Addiction Alcohol Use How Alcohol Causes Brain Shrinkage By Buddy T Buddy T Facebook Twitter Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Learn about our editorial process Updated on May 22, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Huma Sheikh, MD Medically reviewed by Huma Sheikh, MD Facebook LinkedIn Twitter Huma Sheikh, MD, is a board-certified neurologist, specializing in migraine and stroke, and affiliated with Mount Sinai of New York. Learn about our Medical Review Board Print Manuel Breva Colmeiro / Getty Images Multiple research studies have found that the brains of people with severe alcohol use disorder are smaller and lighter than the brains of those who do not have this condition. This brain shrinkage affects the networks that regions of the brain use to communicate with other regions; the parts of the brain that allow neurons to communicate with neighboring neurons are also affected. Some Damage Is Reversible Although chronic alcohol misuse causes significant brain damage, abstinence can reverse some (but not all) of that. With appropriate interventions, people with alcohol use disorder can attain long-term sobriety despite deficits in decision-making. How Alcohol Causes Brain Shrinkage The gray matter of the brain in the cerebral cortex controls most of the brain's complex mental functions. The cortex is filled with neurons that connect by fibers to different regions of the brain and to other neurons inside the brain and spinal cord. The nerve fibers are the white matter of the brain—the "hard-wiring." How to Reverse Brain Damage From Long-Term Alcohol Use These nerve fibers have shorter, more numerous fibers called dendrites that branch out like the roots of a tree to allow the neurons to "talk" with other neurons. A neuron can communicate with as few as five or as many as 10,000 other neurons at a time. These two parts of the brain—the white matter and the dendrites—are most vulnerable to the shrinkage that alcohol misuse can cause. Of course, brain shrinkage is not the only damage alcohol misuse can do to the brain. Alcohol can cause chemical changes that affect the function of neurotransmitters. Does Drinking Alcohol Really Kill Brain Cells? How Alcohol Affects the Brain Chronic alcohol misuse creates complex, toxic metabolic and nutritional interactions that can cause mental deficits. Some of these are still not understood completely: Acetaldehyde, a metabolite of alcohol, could cause toxic effects.Malnutrition, especially thiamine deficiency, could play a role.Cirrhosis of the liver can also cause brain damage.Head injury and sleep apnea can contribute to brain damage. Alcohol, thiamine deficiency, and cirrhosis are linked. Some researchers believe they contribute in a complex manner to brain damage. Is Brain Shrinkage Permanent? Some of the damage done to the brain by alcohol can be reversed once the person stops drinking and maintains a period of abstinence, but some of it is permanent and cannot be undone. The most significant permanent damage caused by alcohol is nerve cell loss. Some nerve cells cannot be replaced once they are lost, and that includes those in the frontal cortex, cerebellum, and other regions deep inside the brain, according to research. However, abstinence can help reverse the shrinkage of dendrites, which studies have shown will begin to grow again and spread after weeks or months of abstinence. This has been linked to improved brain function. When cirrhosis of the liver is treated, some of the brain damage it can cause can begin to reverse. Brain damage due to thiamine deficiency in people who misuse alcohol can easily be treated with thiamine, but repeated deficiencies can cause permanent damage. MRI Images Reveal How Alcohol Can Physically Damage Your Brain Impact of Brain Shrinkage Cause by Alcohol Use One reason that people with alcohol use disorder are so prone to relapse is the damage it causes to the brain's reward system and decision-making abilities. The result is that the drinker is more motivated by immediate rewards than delayed rewards. Addictive substances such as alcohol provide immediate intoxicating rewards. Chronic alcoholism chemically changes the brain's reward system to the point that the drinker's pursuit of rewards becomes pathological. Long-term heavy alcohol consumption affects the brain's frontal lobe functions, which include inhibition, decision-making, problem-solving, and judgment. This kind of brain damage makes it difficult to maintain long-term sobriety. 10 Tips for Cutting Back on Drinking However, people with alcohol misuse disorder can overcome these impairments with abstinence, which helps reverse the damages. They then can achieve long-term, multi-year sobriety when motivated to do so. If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. Was this page helpful? Thanks for your feedback! Learn the best ways to manage stress and negativity in your life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 9 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Mon A, Durazzo TC, Abe C, et al. Structural brain differences in alcohol-dependent individuals with and without comorbid substance dependence. Drug Alcohol Depend. 2014;144:170-177. doi:10.1016/j.drugalcdep.2014.09.010 Yalcin EB, McLean T, Tong M, de la Monte SM. Progressive white matter atrophy with altered lipid profiles is partially reversed by short-term abstinence in an experimental model of alcohol-related neurodegeneration. Alcohol. 2017;65:51-62. doi:10.1016/j.alcohol.2017.05.008 Carter J, Sharon E, Stern TA. The management of alcohol use disorders: The impact of pharmacologic, affective, behavioral, and cognitive approaches. Prim Care Companion CNS Disord. 2014;16(4):10.4088/PCC.14f01683. doi:10.4088/PCC.14f01683 Sullivan EV, Harris RA, Pfefferbaum A. Alcohol's Effects on Brain and Behavior. Alcohol Res Health. 2010;33(1-2):127-143. Butterworth RF. Pathophysiology of alcoholic brain damage: synergistic effects of ethanol, thiamine deficiency and alcoholic liver disease. Metab Brain Dis. 1995;10(1):1-8. Manzardo AM. Thiamine deficiency and alcoholism psychopathology. In: Molecular Aspects of Alcohol and Nutrition. Elsevier; 2016:85-94. doi:10.1016/B978-0-12-800773-0.00007-0 De la Monte SM, Kril JJ. Human alcohol-related neuropathology. Acta Neuropathol. 2014;127(1):71-90. doi:10.1007/s00401-013-1233-3 Crews FT. Alcohol-Related Neurodegeneration and Recovery: Mechanisms From Animal Models. Alcohol Res Health. 2008;31(4):377-388. National Institute on Alcohol Abuse and Alcoholism. Alcohol's Damaging Effects on the Brain. Additional Reading Bartsch, AJ, et al. "Manifestations of early brain recovery associated with abstinence from alcoholism." Brain. Harper, C, et al. "The Pathophysiology of 'Brain Shrinkage' in Alcoholics—Structural and Molecular Changes and Clinical Implications." Alcoholism: Clinical & Experimental Research. Siggins, GR, et al. "Ethanol Augments GABAergic Transmission in the Central Amygdala via CRF1 Receptors." Science. Get Treatment for Addiction Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.