Running Head: SUBSTANCE ABUSE: ALCOHOL AND THE BRAIN

Substance Abuse: Alcohol and the Brain

Joshua Pickett
Youngstown State University
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How Alcohol Affects the Brain

Whether it be the acute effects of being intoxicated, or the long-term effects that come with

continuous years of drinking, alcohol has several different effects on your brain in comparison to the

person who is not drinking. Many of us have seen these acute intoxication symptoms in either ourselves

or another person consisting of difficulty walking, blurred vision, slurred speech, slow reaction times and

impaired memory. These symptoms can appear very quickly and possibly after only one or two drinks,

but these symptoms are commonly expected by someone going out and consuming alcohol. Light or

moderate drinking, such as a drink a day or occasionally going out and drinking socially actually can be

shown to be a good thing for your health, which some people may be surprised to hear, light/moderate

drinking can be linked to reduced risk of heart disease, stroke, gallstones and diabetes, plus there are

social and psychological benefits of going out and having a good time with peers and consuming alcohol.

However, there are some people that are not able to stay in this category of light/moderate drinking

and begin to drink mass amounts every day, becoming a chronic issue. Although there is a lot of

research still being conducted on the chronic consumption of alcohol, there are many things we know

today about how this everyday use can negatively impact the brain directly. These people who are

consuming heavy amounts of alcohol over extended periods of time can develop deficits in their brain

function, leading to this person to possibly have some of those acute intoxication side effects even when

they’re in a state of sobriety. So, at this point the cognitive problems this person is facing is no longer

linked to the alcohol consumption acutely, but instead, from brain damage that prior heavy drinking has

caused. According to the National Institute on Alcohol Abuse and Alcoholism, most heavy long-term

alcohol users will experience a mild to moderate impairment of intellectual functioning as well as

diminished brain size. In addition, there are several brain disorders that have been linked to chronic

alcohol abuse.
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One of the most common disorders chronic alcoholics face is a thiamine deficiency. Thiamine, or

Vitamin B1, is an essential nutrient required by all tissues, including the brain, that up to 80 percent of

alcoholics are deficient in. The problem with this thiamine deficiency is many of these people go on to

develop a serious brain disorder called Wernicke–Korsakoff syndrome (WKS). WKS is a disease that

consists of two separate syndromes, an acute and severe condition called Wernicke’s encephalopathy

and a long lasting and debilitating condition known as Korsakoff’s psychosis. Approximately 80 to 90

percent of alcoholics with Wernicke’s encephalopathy also develop 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; however, it is uncommon that all three of the symptoms manifest

together. So, as health care professionals, we need to be able to identify one or two of these symptoms

that are occurring and be able to make a diagnosis from them. Korsakoff’s psychosis is a chronic and

debilitating disease characterized by persistent learning and memory problems. Patients diagnosed with

this are extremely forgetful and have problems with walking and coordination. These patients will have

retrograde amnesia, but also anterograde amnesia which is very frustrating to them.

When alcohol is consumed, it blocks chemical signals between neurons, which lead to the acute

intoxication symptoms I had talked about earlier. When this heavy drinking continues to happen over

long periods of time, the brain, in attempt to adapt, begins over activating the brains neurotransmitters.

However, when the alcohol finally is excreted from the system, the brain does not stop over activating

these neurotransmitters, leading to painful and potentially dangerous withdrawal symptoms that can

damage these neurons. These neurons, after being heavily exposed to overactive neurotransmitters for

such a long period of time, can eventually “burn out,” which is called neurotoxicity. These neurons that

are burning out, make up pathways linking different parts of the brain, so this will cause noticeable

slowing in reactions of the effected pathways. However, not only are these pathways damaged, but the

brain matter itself is also heavily damaged by chronic alcohol use, leading to brain shrinkage. This brain
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shrinkage happens over an extended period of time and is due to a reduced volume of both white and

gray matter. Since alcohol is affecting such a large portion of the brain, there are numerous cognitive

impairments that can result from chronic heavy use including verbal fluency and verbal learning,

processing speed, working memory, attention, problem solving, spatial processing, and impulsivity. The

parts most susceptible to damage seem to be those associates with memory, problem solving and

impulse control, so the problems in these areas tend to be worse than others that may manifest.

Adolescents are especially at high risk for long lasting or even permanent effects since the most

impacted areas of the brain are still developing. Without treatment, these impairments continue to

worsen eventually developing into alcohol-related dementia.

Although all of these things stated above are issues arising inside the brain itself, this does not

account for the numerous deaths/accidents that occur annually from the consumption of alcohol. Many

people that are intoxicated still choose to get behind the wheel, relating to the poor decision making

which is a side effect of this alcohol consumption, and in doing so, many of these people kill themselves

and possibly others on the road too. These lasting effects talked about may not only lead you to have

these cognitive impairments, but they could lead you to poor decision making that could result in a

serious or even fatal accident.

Yalom's Curative Factor of Group Therapy

Irvin Yalom identified 11 primary “therapeutic factors” in group therapy. Each of these factors

has particular importance for clients with substance abuse disorders and can be used to help explain

why a group works in a particular way for this client population. The factors are as follows:

1. Instillation of hope – Many of these people come to group feeling defeated and

overwhelmed by their inability to control their substance abuse. Taking on their issues with
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a group of others experiencing similar issues gives them a chance to witness change in

others and be celebrated for their own small victories, instilling hope

2. Universality – Clients realize that they’re not alone and feel satisfaction in their connection

with others. They realize that this pain is not individualized at them and have great

outcomes when realizing there is a whole group of people there to support them

3. Imparting information – The information shared is personal and tends to be motivational to

other members. Clients can hear how others have experienced success in similar situations.

4. Altruism – The desire to help others is a fundamental human condition, but many of these

clients are not able to do this due to the ongoing battle within themselves. Here, individuals

recognize that they have something of value to give their fellow group members

5. Corrective Recapitulation of the Primary Family Group – This happens when a client both

consciously and unconsciously relates to another group member as if that person is a

member of his family with whom he has struggled in the past. This group begins to serve as

a substitute family.

6. Development of Socializing Techniques - As participants engage in relationships inside the

group, they learn new social skills that can help them through their isolation and connect

with others. They also learn how to disconnect, which is equally important given the

anxieties often associated with relational loss and grief.

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7. Imitative Behaviors - Clients learn new ways to handle difficult emotions without resorting

to violence or drug use. Group members also learn by imitating other members who are

successfully dealing with difficult issues. It is helpful for a new group member to witness an

ongoing group where people are confronting their problems appropriately, moving beyond

old dysfunctional patterns, and forming new relationships that support change. The group

becomes a living demonstration of these new behaviors, which facilitates and supports

insight and change.

8. Interpersonal Learning - Groups provide an opportunity for members to learn about

relationships and intimacy. The group itself is a laboratory where group members can,

perhaps for the first time, honestly communicate with individuals who will support them

and provide them with respectful feedback.

9. Group Cohesiveness - Group cohesion is a sense of belonging that defines the individual not

only in relation to itself but also to the group. It is a powerful feeling that one has meaning

in relationships and that one is valued.

10. Catharsis - Group participants will gain a sudden insight through interaction with others,

which can cause a significant internal shift in the way they respond to life. Such insights may

be accompanied by bursts of emotion that release pain or anger associated with old

psychological wounds.
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11. Existential Factors - Existential factors of loss and death are often issues of great discomfort

in the substance-abusing population. The brevity of a time-limited group experience forces

these issues to the surface and allows members to discuss them openly in a safe

environment.

AA Meeting and Yalom’s Curative Factors

In the AA meeting we saw some of these factors put into place. During the sharing, one of the most used

factors I heard would have to be installation of hope. While going around the room, we heard many

people talk about feeling defeated and thinking there was no hope until they heard what some of their

fellow members had been through before they got sober. Some other factors seen that I feel were

interrelated were group cohesiveness and altruism. Again, in sharing, many of these members described

that they felt that they did not know where they belonged in society and had no feeling of worth until

they found AA. In finding AA they described that they feel a meaningful connection between their AA

peers in hearing them share at meetings and consider themselves to be family showing the altruism

factor. Lastly, I think another factor we heard a lot in specific to this meeting would have to be imparting

information. Many of the members shared that they were “turned off” by the term higher power used in

the AA 12 steps, until they had learned of what this higher power meant to other people. Almost

everyone in the meeting attributed being able to find a higher power to a story they heard from

someone else at a meeting and how they learned about that higher power guiding them to sobriety and

work the steps. I feel that since this was an open meeting that some factors were not seen that would

be in closed meetings. I feel in closed meetings the members can get into more personal talks and get

into some of the other factors such as existential factors and catharsis that we really did not see much of

in this open meeting.

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Chemical Assistance Medications

There are several drugs that may be able to help in the assistance of sobriety. First, Antabuse;

Per the Alcohol Addiction Center, Antabuse is a drug that hinders your body’s ability to metabolize

alcohol, meaning if you come into to any contact with alcohol in any form, you will become violently

sick. So, the obvious pro to this medication is being that it would deter many from consuming alcohol

due to the symptoms that would result. However, I feel that there are numerous cons that would

outweigh this. Firstly, I feel that many people may feel as if these symptoms are “exaggerated” or feel as

if they can handle them so they may decide to drink anyway, leading to what could be a life-threatening

consequence. Although this terrible episode may cause them to quit drinking afterwards, it is still very

dangerous to those that have the mentality that they can withstand the symptoms. Secondly, this

person cannot come into any contact at all with alcohol in any form such as mouthwash, rubbing

alcohol, etc… So, in the situation of myself, I would have to discontinue the use of mouthwash, and in

being a nurse, we use alcohol almost every single day of our career, which would be an extreme barrier

for someone in the medical field. Lastly, according to Dr Steven Melemis, Antabuse, although rare, can

cause severe liver damage. Many of these alcoholics are chronic users and are already facing liver

damage, do you have to ask would it be wise to potentially damage that vital organ even more?

Next Naltrexone, or Vivia/Revitrol. According to the SAMHSA, Naltrexone blocks the euphoric

and sedative effects of alcohol by binding and blocking opioid receptors leading to reduced cravings.

Unlike methadone or buprenorphine, Naltrexone carries no risk of abuse or addiction nor does it

activate opioid receptors which is an extreme advantage of this medication. Another advantage being

that it actually reduces the bodies cravings for alcohol which can help this person with not actually

picking up that drink. However, if they do pick up that drink, Naltrexone works by blocking out that
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euphoric feeling they have experienced prior to this medication. The only thing I consider a negative is

that researchers have found that it is most effective after three months of use. Many people want an

instant effect from medications, and when they are not feeling better after starting, they may feel as if it

doesn’t work for them, leading to medication noncompliance.

Next, Campral; Campral is another medication that works by decreasing cravings for alcohol.

Although we do not know the action of why this drug decreases the cravings, various research does

prove that it is very effective at what is manufactured for. A definite disadvantage is being that we do

not know why this medication is so effective, so we are not able to further elaborate on the issue, but

this is not really a con to the medication itself, just overall. Overall, I feel that this is a good medication,

due to its effectiveness, and per DrugBank, it has a very low chance of toxicity, and with toxicity the only

major effect that was reported was diarrhea, which is very treatable and not life-threatening.

Lastly, are benzodiazepines; and these are used mainly in the beginning stages of detoxification.

We use these drugs to reduce the occurrence of seizures and other negative effects related to the

withdrawal of alcohol. These medications are good for treating withdrawal symptoms, but a major

disadvantage is that this class of medication can cause an addiction also. So for the acute treatment of

withdrawals I feel that these medications are very beneficial, but we have to be extremely careful not to

make our patient dependent on them like they were alcohol.

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References

Alcohol Addiction Center. (n.d.). Medications to Treat Alcoholism. Retrieved from

https://alcoholaddictioncenter.org.

Butler Center for Research. (2015, May 1). Alcohol Effects on the Brain. Retrieved from

https://www.hazeldenbettyford.org.

Drugbank. (2019, December 8). Acamprosate. Retrieved from https://www.drugbank.ca.

Lautieri, A. (n.d.). Alcohol Effect on Brain: Short & Long-Term Mental & Cognitive Effects. Retrieved from

https://americanaddictioncenters.org.

Melemis, S. (2019, December 4). Alcoholism Treatment with Medication: Recovery Guide. Retrieved

from https://www.addictionsandrecovery.org.

Merz, B. (2017, July 13). This is your brain on alcohol. Retrieved from https://www.health.harvard.edu.

Next Step Therapy. (n.d.). Yalom's Therapeutic Factors. Retrieved from https://nextsteptherapy.ie.

NIAA. (n.d.). Alcoholic Brain Damage (2nd ed., Vol. 27). Rockville, MD. Retrieved from

https://www.niaaa.nih.gov

Substance Abuse and Mental Health Services Administration. (2019, September 27). Naltrexone.

Retrieved from https://www.samhsa.gov.