withdrawal symptoms such as anxiety, restlessness, tremors, and in severe cases, seizures. These long-term changes in neurotransmitter systems highlight the complex and enduring effects of alcohol on the brain’s chemistry and overall stability [1].

The Silver Lining: Your Brain's Remarkable Recovery

Here’s the good news – Your brain has remarkable potential for recovery when given a chance. This is why initiatives like Dry Jan can be transformative, with the effects only exponentially increasing the longer you reconsider alcohol intake. After just one month alcohol-free, studies have documented improvements in cognitive function, driven in part by better sleep quality, which supports memory, focus, and overall mental clarity. Encouragingly, even regions of the brain that have lost volume due to alcohol use, such as the hippocampus and frontal lobe, may begin to show signs of recovery [10]. This demonstrates the brain’s remarkable ability to heal and adapt when given the chance, reinforcing the benefits of taking regular breaks from alcohol.

Tips to cut back

If you’re looking to cut back or optimise your alcohol-free journey, here are some practical strategies/tips to help you "de-booze" your brain effectively:

• Set Clear Goals: Decide whether you’re aiming to moderate your drinking or abstain altogether, and set specific, realistic targets to stay on track.

• Track Your Intake: Use an app or a journal to monitor how much and how often you’re drinking. Awareness is the first step to change.

• Limit Availability at Home: Keep less alcohol in the house to reduce temptation. Out of sight, out of mind!

• Opting for Alcohol-Free Alternatives: On a similar point, stock up on non-alcoholic beers, wines, or mocktails to satisfy cravings or placebo-effect your brain in social drinking situations.

• Drink Water Between Drinks: If you’re moderating, alternating alcohol with water slows your drinking pace and helps you stay hydrated.

• Set Social Boundaries: Let friends and family know about your goals, and don’t be afraid to say no to social situations centred around drinking or to opt for lime sodas and J20s instead of alcohol.

Signing off

The journey of reshaping drinking habits mirrors Ramón y Cajal's profound insight that "Every man can, if he so desires, become the sculptor of his own brain." Through understanding alcohol's effects and taking mindful breaks, each person holds the chisel to sculpt their cognitive wellbeing. Whether through month-long pauses or gradual changes, every alcohol-free moment offers the brain a chance to restore and strengthen itself.

References:

[1] Valenzuela CF. Alcohol and neurotransmitter interactions. Alcohol Health Res World. 1997;21(2):144-8. PMID: 15704351; PMCID: PMC6826822

[2] Davies M. The role of GABAA receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci. 2003 Jul;28(4):263-74. PMID: 12921221; PMCID: PMC165791

[3] Gonzales RA, Jaworski JN. Alcohol and glutamate. Alcohol Health Res World. 1997;21(2):120-7. PMID: 15704347; PMCID: PMC6826830

[4] Di Chiara G. Alcohol and dopamine. Alcohol Health Res World. 1997;21(2):108-14. PMID: 15704345; PMCID: PMC6826820

[5] Shield KD, Parry C, Rehm J. Chronic diseases and conditions related to alcohol use. Alcohol Res. 2013;35(2):155-73. PMID: 24881324; PMCID: PMC3908707

[6] Zahr NM, Pfefferbaum A. Alcohol's Effects on the Brain: Neuroimaging Results in Humans and Animal Models. Alcohol Res. 2017;38(2):183-206. PMID: 28988573; PMCID: PMC5513685

[7] Mira RG, Lira M, Tapia-Rojas C, Rebolledo DL, Quintanilla RA, Cerpa W. Effect of Alcohol on Hippocampal-Dependent Plasticity and Behavior: Role of Glutamatergic Synaptic Transmission. Front Behav Neurosci. 2020 Jan 24;13:288. doi: 10.3389/fnbeh.2019.00288

[8] Meda SA, Hawkins KA, Dager AD, Tennen H, Khadka S, Austad CS, Wood RM, Raskin S, Fallahi CR, Pearlson GD. Longitudinal Effects of Alcohol Consumption on the Hippocampus and Parahippocampus in College Students. Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 Jul;3(7):610-617. doi: 10.1016/j.bpsc.2018.02.006

[9] Piano MR. Alcohol's Effects on the Cardiovascular System. Alcohol Res. 2017;38(2):219-241. PMID: 28988575; PMCID: PMC5513687

[10] Ballard J. What is Dry January? Br J Gen Pract. 2016 Jan;66(642):32. doi: 10.3399/bjgp16X683173. PMID: 26719465; PMCID: PMC4684010