Neurological Effects of Alcohol

How Does Alcohol Impact the Brain and Central Nervous System?

Alcohol misuse has both acute and chronic adverse effects on the brain’s structure and function.¹ The neurological effects of alcohol can occur directly through exposure to this toxic substance or indirectly—the latter of which occurs when other organs such as the liver or pancreas are damaged and subsequently impact the brain.²

When an individual consumes alcohol, the brain and central nervous system (CNS) can be impacted in mild and temporary ways that escalate in intensity. A single drink may result in feeling relaxed or may generate a slowed reaction time. But with additional drinks, more effects emerge including blurred vision, slurred speech, difficulty walking, and more. Episodes of heavy drinking and particularly chronically drinking in excess, however, can expose a person to potential brain deficits that can range from memory problems to debilitating conditions that require custodial care.³

Regular excessive use of alcohol can increase the risk for cognitive decline, dementia, and brain damage. In fact, more than 70% of people with alcohol use disorder (AUD) show some kind of brain disorder, disease, or other pathological condition (e.g., tumor, stroke, and trauma). According to an article in the International Review of Neurobiology, follow-up studies of patients with AUD who have completed detox and are now abstinent reveal that 50 to 75% of them still experience some type of memory or cognitive disturbance.⁴

How and to what extent the brain and nervous system are affected by alcohol are dependent on several factors, such as how much and how often a person drinks, how old the person was when they first started drinking, how long the person has been drinking, the person’s current age, the family’s history of alcoholism, and the individual’s overall level of health.³

Alcohol-Related Neurological Effects and Diseases

Chronic excessive alcohol consumption can result in a wide range of neurological effects. A few examples include:^1,3-6,

• Learning and memory issues.
• Development or exacerbation of mental health conditions.
• Blackouts (i.e., memory lapses).
• Brain damage to regions involved in memory, impulse control, attention, sleep regulation, decision-making, and more.
• Dementia.
• Disproportionate loss of cerebral white matter and reductions in brain volume in critical regions.
• Impairments in executive function (i.e., a set of skills that involve working memory, flexible thinking, and self-control).
• Metabolic injury and degeneration of the cerebellum, cortical, limbic, circuits, and peripheral nerves.
• Neural inflammation and toxicity.

Along with the aforementioned effects, alcohol use and misuse can lead to a host of neurological conditions and diseases, including:⁷

To better understand the neurological effects of alcohol, it helps to explore some of the more well-known pathologies, disorders, and diseases. The following sections provide a brief overview of several neurologic conditions related to alcohol consumption.

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff syndrome (WKS) is a neurological condition resulting from thiamine deficiency. WKS is actually one condition involving two different stages of disease: Wernicke encephalopathy and Korsakoff syndrome.^8,9

Wernicke encephalopathy is an acute degenerative brain disorder that’s considered a medical emergency.¹⁰

Symptoms of Wernicke encephalopathy include:^8,10,11

• Mental confusion.
• Ataxia (i.e., incoordination).
• Eye abnormalities (e.g., uncontrolled movements, bilateral visual disturbances).

A prompt diagnosis and early treatment are crucial to prevent the progression of WKS.⁸ Thiamine replenishment is critical, as are proper nutrition and hydration, as well as stopping alcohol consumption.^8,9 However, if treatment is delayed or Wernicke encephalopathy is not recognized, the disease can progress to Korsakoff syndrome—a long-lasting and potentially permanent memory disorder.^8,9,11

Alcoholic Neuropathy

Alcoholic neuropathy is a form of nerve damage that is caused by alcohol’s toxic effects on nerves in the brain and peripheral and central nervous systems.^12,13 It’s a potentially incapacitating complication of chronic alcohol misuse characterized by pain and dysesthesias (including burning, tingling, etc.) mostly in the legs and feet.¹³

Treatment for alcohol-involved neuropathy involves medication to alleviate pain symptoms and is geared toward preventing the progression of nerve damage through alcohol abstinence, nutritional supplementation, and rehabilitation.¹³

Alcoholic Myopathy

Alcoholic myopathy, or skeletal muscle dysfunction, is a progressive neurological disease that affects 0.5% to 2.0% of people who misuse alcohol. Caused by chronic excessive alcohol use that results in loss of lean muscle mass, alcohol-induced myopathy typically causes pain, weakness, tenderness, and swelling in the muscles near the body’s midline.^1,14

The acute form of the condition is most often associated with binge drinking. Following abstinence, acute alcoholic myopathy typically resolves within 1 to 2 weeks.¹⁴

Chronic alcohol-related myopathy is associated with cumulative lifetime consumption of alcohol, specifically with high-dose, long-term use. As such, it’s most commonly seen in people between the ages of 40 and 60.¹⁴

Alcohol-involved myopathy is treated with complete abstinence from alcohol. Up to 85% of patients with alcoholic myopathy show muscle strength improvements within the first year of sobriety and a return to normal strength by the fifth year of abstinence.¹⁴

Traumatic Brain Injury

Use of alcohol is a risk factor for developing a traumatic brain injury (TBI), which can result in brain damage caused by swelling, increased intracranial pressure, and reduced blood flow to the brain.^11,15 Alcohol intoxication can impair judgement and motor skills that can ultimately lead to intentional and unintentional trauma and injuries, such as car crashes, falls, cycling mishaps, and more. The symptoms and severity of impairment vary depending on the extent of damage, ranging from transient damage that results in a quick recovery to more severe TBIs that cause permanent damage.¹⁵

Traumatic brain injuries can cause a wide range of symptoms depending on the extent of the damage, including:¹⁶  

• Headache.
• Nausea.
• Vomiting.
• Dizziness or vertigo.
• Seizures.
• Vision and speech problems.
• Loss or alteration of consciousness.

Stroke

A stroke happens where there is a loss of blood flow to the brain.¹⁷ Research has shown that moderate amounts of alcohol (i.e., 7 to 14 drinks per week for females and 7 to 21 for males) and/or high amounts (i.e., 14 or more for females and more than 21 for males) have been associated with an increased risk of stroke.¹⁸

Additionally, heavy alcohol use can lead to complications that increase stroke risk, such as: cardiac disease (e.g., arrhythmias and cardiomyopathy), high blood pressure, platelet dysfunction, synthetic liver dysfunction, accelerated atherosclerosis (i.e., artery disease), acceleration of clotting cascade, direct cerebral vasoconstriction, hemo-concentration (i.e., an abnormally high concentration of blood), and hyperhomocysteinemia (i.e., high levels of homocysteine in the blood) due to folate deficiency.¹¹

Common signs and symptoms of stroke include the sudden onset of the following:¹⁹

• Numbness or weakness in the face, arm, or leg, especially on one side of the body.
• Confusion, trouble speaking, and/or difficulty understanding speech.
• Vision problems in one or both eyes.
• Difficulties walking, dizziness, loss of balance, and/or lack of coordination.
• Severe headache without another known cause.

If someone is displaying any of the above symptoms, it’s important to call 911 right away.¹⁹ Depending on the type, stroke may be treated with medication to restore blood flow, surgical procedures, and other interventions, including rehabilitation.²⁰

Neurological Manifestations of Withdrawal: Shakes, Seizures, and Delirium Tremens

Along with symptoms such as insomnia, nausea, vomiting, anxiety, and more, alcohol withdrawal can involve neurological manifestations that range in severity such as shakes, seizures, and delirium tremens.²¹

Alcohol shakes or tremors involve uncontrollable shaking movements that most often occur in the hands, although they can occur in other parts of the body as well.^{22, 23, 24} This type of tremor happens acutely during the first 1 to 2 days following abstinence.¹¹

A seizure involves abnormal electrical activity in the brain, which can result in symptoms such as stiffened muscles, jerking bodily movements, loss of consciousness, biting one’s tongue, and/or loss of bladder control.²⁵ Alcohol-withdrawal-related seizures are generally grand mal seizures, also known as tonic-clonic seizures.^21,22,25,26  These seizures usually last 1 to 3 minutes, after which point a person’s consciousness will (usually) slowly return.²⁵ In cases of chronic alcohol use, seizures related to alcohol withdrawal can occur 6 to 48 hours after the last drink.¹¹

Seizures can also be a symptom of delirium tremens, or DTs, which is a severe and potentially life-threatening manifestation of alcohol withdrawal.²² Delirium tremens can involve symptoms such as:²⁷

• Sweating.
• Tremor.
• Agitation.
• Profound confusion.
• Disorientation.
• Hypertension.
• Hyperthermia.
• Hallucinations.
• Seizures.

DTs is a medical emergency that is treated with a variety of interventions, such as supportive measures, fluid administration if necessary, and medications.²³

How are Alcohol-Related Neurological Diseases Treated?

In general, most of the aforementioned diseases are the result of chronic excessive alcohol use. Limiting alcohol consumption and avoiding excessive alcohol use can help prevent or stop the progression of many alcohol-induced neurological diseases. In many, if not most, cases, improvements in symptoms are seen with continued abstinence from alcohol.

Treatment for Alcohol Use Disorders

Treatment for problematic alcohol use or AUDs may benefit in supporting abstinence from alcohol. The best way to avoid or treat neurological conditions related to alcohol misuse and AUDs is to abstain from alcohol and seek treatment if necessary. No matter how bad things might seem, most people can benefit from some form of treatment.²⁸

The treatment process can look different for everyone but generally begins with alcohol detox to help people safely withdraw from alcohol and become medically stable. Detox is not a standalone form of treatment, however, and people are encouraged to participate in some form of ongoing care to address underlying issues, modify behaviors, and learn skills that are necessary to avoid relapse.²⁹

Treatment can take place in an inpatient or outpatient setting, depending on your unique needs.²⁸ It typically involves a combination of medications, counseling, and behavioral therapies such as:^28,29

• Cognitive behavioral therapy (CBT). CBT helps people change maladaptive behaviors and learn skills to avoid relapse.
• Contingency management (CM). CM involves providing tangible rewards to reinforce positive behavioral outcomes.
• Motivational enhancement therapy (MET). This is a short-term therapy designed to increase a person’s motivation to make changes to their drinking behaviors.

Recovery is a lifelong process that doesn’t end once you’ve completed a treatment program. People are encouraged to participate in some form of aftercare, such as 12-Step programs and groups or individual counseling, to monitor their symptoms and support their ongoing recovery.³⁰  

If you or a loved one is struggling with alcohol misuse, treatment is available. With multiple treatment centers throughout the United States, American Addiction Centers offers everything from detox and inpatient treatment to outpatient treatment and aftercare.

However, we also offer an empathetic ear and tons of treatment-related insight to help get you on the road to recovery. Reach out to us at to speak to an admissions navigator to learn more about treatment, admissions, and how to take your first steps toward recovery.