How Alcohol Affects Your Brain with Akhil Anand, MD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Would you drink alcohol while on the job? Probably not. A pint of beer, glass of wine or shot of whiskey tends to affect our abilities a bit, and that effect gets more pronounced with every sip, which brings us to the brain. It's a complex organ that works 24/7 to keep bodies functioning. When you drink alcohol, your brain quickly starts working under the influence, and the results are what you'd expect and more. Today, we're going to look at what alcohol does to your brain in the short term and long term. Joining us for this chat is addiction psychiatrist Akhil Anand. Dr. Anand is one of the many experts at Cleveland Clinic who pop into our weekly podcast to help us better understand how our bodies work, or in this case, how our bodies work when you add alcohol to the mix. Welcome to the podcast, Dr. Anand. Thanks for setting aside some time to come and chat with us today.

Dr. Akhil Anand:

Thanks for having me, John.

John Horton:

Alcohol always feels like a touchy topic. I think, deep down, we all kind of know that it's not good for us. Yet, alcohol is just deeply ingrained in our culture and traditions, and to be honest, we just keep drinking. Basically, it's become a socially acceptable drug at this point, and that kind of makes conversations like these always feel a little awkward.

Dr. Akhil Anand:

You're right, it is socially acceptable. I think they did a survey and they found that 62% of Americans drank last year. That's 12 and older. I still remember when our politicians drink beer, it normalizes them and they get votes for it. Alcohol's part of our celebration. It's associated with positive moods. Yes, it's very much part of our culture.

John Horton:

But as we're going to talk about here today, it also has an effect on our bodies. And obviously, today, we're talking about what alcohol does to our brains. So walk us through, what does it do when you drink.

Dr. Akhil Anand:

First, I want to say that alcohol — it really depends on the individual, depending on gender, age, body weight, et cetera — but scientifically and theoretically, alcohol works on the brain as a relaxant. So it works on a system called the GABA system. It's a GABA A receptor agonist, and essentially, by binding to that receptor, it relaxes the brain and makes you feel at ease. But alcohol — I tell it to my patients all the time — it's a very promiscuous drug. It doesn't just work on the GABA A system. It works on all these other multiple receptors in your body, and that and excessive use of it can be very harmful to the brain and to the mind.

John Horton:

Now, you mentioned it relaxes you, but I know it also … it affects just cognitive function. Anyone who's had a few drinks, you kind of know, you don't think quite as clearly. So how is that working on your mind?

Dr. Akhil Anand:

So you're right. So again, it depends on the person. It depends on a lot of factors, that I didn't even mention, like other drugs that they may be taking or their medical history and just genetics. But initially, when you drink alcohol, it's about the amount. But initially, when you drink alcohol, it makes you a little bit more talkative. It makes you more social, makes you calmer, and relaxes you. But as you drink more, and you don't need to drink that much more, eventually, the enzymes that break down the alcohol get saturated. So it builds up actually quite quickly. And yes, then you start having the poor muscle coordination, the slurred speech. You can even start having memory issues, when you're in conversation, processing issues, that can lead to being blackout drunk, loss of consciousness, coma, even death. Yes, alcohol poisoning can kill you.

John Horton:

Well, that escalated quickly, as we're talking, but I guess, that is kind of the point of what does happen when you start drinking.

Dr. Akhil Anand:

Yeah, people don't realize this, but alcohol is neurotoxic. It generally damages your brain cells, so its short-term effects can be very dangerous. Long-term effects can also be very dangerous.

John Horton:

Well, with what you just mentioned, and that's something you hear a lot, as far as alcohol, maybe like killing brain cells or damaging the brain, does it do that over time or even in the short term?

Dr. Akhil Anand:

It's short-term, depending on how you drink, it can damage your brain. Generally, over time, there've been new longitudinal studies that have shown that, yes, chronic alcohol use, at very heavy uses, can cause ead damage, specifically gray matter mass, but it can also damage white matter mass and cause brain atrophy over time.

John Horton:

Now, is there even a difference in when adults drink alcohol versus if you're younger and you drink alcohol, with what it does to your brain?

Dr. Akhil Anand:

Yes, specifically when you're younger, your brain is going through a lot of changes, and so, your brain's even more sensitive. So a huge risk factor for people that develop alcohol addiction is early onset of drinking. So if you drink before the age of 14, there's about a 50% chance you're going to develop an alcohol use disorder in your adult. On top of that, you're right, the neurodevelopment stuff, the pruning that happens during the adolescent period, your brain is so sensitive that long-term effects — even early onset drinking — can have on your IQ, your memory, your thought processing, in your adulthood, can really be pronounced in your adolescent years.

John Horton:

So Dr. Anand, this damage that you're talking about, can it be reversed? Or if it sets in, is it permanent?

Dr. Akhil Anand:

So what I'll say is this, John, first of all, it's a very good question. It depends. So if there hasn't been any aggressive permanent damage, then it can be reversible. But if the damage is so severe, no, it can't be. So for example, if you have something called Korsakoff syndrome, which it's used casually and informally as wet brain, that is not reversible, but a condition like Wernicke's encephalopathy, where you do have confusion, where you do have memory issues, you have gait issues, and you can have all kinds of other mood symptoms, if you stop drinking and you improve your nutrition and replace your thiamine, it can be reversible, but certain things may not be reversible.

John Horton:

OK, well, let's look at some of these short-term and long-term effects. And let's kind of start on the short term. So if you're out drinking and you sit down and you have a few beers or a couple of glasses of wine or some cocktails, what kind of happens in your head?

Dr. Akhil Anand:

So initially, like I said earlier, it actually may help your social skills. It can make you more disinhibited, give you some confidence, maybe make you hyper-talkative, but then, very quickly, with another drink or two drinks, very quickly, you can start having more problems. It can make your speech slurred. It can cause you to be a little bit slower in thought processing. It can make you a little bit more sluggish. Your hand-eye coordination may decrease. Make your gait a little issue, when you get up to go to the bathroom. And even a little bit more alcohol can cause even far more effects.

Obviously, when I talk about acute alcohol, the most severe is the alcohol poisoning. But what often people see most commonly is blackout drunk, when they're binge drinking. And I always ask my patients — because they think of blackout drunk as the classic falling on the table and not remembering — blackout drunk is if you were drinking with a friend and you have a conversation with them and you can't remember even a minute of that conversation, you forget topics that you discuss the next day. That is also considered blackout drunk.

John Horton:

So when we get to that point, what is actually happening up in your head? I envision all this alcohol that's kind of going up there and messing things up, but it's just a chemical reaction taking place.

Dr. Akhil Anand:

I think it's the blood concentration of the alcohol. It's not being broken down, and that's the reason what's happening. And over time, if you do it chronically enough, it does cause damage to your brain.

John Horton:

Well, and that was where we were going next, with the long-term effects of alcohol on your brain. So if you continually drink, especially in excess, what kind of damage happens over time?

Dr. Akhil Anand:

It is neurotoxic. Over time, it causes changes to your brain structurally. Particularly, it focuses on interesting parts of the brain that are really important in our overall functioning, like our verbal and memory processing and things like that. There are particular conditions that you can have if you chronically drink. Two of them I mentioned, something called Wernicke's encephalopathy — and then, there's another one that is more interesting. It's even more chronic, called Korsakoff syndrome, where you have not only short-term memory loss, you have long-term memory loss.

You forget things from the past and things that recently happened in your life. If people are completely oriented and conscious, but they just don't remember anything, it's actually a very very scary. Other things that chronic alcohol use can do is it can cause severe mental health issues. Alcohol is a depressive, so if you drink for a long periods of time, it can cause depression, it can cause anxiety. Chronic alcohol use can even cause chronic psychosis. So you can become paranoid. You can even have auditory and visual hallucinations from chronic alcohol. Generally speaking, any type of toxic damage over time that can happen from anything else can happen because of alcohol as well.

John Horton:

Now, can it also play a role in dementia or kind of increase your odds of having some issues with that?

Dr. Akhil Anand:

Right, because it causes the damage to the brain, the gray matter and the white matter, it can lead to dementia. There are specific syndromes, like I mentioned, but it can also cause just overall dementia. They can increase the chances of you developing any form of dementia. It can also increase strokes, which can also cause dementia.

John Horton:

Wow. Sometimes you hear all this stuff and it makes you wonder why it is legal sometimes.

Dr. Akhil Anand:

Honestly, you're right. I don't want to get too political, but I wonder, sometimes, what would happen if we did not have alcohol and aliens came out from the top and brought alcohol — would we legalize it after all we know? I don't know if we would. I don't know if we would.

John Horton:

Well, and that's kind of the issue that we talked about right at the start, and that's where this gets so complicated, is that alcohol, it is so ingrained in society and how we celebrate, and grabbing a few beers with a friend. So it is something that we do. And what I'd like to talk with you about now is ways that people can partake and have a drink or two and maybe minimize those really drastic negative effects.

Dr. Akhil Anand:

Yeah, you're right, it's part of our culture. I think things are changing. I think people are developing more awareness, and there are a lot more things that are now people enjoy versus alcohol. But if you were to be drinking, it's really important to drink in moderation. So following the classic guidelines — no more than two drinks a day for a male, one drink a day for a female, avoid binge drinking at all costs. That's males drinking five drinks at a time at one sitting, and females drinking four drinks at a time.

When you are to drink, make sure you're hydrated, drinking water, make sure you're drinking not to cope with anxiety or stress or self-loathing, drinking in a happy, positive environment. I really do feel the setting can impact alcohol use's effects on your emotional state.

And then, what I would also say is pacing yourself, not having to drink at a higher rate. Knowing what you're drinking, probably avoiding drinking alcohol with high-sugar drinks has also shown to be helpful for hangovers the next day. And yeah, exercising regularly and pacing yourself and not drinking every single night.

John Horton:

So it sounds like the best approach is, if you're going to enjoy a drink, just make sure you enjoy a drink, not 10. And that's a big exaggeration, but you can do it in a way that works, but you have to be careful.

Dr. Akhil Anand:

That's it. And if you're using alcohol to cope with stress or anxiety, if you're going out and intending to drink one drink and you're not able to stop yourself from drinking, if your friends and family are hinting that you have a problem, honestly, a lot of times, before the family knows, the person knows. And it's important to talk to your doctor, meet with the specialist, because a lot of folks, unfortunately, that struggle with alcohol, they don't come to our doctors. And when they do, there are now multiple treatment options, not just medications, but different therapy modalities, that can really help people with alcohol problems.

John Horton:

Well, and Dr. Anand, I feel like this next question could be an entire show, but just, in a brief way, if you could, what are kind of the signs if you know you've kind of crossed over that line and you're no longer just maybe enjoying an alcoholic drink, but now you're in trouble with it and you can't stop and more of a … it does become just an addiction?

Dr. Akhil Anand:

You're not able to cut down your drinking on your own. You tell yourself that you're not going to drink this weekend, but you end up drinking. If you can't control your use, I mentioned earlier, if you're going out to a bar and intending to only drink one drink, but you end up having three or four, if your alcohol use is leading to negative consequences — so doing stuff that you would be ashamed of doing when drinking. And like I said, if family and friends are worried, these are all warning signs of something more than just drinking. There's a problematic behavior, compulsive behavior, regarding it. We call it the four Cs: control, consequences, compulsions and cravings. All those four or any of those four are in the setting of your drinking, you might need to talk to somebody.

John Horton:

Well, this has been an eye-opening discussion, Dr. Anand. And before we say our goodbyes, is there anything that we missed or something else that you'd like to add?

Dr. Akhil Anand:

If you were to have any issues with alcohol or if you know anybody that has issues with alcohol, like I mentioned, there are so many new treatment modalities that can help people. This is a condition like any other addiction, that often folks suffer alone, and get better with community, doctors, self-help groups, like AA. There are a variety of different alternatives to treatment, and you don't have to suffer alone.

John Horton:

Perfect way to wrap things up, Dr. Anand. I appreciate you stopping in today. Thanks for giving us something to think about.

Dr. Akhil Anand:

Thank you, John.

John Horton:

Tipping back an alcoholic beverage is something most of us do from time to time. It's important, however, to understand what alcohol can do to your brain. If you're concerned your drinking habits may be causing long-term issues, talk to someone to get the help you need. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.