Drink?: The New Science of Alcohol and Your Health

by David J. Nutt

The two neurotransmitters that are the most common and the most powerful, because they are effectively the on–off switch of the brain, are gamma-aminobutyric acid (GABA) and glutamate. In essence these two neurotransmitters are the core of the brain. They do all the basic work such as sleeping, laying down memories and thinking.

Secondly, drinking releases dopamine, which is involved in drive, motivation and energy. This is a factor in alcohol’s stimulant effect, which makes you feel exhilarated, more active, gives you feelings of energy and enthusiasm. Dopamine makes you louder – this is an effect people get from cocaine, too.

Thirdly, the high you get from alcohol comes from endorphins. These are your body’s natural opioids, the brain’s natural pain-reducing system, also the source of the runner’s high. This reward system gives you a chilled sort of pleasure and, in some people, may also be a key factor in their addiction.

The causal association is strong enough that alcoholic drinks have been classified as a carcinogen by the International Agency for Research on Cancer . And it’s also why the World Health Organization has decided that no level of alcohol consumption is safe.

This may shock you, but drinking causes brain damage. In fact, the leading preventable causes of dementia are head injury and the damage alcohol does to the brain.

As you withdraw from the effects of alcohol on your brain, you’re likely to get psychological symptoms such as anxiety, sadness, lack of sleep and a short attention span.

If we scan the brains of people affected in this way, we can see changes to the amygdala, the fear and stress centre. These adaptive changes are epigenetic – that is, they are changes at the level of gene expression; fear- and stress-promoting genes are being over-expressed.

regular, chronic alcohol use affects the serotonin system, disrupting the brain in the direction of having low mood.

It’s not uncommon for very heavy drinkers to end up developing paranoia or a psychosis-like state that can make them very suspicious of other people. This is down to changes in the brain, caused by heavy drinking over time, that are similar to those seen in people with schizophrenia and which involve the dopamine system.

After a night out, do you tend to suddenly wake up in the early hours, feeling alert and awake? What you are experiencing is a mini withdrawal from alcohol. This hyperactive, fight or flight state is prompted by a surge of the neurotransmitter noradrenaline. You may also be sweating, and you may find it hard to get back to sleep.

Dehydration not only makes your skin look less plump but it also makes dark eye bags more visible, because it dilates blood vessels (vasodilation). This is also why drinking often leads to spider veins and to rosacea, which looks like flushing and redness on the cheeks.

If you drink regularly – and have a less than perfect diet – I’d suggest you take a multivitamin supplement that includes vitamins D and K. Or at the very least, take a B vitamin complex.

So my definition of addiction is: a behavioural disorder underpinned by changes in the brain, which leads to continued use of a drug or substance in the face of problems such as withdrawal; and that your use of that substance interferes with your family and social life and causes you personal harms.

If you need alcohol to keep going after you’ve drunk alcohol, you are physically addicted. Withdrawal is a physical phenomenon that proves you are dependent on alcohol.

We can describe this process in terms of four brain circuits that underpin addiction: 1) The reward circuit: that is, the hit of dopamine or endorphins you get when you drink.

2) The memory circuit: how you remember that alcohol is rewarding. 3) The drive or motive circuit, the area that makes you want to eat, drink and have sex. 4) The conscious mind, the highest part of your brain. This is the part that should have top-down control. But it can be overridden:

If you drink regularly, i.e. most days, then your tolerance will start to build, there will be a physical change in your brain. In response to the increase in levels of GABA, your GABA system becomes down-regulated. At the same time, your glutamate system is up-regulated. Now, you have to drink more to get the same level of anxiety reduction.

During a detox, you are transferred from alcohol to another drug, usually the benzodiazepine Valium or Librium. Then, over the course of a week, the medication is reduced slowly, allowing your brain to adapt and recover. You do lose a week and it’s not exactly enjoyable but the main thing is, it prevents any serious medical events. There is a downside: some people do find it hard to come off the anti-withdrawal medication.

Similarly to retirement, people often end up with a lot of free time on their hands. The social life of the expat may be based around drinking, and booze is often cheaper, too.

To analyse what’s happening with the drinks industry now, it’s enlightening to look back at what the tobacco industry did in the 1950s and 60s. It spent decades lying about the link between smoking and lung cancer, and denying evidence of any health harms. It also tried to deny the fact that tobacco was addictive.

After all, in terms of cost to the country, smokers are good value. They pay a huge amount of tax via duty and during their working lives, but many die before they can draw their pension. The cheapest death for the NHS is a heart attack. So, for the good of the national finances, the committee decided not to act on the study

the relationship between alcohol intake and harm shows an exponential curve; drinking a litre of wine each day is five times more harmful than drinking half a litre, not twice.

The UK drinks industry know this data. They know that if we went down the route of raising the price of alcohol, they would be more profitable over time. In my opinion, the reason they don’t is that making money in the short term is so easy. And they think that if they make any concessions in this direction, people will begin to question all our other beliefs around alcohol and health.