Psychoactive substances, such as drugs and alcohol, by definition, affect your brain. They numb pain, help you relax, help you focus, or make you feel really good for a brief time. It’s obvious that while you’re under the influence of these substances, your brain doesn’t work as well. Your coordination suffers, you may not be able to concentrate or remember things very well, and your judgment and self-control nose dive. You may also notice that after a long period of drug or alcohol use, your brain isn’t what it used to be. Maybe you have trouble remembering things or focusing even when you’re sober. This may worry you if you’re just starting out in recovery. You may feel like your drug and alcohol use has broken your brain and you’ll never be quite whole again. This thought can be discouraging. If you’ve suffered cognitive impairment from substance use, will your brain ever fully recover? The answer is complicated and depends on the following considerations.


Some changes are temporary and easily reversed

Obviously, when you drink or use drugs, the effects wear off pretty quickly. If you’ve been drinking and using drugs for a while, you’ll likely experience withdrawal symptoms as a result of your brain having adapted to the presence of those substances. There are a number of possible neurological adaptations, depending on which substances you use. For example, if you’ve been drinking heavily for a long time, your brain no longer makes enough of the inhibitory neurotransmitter GABA and it makes too much of the excitatory neurotransmitter glutamate. This is why you probably feel tense and irritable when you quit drinking and may even experience tremors or seizures. 

These chemical adaptations typically change pretty quickly once you get sober. Acute withdrawal lasts a week or two but some symptoms, like emotional numbness, irritability, and depression, may last for weeks or months after withdrawal. Sometimes they last a year or more, but they will eventually go away as the chemical environment of your brain slowly gets back to normal.


Some changes are structural and may never be fully reversed

The really stubborn changes have to do with how the brain responds to addiction itself. The areas that are especially important for addiction include the basal ganglia, the extended amygdala, and the prefrontal cortex. The basal ganglia is involved with forming routines, habits, motivations, and rewards. The extended amygdala is involved in how you respond to stress, including negative emotions like anxiety and irritability. The prefrontal cortex does a lot of things but in this context, the important functions are planning and initiating behaviors and refraining from potentially harmful behaviors. 

In a normally functioning brain, these areas work together to achieve things that are generally good for us and the species, like eating food and having sex. However, drugs and alcohol can enable the basal ganglia to get the upper hand because they reward the brain much more strongly than food or sex. As a result, the basal ganglia is able to wag the dog, which, in this case, is the prefrontal cortex. So for example, while your prefrontal cortex would normally say, “I can’t have a drink right now because I have to pick up the kids from school,” an addicted brain says, “I have time for a couple of drinks before I pick up the kids.” There are planning and calculation involved, just for the wrong ends.

Over time, your prefrontal cortex’s “stop function” gets weaker and the “go function” becomes more involved in planning how to get drugs and alcohol. Your basal ganglia fixate on the reward of drugs or alcohol and your extended amygdala gets hyperactive in the absence of those things. This is what we mean when we say addiction “hijacks” your brain. Since your brain changes at a very deep level, the same systems that urge us to seek food and sex now urge you to seek drugs and alcohol. This is why relapse rates are so high and why it’s important to avoid triggers early on. Cravings and relapse risk do tend to diminish the longer you stay sober. One year and five years are points where recovery gets noticeably easier. 


Some changes affect how you think and may be reversed

You’ve probably heard that alcohol kills brain cells. That appears not to be true. Cocaine and methamphetamines, however, do appear to kill brain cells, as do inhalants. Whether or not this damage can be reversed depends on a number of factors including how many brain cells were killed and where they are in the brain. At a certain point, it’s unlikely that you’ll recover full brain function but that is probably rare, especially for relatively young people. The brain is remarkably adaptable. Even people who have pretty bad strokes are often able to recover much of their original brain function. There are even cases of people who have had a whole hemisphere removed and still are able to function normally. 

Much of the poor brain function from drugs and alcohol is caused by neglect. Brain functions are very much use-it-or-lose-it. For example, if you use cannabis so frequently that you are rarely able to concentrate, your concentration atrophies. If your brain’s “stop function” is habitually run over, it gets weaker. Many of these abilities return when you are able to start exercising them again.


At a certain point, damage may be permanent

As noted above, if you lose too many brain cells, your brain may not be able to compensate. There are also conditions such as early-onset dementia and Korsakoff’s Syndrome that appear to be irreversible. One French study of more than 57,000 people found that excessive drinking was the biggest risk factor for early-onset dementia. The sooner you quit, the lower your risk for irreversible brain damage.


Brain change research is still new

When it comes to recovering cognitive function, there are plenty of reasons to be optimistic. Even a decade ago, most researchers thought the adult brain was pretty much fixed but now it’s apparent that the brain can grow and change throughout life. For example, we now know that exercise releases a hormone called BDNF, which actually grows neurons in the hippocampus, a part of the brain associated with forming new memories. Other studies have found that eight weeks of meditation thickens gray matter in the brain’s prefrontal cortex. 

There are also new technologies such as transcranial magnetic stimulation, or TMS, that help wake up sluggish pathways in the brain. TMS is currently used to treat stubborn depression but experts believe it may be useful in treating addiction as well. The important thing to remember is that everything you do or think affects your brain in some way. If you consistently train your brain to concentrate or be less anxious or exert more self-control, then those abilities will increase. 

Recovery from addiction is a long road. It requires expert guidance, social support, and persistence. At Hired Power, we can help you create a plan for recovery and offer support and accountability for as long as you need it. To learn more about our services, explore our website or call us today at 800.910.9299.