National Council on Alcoholism and Drug Dependence, Inc.
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Using High–Tech Tools to Assess Alcoholic Brain Damage
Researchers studying the effects of alcohol use on the brain are aided by advanced technology such as magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and electrophysiological brain mapping. These tools are providing valuable insight into how alcohol affects the brain’s structure and function.
Long–term heavy drinking may lead to shrinking of the brain and deficiencies in the fibers (white matter) that carry information between brain cells (gray matter). MRI and DTI are being used together to assess the brains of patients when they first stop chronic heavy drinking and again after long periods of sobriety, to monitor for possible relapse to drinking (38).
Memory formation and retrieval are highly influenced by factors such as attention and motivation (39). Studies using MRI are helping scientists to determine how memory and attention improve with long-time abstinence from alcohol, as well as what changes take place when a patient begins drinking again. The goal of these studies is to determine which alcohol–induced effects on the brain are permanent and which ones can be reversed with abstinence.
PET imaging is allowing researchers to visualize, in the living brain, the damage that results from heavy alcohol consumption (40). This “snapshot” of the brain’s function enables scientists to analyze alcohol’s effects on various nerve cell communication systems (i.e., neurotransmitter systems) as well as on brain cell metabolism and blood flow within the brain. These studies have detected deficits in alcoholics, particularly in the frontal lobes, which are responsible for numerous functions associated with learning and memory, as well as in the cerebellum, which controls movement and coordination. PET also is a promising tool for monitoring the effects of alcoholism treatment and abstinence on damaged portions of the brain and may help in developing new medications to correct the chemical deficits found in the brains of people with alcohol dependence.
Another high–tech tool, electroencephalography (EEG), records the brain’s electrical signals (41). Small electrodes are placed on the scalp to detect this electrical activity, which then is magnified and graphed as brain waves (i.e., neural oscillations). These brain waves show real–time activity as it happens in the brain.
Many male alcoholics have a distinctive electrophysiological profile—that is, a low amplitude of their P3 components (see figure). P3 amplitudes in women alcoholics also are reduced, although to a lesser extent than in men. For many years it was assumed that the P3 deficit observed in alcoholics was the result of alcohol’s damage to the brain. Then it was determined that while many of the clinical symptoms and electrophysiological measures associated with alcoholism return to normal after abstinence, the P3 amplitude abnormality persists (42).
Alcoholism and alcohol abuse
PubMed Health. A service of the National Library of Medicine, National Institutes of Health.
A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.
A.D.A.M. Medical Encyclopedia.
Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem
Last reviewed: March 20, 2011.
Alcoholism (alcohol dependence) and alcohol abuse are two different forms of problem drinking.
· Alcoholism is when you have signs of physical addiction to alcohol and continues to drink, despite problems with physical health,
mental health, and social, family, or job responsibilities. Alcohol may control your life and relationships.
· Alcohol abuse is when your drinking leads to problems, but not physical addiction.
Causes, incidence, and risk factors
There is no known cause of alcohol abuse or alcoholism. Research suggests that certain genes may increase the risk of alcoholism, but which genes and how they work are not known. How much you drink can influence your chances of becoming dependent. Those at risk for developing alcoholism include:
· Men who have 15 or more drinks a week
Women who have 12 or more drinks a week
Anyone who has five or more drinks per occasion at least once a week
One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor. You have an increased risk for alcohol abuse and dependence if you have a parent with alcoholism. You may also be more likely to abuse alcohol or become dependent if you:
· Are a young adult under peer pressure
Have depression, bipolar disorder, anxiety disorders, or schizophrenia
Have easy access to alcohol
Have low self-esteem
Have problems with relationships
Live a stressful lifestyle
Live in a culture alcohol use is more common and accepted
Alcohol abuse is rising. Around 1 out of 6 people in the United States have a drinking problem.
People who have alcoholism or alcohol abuse often:
· Continue to drink, even when health, work, or family are being harmed
Become violent when drinking
Become hostile when asked about drinking
Are not able to control drinking -- being unable to stop or reduce alcohol intake
Make excuses to drink
Miss work or school, or have a decrease in performance because of drinking
Stop taking part in activities because of alcohol
Need to use alcohol on most days to get through the day
Neglect to eat or eat poorly
Do not care about or ignore how they dress or whether they are clean
Try to hide alcohol use
Shake in the morning or after periods when they have not a drink
Symptoms of alcohol dependence include:
· Memory lapses after heavy drinking
Needing more and more alcohol to feel "drunk"
Alcohol withdrawal symptoms
when you haven't had a drink for a while
Alcohol-related illnesses such as alcoholic liver disease
Signs and tests
The health care provider will perform a physical exam and ask questions about your medical and family history, including use of alcohol. The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:
· Do you ever drive when you have been drinking?
Do you have to drink more than before to get drunk or feel the desired effect?
Have you felt that you should cut down on your drinking?
Have you ever had any blackouts after drinking?
Have you ever missed work or lost a job because of drinking?
Is someone in your family worried about your drinking?
Tests that may be done include:
· Blood alcohol level (this can tell whether someone has recently been drinking alcohol, but it does not necessarily confirm alcoholism)
Complete blood count (CBC)
Liver function tests
Magnesium blood test
Completely stopping the use of alcohol is the ideal goal of treatment. This is called abstinence. A strong social network and family support are important in achieving this.
Completely stopping and avoiding alcohol is difficult for many people with alcoholism. There will be times when it is difficult. You should aim to avoid drinking for as long as possible.
Some people who abuse alcohol may be able to simply reduce the amount they drink. This is called drinking in moderation. If this method does not work, you should try to quit drinking completely.
DECIDING TO QUIT
Many people with alcohol problems do not recognize when their drinking gets out of hand. The ideal approach to treatment is to help the person realize how much their alcohol use is harming their life and those around them. Studies find that more people with alcohol problems opt for treatment when their family members or employers are honest with them about their concerns, and try to help them see that drinking is preventing them from reaching their goals. Withdrawal from alcohol is best done in a controlled, supervised setting. Complications from withdrawal can be life threatening. For more information, see: Alcohol withdrawal
Your health care provider should order blood and urine tests to check for health problems that are common in people who abuse alcohol.
Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer:
· Counseling and therapy to discuss alcoholism and its effects and how to control your thoughts and behaviors
Mental health support
You may be treated in a special recovery center (inpatient), or you may attend a program while you live at home (outpatient). Medications are sometimes prescribed to prevent you from drinking again.
· Acamprosate is a drug that has been shown to lower relapse rates in those who are alcohol dependent.
Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injectable form.
You cannot take these medications if you are pregnant or have certain medical conditions. The medications are often used with long-term treatment with counseling or support groups. Depression or other mood or anxiety disorders may be noticed after you stop drinking. These should be promptly treated. It is important that the patient has a living situation that supports their need to avoid alcohol. Some programs offer housing options for people with alcoholism or alcohol abuse.
Support groups are available to help people who are dealing with alcoholism.
ALCOHOLICS ANONYMOUS (AA)
Alcoholics Anonymous (AA) is a self-help group of recovering alcoholics that offers emotional support and specific steps for people recovering from alcohol dependence. The program is commonly called a "12-step" approach. There are local chapters throughout the United States. AA offers help 24 hours a day and teaches that it is possible to participate in social functions without drinking.
Family members of a person with an alcohol abuse problem often need counseling. Al-Anon is a support group for partners and others who are affected by someone else's alcoholism. Alateen provides support for teenage children of people with alcoholism.
OTHER SUPPORT GROUPS
Several other support groups are available.
· SMART recovery teaches you have to change your thoughts and behaviors to help people with alcoholism recover.
LifeRing recovery and SOS are two nonreligious programs that offer support for people with alcohol abuse.
Women for Sobriety is a self-help group just for women.
Moderation Management is a program for those who want to reduce how much they drink. It recommends abstinence for people who cannot do this.
How well a person with alcoholism or alcohol abuse does depends on whether or not they can stop drinking. Alcoholism is a major social, economic, and public health problem. Problem drinking can affect every part of a person's life. If you have an alcohol problem, abstinence can help improve your mental and physical health and possibly, your relationships. Treatment programs can help you quit. However, drinking again after treatment is common. It is important to have a good support system.
Alcoholism and alcohol abuse can increase your risk of many health problems, including:
· Bleeding in the digestive tract
Brain cell damage
Brain disorder called Wernicke-Korsakoff syndrome
Cancer of the esophagus, liver, colon, and other areas
Changes in the menstrual cycle (period)
Delirium tremens (DT's)
Dementia and memory loss
Depression and suicide
High blood pressure
Inflammation of the pancreas (pancreatitis)
Liver disease, including cirrhosis
Sleeping problems (insomnia)
Alcohol use also increases your risk for sexually transmitted infections (STIs) and violence. Drinking alcohol while you are pregnant can lead to severe birth defects in the baby. See: Fetal alcohol syndrome/ Calling your health care provider. Seek immediate medical care or call your local emergency number (such as 911) if:
· You or someone you know has alcohol dependence and develops severe confusion, seizures, or bleeding
The National Institute on Alcohol Abuse and Alcoholism recommends: Women should not drink more than 1 drink per day. Men should not drink more than 2 drinks per day. One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
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4. Schuckit MA. Alcohol-use disorders. Lancet
Review Date: 3/20/2011.
Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine.