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Consequences of Intoxication on Brain Structure & Functioning

     Assessment     |     Treatment     |     Resources

  • Results of autopsy show that patients with a history of chronic alcohol abuse have smaller, less massive, and more shrunken brains than nonalcoholic adults of the same age and gender.  Brain shrinking is especially extensive in the cortex of the frontal lobe - the location of higher cognitive faculties.
  • The findings from neuroimaging techniques, consistently show an association between heavy drinking and brain damage, even in the absence of chronic liver disease or dementia. Earlier onset age is correllated with greater damage. 
  • Studies show that the best predictor of alcohol or drug related impairment is: maximum quantity consumed at one time, along with the frequency of drinking that quantity.
  • In addition to the primary brain damage from drug or alcohol intake, alcohol and drug use is also related to a higher level of head injuries (due to falls, fights, motor vehicle accidents, etc.). 
  • Repeated imaging of a group of adolescents who continued drinking over a 5-year period showed progressive brain shrinkage that significantly exceeded normal age-related shrinkage.  Moreover, the rate of shrinkage correlated with the amount of alcohol consumed.
  • About 15% of alcoholics experience seizures during withdrawals, and the likelihood of having such seizures, as well as their severity, increases with the number of past withdrawal episodes.  Seizures are correlated with brain injury and shrinkage of both frontal lobes
  • Co-morbid Psychiatric diagnoses including: Depression, Anxiety, PTSD, Obsessive Compulsive Disorder, and Personality Disorders

The relationship between alcohol consumption and deterioration in brain structure and function is not simple.  Measures such as average quantity consumed, or even total quantity consumed over a year, do not predict the extent of brain damage. 

Neuropsychological Assessment is necessary to evaluate damage due to exposure and help direct the treatment process.   


Neuropsychological Assessment will evaluate cognitive domains that are affected by substance abuse including: executive functioning, memory, attention, visual spatial skills and emotional functioning.  It is often the case that there is co-morbid psychiatric problems such as depression, anxiety, or other mental illness that is a consequenc of, or part of the original problem.   This thorough investigation gives an understanding of how to move forward in treatment and the potential permanent impairments from drug and alcohol exposure. It is important to understand and be honest with how one is affected, so that treatment can be focused, and accommodations may be available when necessary. 

Treatment and Recovery

Despite the grim realities described above, the situation is not hopeless: Proper Assessment leads to focused treatment in which there is functional and structural recovery! Learning means strengthenging the neurological connections, Cognitive functions, and motor coordination.  Cerebral atrophy may be reversed or dimished with Cognitive Rehabilitation.

Research shows:

  • Indications of structural pathology can disappear completely with treatment and long-term abstinence.
  • Hyper-excitability of the central nervous system persists during the first several months of sobriety and then normalizes.
  • Frontal lobe blood flow continues to increase with abstinence and treatment.
  • In general, skills that require novel, complex, and rapid information processing take longest to recover.  New verbal learning is among the first to recover.  Visual-spatial abilities, abstraction, problem solving, and short-term memory, are the slowest to recover.  Withdrawal symptoms are themselves dangerous.

Although changes in brain structure may be gradual, performance deficits may appear abruptly.  The individual often appears more capable than is actually the case, because existing verbal abilities are among the few faculties that are relatively unimpaired by chronic alcohol abuse and changes in the brain.  Despite the perception that one is fine, other faculties including memory, attention, problem solving, and visual spatial functioning will likely be impaired.  


  • Rosenbloom, M. etal. Alcohol Health Research World., 19, 266-272, 1995
  • Pfefferbaum, A. etal. Alcohol Clinical and Experimental Research, 21, 521-529, 1997
  • Pfefferbaum, A. etal. Archives of General Psychiatry. 56, 905-912, 1998
  • Oscar-Berman, A. Alcohol Health Research World., 21, 65-75, 1997
  • Neuropsychology of Alcoholism - Parsons etal. 1987
  • Gansier D. etal.  Journal of studies of Alcohol, 61, 32-37. 2000
  • Neuropsychology of Alcoholism - Parsons etal. 1987
  • Sullivan, E. etal. Alcohol Clinical and Experimental Research, 20,   348-354, 1996






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