Introduction

Alcohol is bad for the brain. It has a numbing effect on all brain cells, slowing down the communication between neurons.

In the long term, brain cells will be lost. Loss of brain tissue can occur after a short period of binge drinking. Alcohol is toxic to brain cells and causes vitamin B1 deficiencies.

In this video professor of neuropsychology Erik Scherder explains in Dutch what alcohol does to the brain.

Influence of alcohol:

In the short term (under the influence or immediately after drinking):

• Deterioration of cognitive abilities such as attention, memory, planning and self-control. We need many of these functions to keep ourselves safe. That is why driving a car or operating machinery after drinking alcohol is very unsafe.
  
• Increased risk of aggression. Because alcohol deteriorates your self-control, you have less control over yourself.
  
• Alcohol poisoning (also known as binge drinking). This occurs with a lot of drinking or earlier in people who are very sensitive to alcohol.

In the long term:

• Damage to white and grey matter in various brain areas.
  
• Deterioration of cognitive abilities, such as attention, memory, planning and self-control.
  
• Increased risk of dementia.
  
• Wernicke Encephalopathy (with large amounts of alcohol).
  
• Korsakov's Syndrome (with large amounts of alcohol).
  

Alcohol is harmful to everyone. This damage is not limited to the brain, but also applies to many other bodily functions. For adults, the Dutch Health Council therefore advises not to drink alcohol or at least not more than 1 glass per day.
Do not drink alcohol before and during your pregnancy due to the risk of Fetal Alcohol Syndrome (FASD).

Young people and young adults are extra vulnerable.

The brain develops until the age of about twenty-five.

Until then, children are extra vulnerable to toxic influences.

Excessive drinking from a young age can cause irreparable damage. Alcohol can disrupt the development of the brain.

Not only does damage to the brain occur much faster, but young people also get life-threatening alcohol poisoning much faster.
Drinking under the age of eighteen is therefore strongly discouraged. Therefore, as a parent, be clear that your rule is that your child does not drink before he or she is eighteen.
It is a myth that it is good to ‘teach young people to drink at home’. Don’t go along with that.

Set a good example at home yourself. For example, don’t drink in the presence of teenagers under eighteen.

Alcohol, brain areas and functions

Alcohol causes damage to various brain areas. Alcohol consumption has an effect on the structure of the brain. It affects the quality of the so-called 'gray matter' in the brain. The gray matter processes information. Alcohol also appears to affect the 'white matter' of the brain. The white matter contains the extensions of nerve cells, and is in fact 'the wiring' of the brain.

It is a misconception that only heavy drinkers would be at risk of brain damage. Even moderate alcohol consumption can have a negative effect. However, if someone stops drinking alcohol completely, and is otherwise healthy and has no vitamin deficiency, then the cognitive limitations can recover over time.

Below we describe brain areas and functions that deteriorate and are disrupted by alcohol.

• Damage to the frontal cortex (in the forehead) causes a decline in social and intellectual skills. This area is responsible for character (formation), personality, self-control and social functioning, but also for goal-oriented action, reasoning and problem solving.

• Because self-control is reduced, there is a greater chance of impulsive reactions such as aggression. There are also fewer inhibitions, including to continue drinking. The effect of alcohol therefore directly contributes to people continuing to drink. It removes the brake.

• The storage of memories is less effective. It is also more difficult to remember that you still wanted to do something. For example, you remember less well that you were going to visit a family member.

• Blackouts can occur with very large amounts of alcohol. With a blackout, there is no longer any memory of an event or an evening with a lot of alcohol. It is, as it were, a hole in the memory.

• Damage to the hippocampus due to frequent heavy drinking causes long-term memory problems. It is then more difficult to absorb, store and learn new information.

• The influence of alcohol on the cerebellum (little brain) causes problems with motor skills, coordination and balance. Disrupted coordination is already noticeable when someone drinks heavily on one occasion. Long-term excessive drinking can lead to permanent damage.

• The medulla oblongata in the brainstem is responsible for breathing and heart rate, among other things. Excessive drinking numbs this part of the brain and can cause a person to fall into a coma and die. This is particularly seen in binge drinkers. See the heading below on how to recognise acute alcohol poisoning.

• The pituitary gland is a gland located in the middle of the head under the brain. The pituitary gland is responsible for a large number of hormones, including growth hormone. Drinking a lot at a young age can lead to growth disorders (decrease in growth hormone). For an image of which hormones are increased, decreased and remain the same, see this link.

Recognize acute alcohol poisoning

Binge drinking and alcohol overdose means alcohol poisoning.

This is a life-threatening situation.

An alcohol overdose affects breathing, consciousness, heart rate, body temperature and gag reflex.

Alcohol poisoning is related to body weight (the lower weight, the higher risk), brain volume, drinking speed and stomach contents.

Not all of the symptoms below have to be present!

• Person no longer responds to being spoken to to pain stimuli
• Confusion / disorientation
• Poor vision
• Nausea / Vomiting
• Diarrhea
• Epileptic seizure
• Slow breathing (less than eight times per minute)
• Irregular breathing (more than 10 seconds between breaths)
• Risk of respiratory arrest
• Blueish skin or pale skin
• Low body temperature
• Fainting
• Unconsciousness without being able to be woken up
• Risk of cardiac arrest

What should you do in case of alcohol poisoning? How to act?

Call the emergency number and report the symptoms you recognize from the list above. Not everyone realizes that it can be a life-threatening situation! Ask if the person has diabetes to rule out that cause of passing out.

Try to keep the person awake and if he or she is a bit more alert, let the person drink water, but only if the person cannot choke.

Lay the person on their side (stable side position) if he or she cannot sit, even if the person is unresponsive.

Keep the respiratory tract clear. Keep the person warm. Do not give coffee! Do not let the person sleep off the intoxication! Do not try to induce vomiting because the person can choke on the vomit!

If breathing has stopped completely, give ventilation.
Let a doctor take further action.

Wernicke encephalopathy

Life-threatening vitamin B1 deficiency

People who are addicted to alcohol can have a vitamin B1 deficiency (thiamine deficiency). A potentially life-threatening complication of such a vitamin B1 deficiency is Wernicke encephalopathy.
Wernicke encephalopathy can also be caused by malnutrition or by frequent vomiting (for whatever reason), which also prevents the absorption of vitamin B1 (thiamine). It is an acute and life-threatening disease.
Characteristic are three symptoms (triad):

1. confusion, drowsiness, mental disorder
   
2. coordination problems (ataxia), gait disturbances
   
3. eye movement disorder, paralysis of the eye muscle (ophthalmoplegia) and/or nystagmus (wobbly eyes).
   

Complaints of hearing loss are also mentioned but do not fall under 'the triad'.
If there are only two features of the Wernicke encephalopathy triad, plus a history of malnutrition, that is also an indication of Wernicke encephalopathy.

It is important to treat quickly!
If treated quickly, this condition can be cured completely. In this phase, Korsakov's Syndrome can be prevented by giving a large amount of vitamin B1, in the form of injections or through an infusion.
If left untreated, the symptoms can progress to Korsakov's syndrome or someone can go into a coma and die.

How does a vitamin B1 deficiency occur?
Vitamin B1 (thiamine) is not produced in the body itself, but must be absorbed through food, such as grain products, potatoes, egg yolks, liver, dairy products or legumes. People who drink too much alcohol eat less and less. This is partly due to the sugars in alcoholic beverages that are a source of calories.
In addition, alcohol damages the mucous membranes of the intestines, which means that vitamin B1 cannot be absorbed properly.

The liver, where vitamin B1 is stored, is often damaged by alcohol. This means that there is a combination of factors that can cause too little vitamin B1 to be absorbed into the bloodstream.

The brain is affected

A number of structures in the centre of the brain are affected in particular: the thalamus and corpus mammilare/mammilaria.

Wernicke-Korsakov syndrome

Because Wernicke's syndrome precedes Korsakov's syndrome in 80 to 90% of cases, it is often referred to as Wernicke-Korsakov syndrome.

Korsakov's syndrome

Korsakov's syndrome is a brain damage that occurs when people have suffered from Wernicke encephalopathy and have not been treated in time. This syndrome affects a part of the brain.

This causes very serious memory loss. The patient mainly loses the ability to learn something new, while often the concept of time is also disturbed.

The executive functions are affected such as planning, organizing,
problem-solving skills but also the ability to take care of oneself can be affected.

The patient's behavior changes. He or she becomes apathetic and furthermore the emotions become flattened.

Someone with Korsakov can express themselves well verbally and paint a picture of themselves that sounds very plausible, but that has little to do with reality.

This is also called confabulating (fantasizing, making up), because conscious lying is usually not involved.

Korsakov is one of the best-known disorders of the brain in cases of excessive alcohol consumption. This disease does not always have to occur after very many years of alcohol abuse. Whereas this disease used to manifest itself only in people over fifty, doctors have now diagnosed the first cases of Korsakov in people in their twenties.

For more information click here and here. 

Many people do not know that alcohol consumption can also cause dementia. The relationship with alcohol consumption has been found for various types of dementia.
People who binge drink (i.e. drink a lot in a short period of time) and drink heavily and for a long period of time are particularly at risk.
People with alcohol addiction are a risk group, but people without an addiction who do drink heavily should also be careful.
In addition, alcohol plays a very large role in the development of dementia among relatively young people.
For example, a large French study among people with dementia showed that there was a link with alcohol consumption in almost 4 out of 10 young dementia patients (before the age of 65).
In this study, they advocate the importance of screening for alcohol consumption by doctors because alcohol consumption is a risk factor for medical conditions such as dementia.

Quitting or reducing alcohol consumption

There are many low-threshold interventions to reduce or stop drinking alcohol.

Many of these can be carried out anonymously and independently.

See this page for an overview of various options for quitting.

FAS(D) Fetal Alcohol Syndrome

When a pregnant woman drinks alcohol, she risks brain damage to her unborn baby. This is called Fetal Alcohol Syndrome, or FAS.

One night of drinking may be enough to cause physical and neurological damage to the unborn baby.

These children may have neurological abnormalities, facial abnormalities, behavioral abnormalities or delayed growth and may be mentally handicapped, physically impaired, or have insufficient brakes

or a conscience that does not function or functions only moderately.

Of course, every child is different and the degree of severity can vary.

Read more on our special FASD page.