Dual Diagnosis: Alcohol-Related Brain Damage

Quick links for alcohol-related brain damage

• Wernicke-Korsakoff syndrome as a product of alcohol-related brain damage
• Alcohol-related brain damage: Wernicke’s encephalopathy
• Alcohol-related brain damage: Korsakoff’s psychosis
• Alcohol-related brain damage: What is alcohol dementia?
• How does alcohol cause brain damage?
• How much alcohol is too much?
• Treating alcohol-related brain damage: Wernicke-Korsakoff syndrome
• Treating alcohol-related brain damage: Dementia
• How to get more information about alcohol-related brain damage
• References for alcohol-related brain damage

As one of the most dangerous substances in the world, alcohol can have a profound effect on the body and mind.

It can cause harmful addiction and, with enough use, severely impact the brain.

With excessive use, alcohol has been known to affect brain cells, alter brain chemistry and disrupt the development and nourishment of brain tissue, all of which can have significant impacts on an individual.

Alcohol’s effect on the brain is not the same for everyone, and those who drink excessively will experience different changes.

Some may experience minor alterations in their memory or cognitive skills, whereas others may develop more serious conditions.

An individual diagnosed with alcohol-related brain damage may suffer from an alcohol-induced stroke or have had a drunken head injury.

Most commonly, however, they develop either Wernicke-Korsakoff syndrome or alcohol-related dementia.

Wernicke-Korsakoff syndrome as a product of alcohol-related brain damage

One of the most impactful ways alcohol can affect the brain is by causing Wernicke-Korsakoff Syndrome, [1] otherwise known as ‘wet brain.’

This type of brain damage is caused when alcohol begins disrupting the brain’s relationship with its essential nutrients, which it normally uses to maintain chemical balance.

Alcohol can even cause there to be deficiencies in some nutrients, specifically thiamine (vitamin B).

Thiamine is required throughout the whole body in order for organs such as the liver, heart and brain to function properly.

It is primarily absorbed through our food – rich in products such as meats, cereals and nuts – but alcohol has been known to limit this process when large quantities are consumed.

Alcohol blocks the absorption of thiamine and therefore causes a deficiency. The brain becomes imbalanced when this happens, sparking a combination of disorders to manifest.

Initially, a condition called Wernicke’s encephalopathy will develop, [2] and then, if this is left untreated, Korsakoff’s psychosis will follow.

Alcohol-related brain damage: Wernicke’s encephalopathy

When the body does not get enough thiamine from its diet, parts of the brain can swell, causing a range of symptoms that can sometimes be mistaken for alcohol withdrawal.

These include:

• Uncontrollable eye movement
• Poor balance or disorientation
• Memory loss and confusion
• Weight loss

These effects are considered to be very treatable and short-term, but they can worsen if nothing is done about them.

Alcohol-related brain damage: Korsakoff’s psychosis

If Wernicke’s encephalopathy is left untreated, the damage caused to the brain can worsen to the point where it cannot recover.

This long-term damage can cause Korsakoff’s psychosis, [3] which brings with it more durable and life-altering symptoms.

These include: [4]

• Memory problems and difficulty learning new things
• Repeatedly doing or saying the same things
• Personality changes, such as becoming more indifferent
• Inability to notice memory problems
• Filling memory gaps with fake events – known as confabulation
• Poor judgement or decision-making
• Inability to concentrate
• Lower IQ performance

Alcohol-related brain damage: What is alcohol dementia?

The other primary condition of alcohol-related brain damage is dementia, [5] caused by alcohol’s impact on brain cells.

Alcohol damages nerve cells in the brain, often destroying them or otherwise stopping them from working.

As a result of this, there are fewer vessels available to carry messages around the brain, therefore reducing an individual’s cognitive ability and memory.

It is also possible for alcohol to reduce the size of some brain areas. As brain cells die, it is possible for tissue to shrink in certain areas, such as the frontal lobe.

This damage and shrinking means that an individual may struggle to think things through, remember how to do things around the house or be able to look after themselves.

What are the symptoms of alcohol-related dementia?

The symptoms of alcohol-related dementia primarily involve an individual’s reduced cognitive ability.

They mainly struggle to do the following things:

• Focus on and complete everyday tasks
• Control emotions
• Make logical or thought-through decisions
• Show empathy or sympathy
• Plan or organise events and tasks
• Remember new information

It is also common for an individual to experience sudden mood swings and depression.

In some circumstances, coordination and balance may be affected, causing an individual to fall over or struggle to walk.

How does alcohol cause brain damage?

Alcohol-related brain damage, including the conditions mentioned above, is caused by alcohol altering the brain’s usual activity.

It damages and interrupts different areas of its functioning, triggering imbalances.

Specifically, alcohol has been known to:

• Damage blood vessels, increasing blood pressure and the risk of stroke
• Reduce absorption of essential nutrients, such as thiamine
• Increase the risk of head injury as a result of drunkenness
• Damage nerve cells, reducing brain signals

How much alcohol is too much?

Damage to the brain only occurs when an excessive amount of alcohol is consumed.

‘Excessive’ generally means that more than the recommended amount has been consumed within a specific period of time.

In the UK, it is recommended that individuals drink no more than 14 units of alcohol per week. [6]

These units should be consumed over a span of several days rather than at once.

Men should consume no more than 8 units within one drinking session, and women should consume no more than 6 units. Older people are also recommended to consume less.

Treating alcohol-related brain damage: Wernicke-Korsakoff syndrome

As this condition develops in two stages, there are two stages of treatment.

To treat Wernicke’s encephalopathy, the thiamine deficiency needs to be offset. Frequent doses of the nutrient must be administered in conjunction with alcohol detox.

The latter may need to take place in a facility where medical professionals can monitor an individual’s condition and administer withdrawal-easing drugs where necessary.

If, however, the condition is left untreated and is allowed to develop into Korsakoff’s psychosis, an individual will need thiamine injections alongside several other nutrition and hydration supplements.

In addition, an individual will also need to undergo an alcohol detox, as well as long-term rehabilitation designed to improve and regain as much of their memory and cognitive skills as possible.

Treating alcohol-related brain damage: Dementia

For dementia, the treatment also tends to involve an alcohol detox initially.

Unlike Alzheimer’s, alcohol-related dementia does not tend to worsen over time, and so will likely improve in condition when alcohol is withdrawn.

The process of detox is usually very difficult, involving an individual having to remain within a medical facility while their body goes through the pain and discomfort of withdrawal symptoms.

Such symptoms may include:

1. Nausea
2. Shaking
3. Insomnia

Drugs may be prescribed in order to ease the discomfort of withdrawal for some individuals.

Following this weaning phase, an individual then receives therapy in order to help alter their perceptions of alcohol and stress.

The effects of dementia may make this process more difficult, but medical staff are on hand to help.

Once an individual has received sustained treatment to tackle their dependency on alcohol, they are then supported on a long-term path towards regaining some of their cognitive ability.

This rehabilitation looks to improve their memory and help them control their emotions again.

How to get more information about alcohol-related brain damage

If you or someone you know is struggling with alcohol-related brain damage, or you suspect that this may be the case, it is important to seek out help.

Speak to a GP or alcohol support charity to discuss the details of your situation.

This will enable the professional to provide information on what possible treatment methods are available in your area and how you can improve the situation from home.

References for alcohol-related brain damage

1. https://www.ninds.nih.gov/health-information/disorders/wernicke-korsakoff-syndrome
2. https://www.ncbi.nlm.nih.gov/books/NBK470344/
3. https://www.msdmanuals.com/en-gb/professional/special-subjects/illicit-drugs-and-intoxicants/korsakoff-psychosis
4. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr185.pdf?sfvrsn=66534d91_2
5. https://www.alzheimers.org.uk/about-dementia/types-dementia/alcohol-related-dementia
6. https://www.nhs.uk/better-health/drink-less/