Alcohol's Effects on the Brain: An Interview with William Shoemaker
Q. Is the addiction to alcohol physical or mental?
A. Both. There are physical symptoms when people who chronically consume alcohol withdraw from it, and there is also a psychological dependence on alcohol. So it is both.
Q. Can people who experience the physical addiction also have the mental addiction, or are these both mutually exclusive?
A. They usually go together.
Q. Is there a difference in the brain chemistry of a long-time alcoholic and a nondrinker?
A. When someone has been an alcoholic for a long time, many of the cells in the brain die; as a result, their brain is going to be different. If you looked at the constituents of the brain, you would see that certain cell populations have dropped out--disappeared--in the alcoholics.
And if you do a CT [computed tomography] or PET [positron emission tomography] scan on these people, the total volume of brain is smaller. There has been some shrinkage; the shrinkage is due to death of cells that are not replaced.
Q. If an alcoholic stops drinking, does the brain return to its healthy size or does it remain shrunken?
A. Well, if it has gotten to the point where the cells have died, they do not come back. If it has gone to that extent, then ceasing to drink is going to stop the neurodegenerative trend, but it is not going to go back to normal. Certainly, there are many people like this, and they can live happy and useful lives, even with a certain amount of brain damage.
Q. What kind of problems come about from a long-term change in the brain?
A. Many things change. The lesions from long-term alcohol use have a certain pattern. Many of the people who are in this situation are found to have Korsakoff's disease. Motor impairment and cerebellum impairment develop, so balance is affected. Memory and cognitive function are affected.
Many times people cannot take care of themselves, and they may need to be hospitalized or placed in nursing homes.
Q. Do brain cells regenerate once they are gone?
Q. Does alcohol abuse have any affect on a person's physical appearance?
A. You really can't tell by looking at people whether they are addicted. Certain vascular conditions can show. This sometimes happens with alcoholics, especially, in the nasal area. Sometimes you'll see this, but there are other things that cause this vasculitis, not just alcohol. You will see it in long-term alcoholics. You have to do a medical work-up and a psychiatric workup, with an emphasis on questions about substance abuse to determine whether a person has alcoholism.
Certainly, other kinds of chemical addictions, say cocaine or heroin addiction, in which the time course to teach the addiction state is much shorter, you can't tell by looking; there are no physical findings at all.
Q. What diseases or physical problems can come about from alcohol addiction?
A. Many, many things. Chronic alcoholism is related to liver disease and cirrhosis, which can be fatal. Pancreatic disease also can be life-threatening. People may also have cardiovascular complications. It is a number of different things.
Q. If you take a drink, what happens in the brain?
A. If it were easy to tell you this in "1, 2, 3," we wouldn't be studying it so intensely. But this gets technical.
Alcohol has affects on different neurotransmitter systems in the brain. In low amounts, it affects the GABA [gamma amino butyric acid] system. As the blood levels become higher, alcohol affects another common transmitter system, NMDA glutamate. This is a description of an acute alcohol effect, such as what happens if you go out drinking on a Friday night. These effects can be seen and felt. The next day, depending on how much you drink, the system would reset itself and it would be back to normal.
With chronic alcohol use, the cells in the brain and other tissue now find themselves maintained in a fluid that contains alcohol and they adapt to it. …