The Price the Brain Pays: Adolescents and Drinking
Binge drinking can cause long-term damage to the brain’s abilities.
Posted Aug 13, 2020
Looking down at the young woman lying comatose on the hospital bed, I shook my head. She was 18 years old, but with her round, girlish face, she looked even younger. Just a few weeks earlier her parents had sent her off to college, and I could only imagine how devastated they would feel if she came home in a coffin.
Deema was a sorority pledge who had been unable to resist the pressure to drink a fifth of vodka during a hazing ritual. When she passed out before finishing the bottle, her sorority sisters had left her on a sofa to sleep it off. A few hours later, another pledge noticed that Deema was barely breathing and called 911.
Now Deema was in intensive care, unconscious and near death from one of the highest blood-alcohol levels I had ever seen. We had pumped out her stomach and hooked her up to an IV line, but despite our best efforts, her heart rate was less than eight beats a minute. She was still unable to breathe on her own, and her skin had a blue-gray cast, as if she had already begun to slip away. There was little hope that she would survive the massive injuries to her heart, respiratory system, and brain.
Against all odds, Deema’s body was able to metabolize what could have been a lethal dose of alcohol. Six hours later, she suddenly woke up from her coma, appearing extremely frightened with no idea where she was, or why. After telling her what had happened, I reassured her that she was well on her way to making a complete recovery. Within 24 hours, she was released to the care of her still horrified family. Deema was subdued, and if she continued pledging the sorority, I never heard.
The Vulnerability of the Adolescent Brain
At the time, I was confident that Deema had not sustained any long-term damage to her vital organs. Today, I’m not so sure that she didn’t damage her most vital organ, her brain.
When I first started practicing medicine, the stages of development surrounding and including infancy were thought to be the critical period for brain development. Today we know that brain development continues on into adulthood, with young people between the ages of 15 and 25 experiencing rapid and extensive remodeling of their brains—more so than at any other stage except infancy[i]. This extreme makeover gives adolescents the brain capacity they need to move past childhood and adopt adult behaviors and perspectives.
Like the infant brain, the developing adolescent brain is damaged by exposure to high levels of alcohol. Heavy drinking can impair a young person’s memory and ability to process and relay information. Frequent binge drinking—the norm for many adolescents and young adults—can cause long-term damage to the brain’s ability to make decisions, plan, organize, focus attention, control impulses, and accurately assess risk.[ii]
Memory and Learning
Considerable research indicates that heavy drinking at any age can shrink the size of the hippocampus, an area of the brain that plays a critical role in short- and long-term memory.[iii] This damage appears to increase with blackout drinking—losing memory, but not consciousness. Disconcertingly, one in two college-age drinkers say they have experienced blackouts, and many drink to a blackout state on a regular basis.[iv]
Frequent high levels of alcohol also impair the brain’s ability to communicate with itself, which depends in part on specialized brain chemicals called neurotransmitters. Alcohol and other drugs mimic the chemistry of neurotransmitters, altering the content of the brain’s messages and slowing down the speed at which they are delivered. This malfunction interferes with the ability to learn, one of the most important tasks of adolescence.
Perhaps because of this damage to memory and the brain’s messaging system, young people who drink heavily don’t perform as well as nondrinkers—academically, socially, or in sports. Adolescent drinkers in the United States are five times more likely than nondrinkers to drop out of high school,[v] and binge drinking may also play a role in declining rates of college graduation, as well as the increase in students who do not graduate in four years.
Brain Plasticity: Bad News/Good News
The ability of our brain cells to change in response to experience is called plasticity. This quality makes the brain vulnerable to long-term and even permanent injury from high levels of alcohol and other drugs.
But plasticity also enables the brain to repair itself, once it is out from under the burden of mind-altering substances. This capacity for self-healing enables heavy drinkers and people addicted to alcohol or other drugs to recover most, if not all, of their former brain function—if they stop drinking and using.
[i] For a clear description of the adolescent brain, addiction, and recovery approaches, see “An Interview with Michael L. Dennis,” Addiction: The Film, HBO, https://www.hbo.com.
[ii] For an extensive discussion of the impact of alcohol on the adolescent brain, see Susan F. Tapert et al., “Alcohol and the Adolescent Brain—Human Studies,” National Institute on Alcohol Abuse and Alcoholism, http://pubs.niaaa.nih.gov.
[iii] Thomas P. Beresford et al., “Hippocampus Volume Loss due to Chronic Heavy Drinking,” Alcoholism: Clinical and Experimental Research 30, no. 11 (2006): 1866–70.
[iv] Aaron White and Ralph Hingson, “The Burden of Alcohol Use: Excessive Alcohol Consumption and Related Consequences among College Students,” Alcohol Research: Current Reviews 35, no. 2 (2014): 201–18.
[v] “Alcohol and Drug Problem Overview,” The Partnership at Drugfree.org, http://www.drugfree.org.