In 1967, writer and educator Marshall McLuhan published "The Medium is the Message." It changed the way people thought about the impact of television, and the future of communication. Symposium findings from the June 2000 Research Society on Alcoholism meeting in Denver suggest that alcohol-induced brain injury may be the medium for the progression of alcoholism. The summary, published in the February issue of Alcoholism: Clinical & Experimental Research, may change the way researchers think about the influence of alcohol-related brain injury on how people develop addictions, respond to treatment, and ultimately recover.
"What these researchers are saying is that injury to the brain resulting from alcohol consumption is sum and parcel of the progression of the illness," said Peter R. Martin, professor of psychiatry and pharmacology, and director of the Vanderbilt Addiction Center at the Vanderbilt University School of Medicine. "It’s a different perspective on how alcoholism may progress. In the past 20 years, the emphasis of research has been on what makes some people respond to alcohol, regardless of whether their brain is damaged. What they’re saying here is that by drinking, you modify the brain, and the brain can be modified differentially in people. The neurotoxicity of alcohol ‘feeds back’ and determines, modulates, or modifies the course of the alcoholism."
Symposium proceedings included four studies that addressed both preclinical (before the onset of the disease) and clinical (related to the symptoms and course of a disease) findings. According to Fulton T. Crews, director of the Center for Alcohol Studies at the University of North Carolina and one of the presenters, the symposium’s ‘common ground’ was the relation of alcohol-induced deficits in central nervous function to addiction and recovery.
"Data indicates that risk factors for alcoholism include heavy binge drinking, genetics and adolescent drinking," said Crews. "These may also be risk factors for increased brain damage." That’s the bad news; that simply drinking alcohol can injure someone’s brain, its neurotoxic effects depending on the individual’s genetic makeup, age, metabolism, and even gender. The good news is that because of the close ‘working relationship’ between alcohol and the brain, recovery seems possible with the right kind of treatment.
"Preclinical studies have suggested that brain damage is a component of the progression from casual drinking to addiction," said Crews. "We know that alcoholics have decreased brain size. Clinical studies have suggested that ‘exercising the brain’ likely improves brain regrowth as well as recovery from the addiction. Regrowth of the frontal cortex in particular could be essential for a successful recovery. Including certain activities in therapy - activities that require the use of the frontal cortex, the site of executive function, impulse inhibition and goal setting - have been shown to improve recovery and increase retention in the treatment program. Also, thiamine therapy seems to increase treatment effects, likely by restoring aspects of central nervous system function."
In short, therapies that exercise certain areas of the brain can improve its function. This can, in turn, help improve an individual’s chances of recovery from alcoholism. The decrease in brain size that seems to accompany alcoholism appears to reverse during the recovery process. In addition, thiamine supplementation may help recovering alcoholics regain their capacity to remember.
"The main point to be made here for the reader is that drinking alcohol can cause brain injury," said Martin. "Maybe what determines why some people become alcoholics is not so much how they respond to the pharmacological actions of alcohol, but how sensitive their brain is to being damaged by alcohol, which modifies their brain, thereby modifying the pharmacological actions of alcohol."
Martin added that future research should be directed at recovery. "We need to remember that even when an alcoholic stops drinking, there have been changes in the brain. We need to spend more time trying to understand how the brain recovers after people stop drinking, because that’s going to determine how well they ultimately do."