How Does Alcohol Impact Cognitive Ability?
Occasional and moderate drinkers:
- Memory impairment
- Impaired decision-making
Heavy and/or chronic drinkers:
- Diminished gray matter in the brain
- Inability to think abstractly
- Loss of visuospatial abilities
- Wernicke-Korsakoff syndrome
- Memory loss
- Loss of attention span
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Alcohol is an integral part of the American social scene. The failed experiment of Prohibition demonstrated the formidable demand Americans have for alcohol.
As advertisements caution, alcohol is meant to be enjoyed responsibly; however, alcohol consumption can cause individuals to lose their ability to think responsibly.
Alcohol is associated with a host of familiar cognitive changes, such as a loss of inhibitions, confused or abnormal thinking, and poor decision-making. Recreational alcohol users generally recover from its effects without any long-term problems. However, even short-term loss of control over normal mental functioning can result in legal and personal troubles that would likely not have occurred if alcohol were not involved. Alcohol consumption continues to maintain a foothold so strong in American culture that it is nearly impossible to imagine life without it.
What Is Alcohol?
As the National Institute on Drug Abuse explains, the active ingredient in beer, wine, and liquor is ethyl alcohol, or ethanol, which is known colloquially as alcohol.
The process known as fermentation produces alcohol. When yeast is fermented, sugar breaks down into carbon dioxide and alcohol. Carbon dioxide exits the process through gas bubbles and leaves behind a combination of water and ethanol. The process is so precise that if any air is present in the yeast, the result will be ethanoic acid, a chemical found in common vinegar.
Alcohol is basically made from sugar and yeast, but different sources of sugar can produce different types of alcohol. For instance, the sugar from grape pulp is combined with yeast to create either red or white wine. In the case of beer, the source of the sugar is usually barley, but it can also be other grains, such as wheat or rye. To release the sugars, the grains must be malted, mashed, and boiled. Once the sugars are ready for use, yeast is added and the fermentation process begins. Different liquors are made different ways. When it comes to vodka, for example, there is a popular belief that potato is usually the source of the sugar; however, the majority of vodka is made from fruit, barley, wheat, sorghum, or corn.
Alcohol products, such as wine, beer, and liquor, are made in commercial distilleries, but the process of making DIY alcohol (moonshine) still relies on the basics discussed above. In some parts of the world, such as Scandinavian Europe and Russia, moonshine is a popular and low-cost alternative to commercial alcohol in some locales. Moonshine is known for its potency, which can be dangerous. Moonshine can be 150-proof, which translates into it being 75 percent alcohol. An added hazard is that it is not created in a regulated setting; therefore, there are fewer, if any, quality and safety guarantees. Although there is not a pressing public concern about rampant sales of moonshine, there are reports of Americans making DIY alcohol and finding themselves in legal hot water as a result. For instance, a 51-year-old man was arrested in Ohio after selling moonshine out of his camper at a fair. The man’s ostensible motive was to make a profit. The Ohio court ordered the moonshine maker to pay an $800 penalty and required him to complete 50 hours of community service.
Making moonshine may sound antiquated to modern ears, but it demonstrates the relative ease with which alcohol can be illegally made. Although some Americans still have Prohibition sympathies, the ability to home-produce alcohol serves as a reminder that it would likely be impossible to entirely remove alcohol from the American landscape.
Alcohol Consumption in the US
The National Survey on Drug Use and Health is a key source of information about the patterns of alcohol and other drug use in America. The 2013 survey made the following estimated findings with respect to alcohol consumption:
- About 52.2 percent of Americans aged 12 or older were current alcohol users.
- Approximately 6.3 percent of the population aged 12 or older (16.5 million) were heavy alcohol users.
- In the past 30 days, 22.9 percent of the population aged 12 or older (60.1 million) reported binge drinking behavior.
- About 10.9 percent of Americans aged 12 or older reported that they had driven a car under the influence at least once in the past year.
- Approximately 8.7 million Americans under the legal drinking age (12-20 years of age) were current alcohol users. This statistic includes 5.4 million binge drinkers and 1.4 million heavy drinkers.
Alcohol is the most commonly abused drug in the US, with marijuana occupying second place. Despite the known dangers of excessive alcohol consumption, these statistics clearly reflect that many alcohol users engage in heavy use and binge drinking. Further, despite the well-known fact that alcohol impairs brain functioning, an estimated one in 10 Americans aged 12 or older operated a vehicle under the influence. This statistic demonstrates that only a fraction of those who drive under the influence are actually detected.
It is well established in the mental health field that alcohol consumption can exacerbate an underlying mental health disorder.
In the field of substance abuse treatment, an individual who simultaneously has a substance use disorder and at least one other mental health disorder is considered to have a dual diagnosis. Whether alcohol causes or simply accompanies the underlying mental health disorder is not clearly understood. However, there is general consensus that individuals who abuse alcohol and have a mental health disorder diagnosis require treatment for both conditions.
Alcohol in the BrainWhile it is true that alcohol can initially perk people up and even help them to socialize at a party, alcohol is a central nervous system depressant. The depressant effects of alcohol are witnessed when people who have been drinking have slurred speech and poor limb coordination that prevents them from being able to walk properly. Although these outward signs of intoxication can be easily observed, it isn’t as clear how alcohol acts on a deeper level inside the body. So, how does alcohol act at the neurological level?
Alcohol acts on the receptor sites for the neurotransmitters (chemical messengers) known as GABA, glutamate, and dopamine. Alcohol’s activity on the GABA and glutamate sites results in the physiological effects associated with drinking, such as a slowing down of movement and speech. Alcohol’s activity on the dopamine site in the brain’s reward center produces the pleasurable feelings that motivate many people to drink in the first place.
As a Psychology Today article on this topic discusses, the degree to which alcohol impacts a person’s mood, behavior, and neurological functioning depends in part on whether the blood alcohol content (BAC) is elevating or decreasing. With 1-2 drinks, the person may feel excited or more talkative, but with more and more alcohol in their system, they become more sedated and being to lose control of their movement and may experience impaired thinking and memory. The fluctuation in BAC helps to account for why the same person can go from being the life of the party to needing help with basics, like walking.
In addition, the following factors have been shown to influence how alcohol impacts a person’s brain functioning over time:
- The volume a person drinks
- How often a person drinks
- The age at which drinking began
- The number of years a person has been drinking
- The person’s sex, age, and genetic factors
- Whether the person’s family has a history of alcoholism
- Whether the person was exposed to alcohol as a fetus
- The person’s general health condition
When considering the negative consequences of alcohol, people often think of what can happen in public, such as getting into a car accident or an alcohol-induced altercation. However, people play a game of roulette with themselves when they drink, especially when they drink heavily, because the effects of alcohol on the brain are uncertain both in the short-term and long-term. If other drugs are added to the alcohol consumption, the risks become more serious.
In occasional drinkers, alcohol can produce one or more short-term effects after one or more drinks. Memory impairment can begin after a few drinks, and it can become increasingly worse as the consumption increases. A high volume of alcohol consumption, especially on an empty stomach, can result in a blackout. Occasional drinkers will usually recover from a blackout without any lasting mental problems. However, there are numerous dangers associated with acute alcohol intoxication, such as engaging in reckless activities like unprotected sex, vandalism, and driving. Further, an alcohol-involved incident, such as a car accident, can cause ongoing problems as court dates will need to be attended, fines must be paid, and educational or treatment requirements will have to be met.
As the Centers for Disease Control and Prevention discusses, the Dietary Guidelines for Americans considers a moderate drinker to be a person who consumes one drink (applies to women) or two drinks (applies to men) per day. Despite extensive news coverage of medical reports that moderate drinking has positive health benefits, the guidelines advise that this is not a reason to start drinking. Moderate alcohol consumption has negative associations, such as increasing the risk of breast cancer and causing violence, falls, drownings, and car accidents. Moderate drinking does not insulate a person from the cognitive impairment associated with drinking and the dangerous consequences that can result.
Heavy and Chronic DrinkingUnlike an occasional or moderate drinker, a person who drinks heavily over an extended period of time may develop deficits in brain functioning that continue even if sobriety is attained. In other words, cognitive problems no longer arise from drinking alcohol but from brain damage that prior drinking caused. In short, long-term alcohol abuse can negatively impact the brain’s “hard wiring” such that even when drinking ends, the cognitive problems persist.
According to the National Institute on Alcohol Abuse and Alcoholism, most heavy long-term alcohol users will experience a mild to moderate impairment of intellectual functioning as well as diminished brain size. The most common impairments relate to the ability to think abstractly as well as the ability to perceive and remember the location of objects in two- and three-dimensional space (visuospatial abilities).
In addition, there are numerous brain disorders associated with chronic alcohol abuse. For example, research supports that up to 80 percent of chronic alcohol users have a thiamine deficiency, and some in this group will progress to a serious brain disorder known as Wernicke-Korsakoff syndrome (WKS). Symptoms of WKS include confusion, paralysis of eye nerves, impaired muscle coordination, and persistent problems with memory and learning ability.
Fortunately, certain types of cognitive impairment can be reversed through abstinence from alcohol. Studies show that those who have recently undergone medical detox exhibit mild but significant improvement in certain cognitive abilities, especially those related to visuospatial tasks, problem-solving abilities, and short-term memory. Through ongoing abstinence, over a period of several months to one year, a recovering individual will continue to improve cognitive skills, such as visuospatial abilities, working memory, and attention span. In addition, research shows that brain volume can increase with abstinence.