Does Alcohol Withdrawal Cause Brain Damage?

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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Is Brain Damage Possible With Alcohol Withdrawal?

Withdrawal from alcohol is a complex psychological and physiological process. It occurs when a person either significantly decreases their intake or suddenly stops consuming alcohol. Those experiencing alcohol withdrawal may experience a wide range of effects. While withdrawing from alcohol is generally not said to be a direct cause of brain damage, there are symptoms that people could experience that may make a person vulnerable to neurological health risks. 

To better understand the relationship between alcohol withdrawal and brain damage, it is imperative to explore how withdrawal from alcohol affects the body as a whole. You also need to explore the varying degrees of severity that can occur with alcohol withdrawal. This will provide a more comprehensive picture of the neurological effects of alcohol withdrawal, including the potential for brain damage.

Exploring Alcohol Withdrawal

Alcohol withdrawal is a collection of symptoms that occur when a person who typically has a prolonged and heavy consumption of alcohol abruptly stops or decreases their alcohol intake. The nature and severity of the symptoms varies greatly due to factors, such as someone’s individual health, level of alcohol dependence and whether they have co-occurring psychiatric or medical conditions.

People experience withdrawal due to the central nervous system (CNS) essentially getting used to the presence of alcohol. When someone suddenly stops or reduces their intake, the CNS becomes hyperactive, which can result in an array of psychological and physical symptoms. 

Mechanisms of Alcohol Dependence

The brain’s neurochemistry changes as a result of chronic alcohol consumption. This happens when the CNS adjusts neurotransmitter levels due to the presence of alcohol. The neurotransmitters that are most notable when this occurs include glutamate and gamma-aminobutyric acid (GABA). 

As someone continues to consume alcohol regularly, they may develop a tolerance to it. This means that if they wish to get the desired effects, they have to gradually increase their intake over time. Some people might develop dependence to alcohol. If they go without or significantly reduce how much they are drinking, they can experience the symptoms of alcohol withdrawal.

Alcohol Withdrawal Symptoms

The symptoms of withdrawal are typically categorized into three stages. People may only experience one or two stages, or they may progress through all three stages as they continue to abstain from alcohol. 

Minor Alcohol Withdrawal Symptoms

Minor withdrawal symptoms may occur about six to 12 hours after someone has their last drink. The symptoms might include:

  • Sweating
  • Nervousness or anxiety
  • Headache
  • Tremors
  • Nausea and vomiting
  • Irritability 

Intermediate Alcohol Withdrawal Symptoms

Intermediate symptoms may occur approximately 12 to 24 hours after alcohol cessation. These symptoms may include:

  • Elevated blood pressure 
  • Confusion
  • Insomnia
  • Increased heart rate
  • Rapid breathing
  • Disorientation
  • Auditory or visual hallucinations 

Severe Alcohol Withdrawal Symptoms

The most severe symptoms are referred to a condition known as delirium tremens. This is a severe condition requiring medical treatment. Symptoms of this condition generally begin approximately 48 to 72 hours after abstaining from alcohol. The symptoms may include:

  • Agitation
  • Fever
  • Intense sweating
  • Profound confusion
  • Severe hallucinations
  • Seizures or convulsions 

Severe Alcohol Withdrawal Risk Factors

It is important to note that not all people will experience the severe symptoms of alcohol withdrawal when they stop drinking. There are certain risk factors that could increase an individual’s risk of the severe symptoms.

Prolonged and heavy alcohol use is a common risk factor. Those with this history are more susceptible to severe withdrawal symptoms. If an individual has experienced alcohol withdrawal in the past, they are at a higher risk with subsequent attempts to abstain from alcohol. 

Older adults are at a higher risk. This is due to the body’s age-related changes. If someone has certain medical conditions, they are at a higher risk. Examples of co-occurring medical conditions that increase the risk include epilepsy or liver disease. 

Alcohol Withdrawal and Brain Damage

Alcohol withdrawal may cause damage to the brain, depending on withdrawal severity. The effects of severe alcohol withdrawal could also have an impact on neurological function. Experts state that the duration and severity of withdrawal are vital when it comes to whether brain or other neurological complications occur. 

Seizures

Some individuals experience seizures when they are withdrawing from alcohol. Several factors come into play when it comes to seizures due to alcohol withdrawal.

The brain’s primary inhibitory neurotransmitter is GABA. When someone uses alcohol chronically, this may enhance GABA’s inhibitory effects, resulting in the receptors having a higher level of sensitivity to the inhibitory effects of alcohol. This means that the brain could become hyperexcited due to the imbalance that might occur when alcohol is removed abruptly. 

Repeated episodes of alcohol withdrawal may increase the severity of the symptoms that a person experiences. This is referred to as the kindling effect. With every episode of withdrawal, a person experiences, their brain becomes more sensitive, increasing the risk of hyperexcitability, which could result in seizures. 

The brain’s primary excitatory neurotransmitter is glutamate. The suppression of glutamate activity occurs as a result of chronic alcohol use. This makes it more difficult for this neurotransmitter to counterbalance GABA’s increased inhibitory effects. When someone abruptly stops drinking alcohol, it overactivates glutamate, resulting in a higher level of neural excitability. 

Electrolyte imbalances are possible with chronic alcohol use, especially low magnesium levels. When levels of this mineral are low, there is a risk of heightened neural excitability, which could lead to seizures.

Abruptly stopping alcohol use could cause an increased firing of neurons due to a neural activity surge. Seizures can occur as a result of this hyperactivity. 

Thiamine Deficiency

Thiamine deficiency is not uncommon when an individual chronically uses alcohol. This is due to alcohol interfering with the body’s ability to absorb and use thiamine. Thiamine plays a role in energy metabolism. It is also vital for the nervous system to function properly. 

When someone is experiencing withdrawal, thiamine deficiency may occur as a result of malabsorption and inadequate nutrition. During withdrawal, the body also has increased metabolic demands. Since this nutrient is vital for energy metabolism, it could lead to the exacerbation of neurological symptoms when someone is experiencing withdrawal. 

When thiamine deficiency is severe enough, it could result in Wernicke-Korsakoff Syndrome, a type of neurological disorder. This condition is characterized by ataxia, memory impairment and confusion. 

Delirium Tremens

This alcohol withdrawal symptom is potentially life-threatening and severe. While this effect of withdrawal does not cause brain damage directly, it could lead to seizures. The seizures could then exacerbate the neurological impact that the brain experiences. 

Persistent Cognitive Impairment

Individuals who have a history of prolonged and heavy alcohol consumption may be at risk for persistent cognitive impairment. This is possible even after they abstain from using alcohol. The effects could include memory, attention and executive function deficits. Over time, cognitive function could decline further if the person has multiple episodes of drinking and then experiencing withdrawal. 

Alcohol Withdrawal Treatment

Early intervention and treatment are important for those going through alcohol withdrawal. There are treatments during the detoxification phase of alcohol withdrawal that could help make an individual less likely to experience the severe withdrawal symptoms that could cause brain and neurological issues. 

Medical Supervision

Medical supervision is vital during alcohol withdrawal. This allows trained professionals to monitor individuals to provide aid before they experience severe symptoms. 

The detoxification process can occur in either an inpatient or an outpatient setting. When withdrawal is mild, individuals may use an outpatient setting for the detoxification process. They will live at home but still get support to help them through this part of alcohol abstinence. 

When alcohol withdrawal symptoms are severe, a person might require inpatient treatment. This allows trained professionals to monitor them around-the-clock. Inpatient treatment is especially vital for those at risk for delirium tremens and other severe withdrawal symptoms.

Medications

Certain medications may help to either prevent or control some of the symptoms of withdrawal. Those with a thiamine deficiency may benefit from supplementation. This could help prevent the more severe Wernicke-Korsakoff Syndrome. 

Those experiencing or at risk for seizures may be provided benzodiazepine medications to manage this symptom. Common examples include lorazepam or diazepam. These medicines work to prevent seizures by calming the nervous system.

In some cases, certain other medications might be provided if certain other withdrawal symptoms are severe; for example, medicines for insomnia, anxiety and nausea. 

Hydration and Nutritional Support

During acute alcohol withdrawal, hydration is critical. It may help lessen the severity of certain symptoms. If someone is severely dehydrated, healthcare professionals may administer intravenous fluids.

Nutritional deficiencies are possible with heavy alcohol use, especially when the use is long term. Because of this, individuals may work with a nutritionist to help them consume a balanced diet throughout the withdrawal process.

Support and Counseling

During the withdrawal process, professionals might provide motivational enhancement therapy or cognitive behavioral therapy. Both of these could help an individual to work on the psychological aspects of their alcohol consumption.

Motivational enhancement therapy works to help people to strengthen their motivation for change. It also helps people tackle any ambivalence they have regarding making positive life changes. The following are the components of this therapy:

  • Expressing empathy
  • Avoiding argumentation
  • Supporting self-efficacy
  • Developing discrepancy
  • Rolling with resistance
  • Goal setting
  • Assessment and feedback

Cognitive behavioral therapy helps someone in their relationship with their feelings, behaviors and thoughts. The approach is goal-oriented and can aid a person in determining and changing their behavior and thinking patterns. This therapy also aids individuals in developing coping strategies to better deal with the challenges that they face. The principles of this therapy include:

  • Behavioral techniques
  • Relaxation techniques and mindfulness
  • Cognitive restructuring
  • Exposure therapy 

If you or someone you love has an alcohol use disorder, contact us at the Alcohol Awareness hotline at (855) 955-0771. We can help you find a support group in your area so you can get the help you need.

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