[This is part two of a series that examines alcohol use disorder as a brain disorder and how public perceptions prevent those with the disorder from seeking treatment.]

Alcoholism is not a choice; it is a brain disorder, characterized by continued alcohol use despite harmful consequences. However, it is often confused with heavy drinking, and should not be used to describe someone who drinks heavily by choice.

There is no one cause for alcohol use disorder (AUD), but research has suggested that those who have a family history of alcoholism have a higher risk of developing an AUD. Studies show that alcoholism is 50% attributable to genetics, the National Institute of Alcohol Abuse and Alcoholism (NIAAA) states. Studies have also shown that alcohol also has negative impacts on the body.

Scientific research has established that chronic heavy drinking and alcoholism can have serious repercussions for the functioning of the entire nervous system, particularly the brain. These effects include changes in emotions and personality as well as impaired perception, learning, and memory.

A 1997 report, Impairments of brain and behavior: the neurological effects of alcohol, appearing in the National Library of Medicine National Center for Biotechnolgy Information (NIH), states that neuropathological and imaging techniques have provided evidence of physical brain abnormalities in alcoholics, such as atrophy of nerve cells and brain shrinkage. At the cellular level, alcohol appears to directly affect brain function in a variety of ways, primarily by interfering neurotransmitters.

In more simple terms, alcohol has a toxic effect on the central nervous system and can cause significant brain impairment, states Australia’s Better Health Channel website. The conditions caused by alcohol misuse are called Alcohol Related Brain Impairment (ARBI). A person with ARBI might experience problems with new learning, memory, thinking-related abilities and physical coordination.

The website continues, saying: Alcohol related brain impairment is more likely to occur if a person drinks heavily on a regular basis over many years. A decline in thinking-related abilities is gradual and depends on how much alcohol is consumed and for how long.

It is also possible for damage to the brain to occur over a short period of time, if the drinking is excessive enough and diet is compromised. This is known as ‘binge drinking’ or ‘heavy episodic drinking’ and is a short-term, high-risk way of drinking alcohol.

ARBI is associated with changes in cognition (memory and thinking abilities), difficulties with balance and coordination, and a range of medical and neurological disorders. These can include Frontal lobe dysfunction, in which the brain’s frontal lobes are involved in abstract thinking, planning, problem solving and emotion. Damage results in cognitive (thought) difficulties.

While this may sound overwhelming, studies into the effects of alcohol on the brain have shown that the brain is able to repair itself remarkably quickly after stopping drinking. Research indicates that the impact on the brain’s grey matter, which shrinks from alcohol abuse, begins reversing within two weeks when chronic alcohol abusers become abstinent.

Priory, a mental health, addiction and social care services facility, states in a report, Alcohol related brain damage and recovery, that while the shrinking of any portion of the brain is worrying, but the damage done by alcohol is especially concerning because some of the shrinkage is probably due to cell death. Once brain cells die, the effect of the brain damage is permanent. Thankfully, some of the changes in the alcoholic brain are due to cells simply changing size in the brain. Once an alcoholic has stopped drinking, these cells return to their normal volume, showing that some alcohol-related brain damage is reversible.

“We found evidence for a rather rapid recovery of the brain from alcohol induced volume loss within the initial 14 days of abstinence,”Gabriele Ende, professor of medical physics in the Department of Neuroimaging at the Central Institute of Mental Health, is quoted as saying. “Although brain shrinkage, as well as a partial recovery with continued abstinence have been elaborately described in previous studies, no previous study has looked at the brain immediately at the onset of alcohol withdrawal and short term alcohol recovery. Our study corroborates previous findings of brain volume reduction for certain brain regions.”

While the brain can rapidly repair itself once alcohol consumption stops and recovery begins, very few people with AUD seek treatment for their medical conditions or disorders. The Number one barrier to recovery, studies have proven, is the stigma attached to AUD and those who seek treatment.