Alcohol-related Brain Shrinkage: How Alcohol Misuse Can Impact Brain Function

Alcohol and Brain

Brain shrinkage is a natural part of the aging process. A slow and steady reduction in brain volume begins in our 30s or 40s, and this process accelerates in those aged 60+.

However, research shows that people with alcohol addiction who misuse alcohol over a prolonged period of time often have lighter, smaller brains. Some studies have even connected moderate alcohol consumption (14-21 units/week) to evidence of a lower brain volume due to shrinkage.

Here, we explore how drinking alcohol affects the brain, including its role in accelerating brain shrinkage and some of the potential impacts on day-to-day life.  

When alcohol meets brain 

We all know the immediate impact alcohol has on the brain. After a few drinks, people can quite quickly experience blurred vision, slurred speech, slowed reactions, or impaired memory. For occasional drinkers, these short-term impacts rapidly resolve once the alcohol intake stops. 

However, misusing alcohol over a prolonged period can lead to ongoing cognitive issues – even when sober. Part of understanding this complex long-term effect can be explained by exploring the role of brain shrinkage.  

How alcohol accelerates brain shrinkage

The cerebral cortex (gray matter) is the wrinkly outer layer of the brain, which is connected to a complex communication network of nerve fibers (white matter). 

When we drink alcohol, it is toxic to these nerve fibers and the tiny dendrites that branch out from every fiber to form the connecting pathways of our nervous system. Over time, too much alcohol causes these nerve fibers and dendrites to die off, which results in a loss of brain volume – a shrinking brain. 

Is brain shrinkage permanent?

The cell loss caused by alcohol can be permanent, as some nerves, particularly in the frontal cortex, cerebellum, and other brain areas, cannot be regenerated.

Fortunately, research shows that after just a few months of abstinence, the brain can partially reverse any shrinkage. This happens as the dendrites recover and re-grow, restoring some brain volume and improving blood flow to the cerebral cortex. 

“Despite the negative consequences of heavy drinking, there is hope of recovery with abstinence, which in animal models can result in neural stem-cell proliferation and the formation of new neurons and other brain cells, indicative of brain growth.”  (Fulton T. Crews. 2008. Alcohol-Related Neurodegeneration and Recovery, Alcohol Research and Health.)

How does brain shrinkage impact daily life? 

Lack of focus

The impact of brain shrinkage will depend on which part of the brain’s communication pathways are affected. For example, the frontal lobe is commonly an area of shrinkage, and this part of the brain controls emotions, memory, problem-solving, impulse control, social interaction, and motor function. 

Therefore, the potential range of health impacts is quite broad-ranging and can seriously affect a person’s quality of life. For example:

Cognitive and memory problems 

  • Memory loss – you may find it hard to remember appointments, recent events, or directions to familiar locations.
  • Processing new information – you could find it difficult to remember people you’ve just met or to recall information you’ve just received. 
  • Difficulty with familiar routines – you might begin to struggle with tasks such as cooking a meal or using the telephone.
  • Mood or behavioral changes – you may experience more episodes of low mood, a lack of interest or motivation, or feeling more irritable.
  • Impaired focus – you might find that maintaining concentration on a task for some time is no longer possible. 
  • Language problems – you may find it challenging to remember words or names or forget the end of a sentence part way through.
  • Decision-making – you might find it harder to weigh up different options and form a balanced opinion or make a decision. 
  • Poor choices – you may not be able to accept or evaluate that there is an issue with your alcohol use and, therefore, may refuse any offers of help.

The following physical problems are also linked to shrinkage of the brain: 

  • Poor temperature control 
  • Muscle weakness 
  • Disturbed sleep patterns 

Alcohol-related dementia

Alcohol-related dementia is a specific form of dementia caused by brain shrinkage. Commonly diagnosed when people are in their 40s, it is experienced much earlier than other forms of dementia. 

People diagnosed with alcohol-related dementia experience memory loss and can find it challenging to plan and complete complex tasks such as cooking, shopping, or managing finances.

Are women more at risk? 

In general, women are more vulnerable to many of the effects of alcohol use. However, regarding alcohol’s impact on brain size, current evidence is less conclusive.

Some studies suggest women report drinking excessively for significantly less time than men (approx. 50% less time) before we see evidence of brain shrinkage. However, other studies are less definitive:  

“In fact, two reports appearing side by side in the American Journal of Psychiatry contradicted each other on the question of gender-related vulnerability to brain shrinkage in alcoholism. 

Clearly, more research is needed on this topic, especially because alcoholic women have received less research attention than alcoholic men despite good evidence that women may be particularly vulnerable to alcohol’s effects on many key organ systems.”  (National Institute on Alcohol Abuse and Alcoholism) 


Alcohol-related brain damage (ARBD)

The impact of alcohol on how our brains function is more complex than the issue of shrinkage alone. Alcohol misuse can damage the brain in a variety of other ways, including: 

  • Chemical changes impair neurotransmitters, which take messages from the brain to the body.
  • Damage to blood vessels can cause high blood pressure and a raised risk of stroke.
  • The body breaks alcohol down into a chemical called acetaldehyde, which can damage cells and tissues in the brain. 
  • Poor nutrition can impair brain function – for example, low levels of thiamine (vitamin B1) can cause Wernicke-Korsakoff syndrome
  • Liver cirrhosis causes hepatic encephalopathy, a potentially fatal brain disorder that impacts sleep, mood, anxiety, depression, coordination, and attention span. 
  • An overall increased risk of head injury can result in physical brain damage.

Again, some of this damage is reversible if it is diagnosed and properly treated. For example, Wernicke-Korsakoff syndrome results from a lack of vitamin B1 caused by long-term, heavy drinking. 

The syndrome combines Wernicke’s Encephalopathy with Korsakoff’s Psychosis. The encephalopathy element refers to deteriorating brain tissue that causes sudden confusion, numb hands and feet, rapid eye movement, blurred vision, poor balance and gait. Some people also develop Korsakoff’s Psychosis, which involves memory, mood, and orientation issues. 

Wernicke-Korsakoff syndrome can be reversed if recognized early and treated with high doses of thiamine (vitamin B1) under medical supervision.

When to seek help 

If you’ve noticed difficulty with cognitive functions, such as mood and behavior changes, memory loss, lack of focus, poor coordination or balance, then it’s important to seek professional advice to understand the role that alcohol usage may be playing as an underlying cause.  

With a greater understanding of how alcohol addiction can impact the brain, and equipped with the knowledge that there is scope to partially reverse brain shrinkage, there is every reason to seek help with the hope that your road to recovery will bring significant improvements in daily functioning.

How Tikvah Lake can help

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We are an extremely personalized six-bed residential addiction and mental health treatment center in Florida, offering the highest level of care from our experienced clinical and medical staff

Our luxury rehab facility is private, and the accommodation is second to none.

We believe alcohol addiction is a personal problem that demands a personalized solution. Our clinical director works one-on-one daily with every guest to ensure lifelong recovery. 

If you are ready to heal, we’re ready to help.

Call us for an initial chat about how we could help you or someone you care about.


  1. Topiwala, A. et al. 2017. Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study BMJ 2017; 357:j2353
  2. Fulton T. Crews. 2008. Alcohol-Related Neurodegeneration and Recovery Alcohol Research and Health
  3. Hommer, D.W. 2003. Male and female sensitivity to alcohol-induced brain damage. Alcohol Research & Health 27(2): 181–185

About Adam Nesenoff

Adam Nesenoff has been working in recovery for over ten years.

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