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Secrets of a Formerly Miserable Wife

Author Diane England, Ph.D. has the credentials you expect, plus she has 
empathy and speaks from the heart because she has been there, too.

“Do You Know How and Why Alcohol       Creates Brain Damage?”

At, we make the assumption that your spouse suffers from unhealthy levels of narcissism, if not actual Narcissistic Personality Disorder, or NPD. Since addictions, including alcoholism, often are present when a man exhibits pathological narcissism, we include articles related to alcoholism at this site. But of course, sometimes the woman, perhaps because of her codependency, may drink with her husband since he wants this. Or, she might use alcohol as a pain relieve from his emotional abuse and verbal abuse. Anyway, whatever the reason, if you abuse alcohol, realize this information could apply to you as well, and, not just your partner with his narcissism, addictions, and abusive ways.

Alcohol affects the brain. This is obvious because sometimes after only one or two drinks, a person has difficulty walking, suffers blurred vision, has slurred speech, exhibits slowed reaction times, and has impaired memory. Based on personal experience, most people believe these problems resolve when they stop drinking. This isn’t necessarily true, however. A person who drinks heavily over an extended period of time can have brain deficits that persist well after he or she achieves sobriety.

Today, an important area of research related to alcohol and alcoholism includes the effects of alcohol on the brain. Also, is it possible to reverse any of the alcohol-related brain damage?  After all, some of the effects of alcohol on the brain range from simple “slips” in memory to permanent and debilitating conditions that require lifetime custodial care.

What factors influence the effects of alcohol on the brain? Brain research findings suggest the following are probably significant:

·         how much and how often a person drinks

·     the age at which the person began drinking, and how long this behavior has been going on

·       the person’s age, level of education, gender, genetic background, and family history of alcoholism

·      whether the individual is at risk due to prenatal alcohol exposure

      ·         the subject's general health status

In our discussion of alcohol and the brain, let’s look at blackouts and memory lapses first.

Has Your Alcoholic Experienced Blackouts or Memory Lapses?

Alcohol can produce detectable impairments in memory after only a few drinks. But as the amount of alcohol increases, so does the degree of impairment. Large quantities of alcohol, especially when consumed quickly and on an empty stomach, can produce a blackout, or an interval of time for which the intoxicated person cannot recall key details of events, or even entire events.

Blackouts are much more common than previously assumed, even among social drinkers. They should be viewed as a potential consequence of acute intoxication, regardless of age or whether the drinker is clinically dependent on alcohol.

People often participate in potentially dangerous events during blackouts.

Did you know that women are at greater risk than men for experiencing blackouts? This might be because of the way we metabolize alcohol in comparison to men. Also, women appear more susceptible than men to milder forms of memory impairment, and even when both sexes consume similar amounts of alcohol.

Other Ways Alcohol Affects Women Even More Negatively than Men

Women are more vulnerable than men to many of the medical consequences of alcohol use. For example, alcoholic women develop cirrhosis, alcohol–induced damage of the heart muscle (i.e., cardiomyopathy), and nerve damage (i.e., peripheral neuropathy) after fewer years of heavy drinking than do alcoholic men.

Studies comparing men and women’s sensitivity to alcohol–induced brain damage, however, have not been as conclusive. It appears that both male and female alcoholics show significantly greater brain shrinkage than control subjects. Alcoholics of both sexes also show similar learning and memory problems as a result of heavy drinking. However, it should be noted that women exhibited these differences after drinking excessively for only half as long as the alcoholic men. Thus, women are more vulnerable to alcohol–induced brain damage than men.

Is it the Alcohol or other Health Issues?

Those who consume massive amounts of alcohol for long periods of time often develop serious and persistent changes in the brain. But is this the result of the effects of alcohol on the brain, poor general health, or severe liver disease? At this time, we don’t have definitive answers.

What is an example of what I’m talking about? Well, for example, we know that thiamine deficiency is common among people with alcoholism. It, in turn, results from poor overall nutrition. Thiamine, which is also known as vitamin B1, is an essential nutrient required by all tissues, including the brain. And while most people consume sufficient amounts of thiamine in their diets, this often isn’t true of alcoholics. As a result, some develop serious brain disorders such as Wernicke–Korsakoff syndrome (WKS). WKS is a disease that consists of two separate syndromes. One is called Wernicke’s encephalopathy. It is short–lived and severe. There’s also a long–lasting and debilitating condition known as Korsakoff’s psychosis.

The three symptoms of Wernicke’s encephalopathy include mental confusion, paralysis of the nerves that move the eyes (i.e., oculomotor disturbances), and difficulty with muscle coordination. In fact, patients with Wernicke’s encephalopathy may be too confused to find their way out of a room. Then again, they might be unable to walk.

Many Wernicke’s encephalopathy patients do not exhibit all three of these signs and symptoms. In fact, we now know from studies performed after death that encephalopathy may never have been diagnosed because not all the “classic” signs and symptoms were present or recognized.

Approximately eighty to ninety percent of alcoholics with Wernicke’s encephalopathy also develop Korsakoff’s psychosis, a chronic and debilitating syndrome characterized by persistent learning and memory problems. Patients with Korsakoff’s psychosis are forgetful and quickly frustrated. They also have difficulty with walking and coordination. Although these patients have problems remembering old information (i.e., retrograde amnesia), it’s nevertheless their difficulty in “laying down” new information (i.e., anterograde amnesia) that’s the most striking. For example, these patients might discuss an event in their lives in detail, but then an hour later, not ever remember having the conversation.

The cerebellum, an area of the brain responsible for coordinating movement and perhaps even some forms of learning, appears to be particularly sensitive to the effects of thiamine deficiency. It’s the region where we most frequently see brain damage associated with chronic alcohol consumption.

Administering thiamine helps to improve brain function in patients in the early stages of WKS. But when brain damage is more severe, the course of care shifts from treatment to providing support to the patient and his or her family.

Actually, custodial care may be necessary for the twenty-five percent of patients who have permanent brain damage and significant loss of cognitive skills because of this lasting effect of alcohol on the brain.

Brain research suggests a genetic variation might explain why only some alcoholics with thiamine deficiency develop severe conditions such as WKS. But at this point, scientists can’t say this for certain.

Did You Know about this?

Most people realize that heavy long–term drinking can damage the liver. Of course, this is the organ chiefly responsible for breaking down alcohol into harmless byproducts, and then clearing it from the body. But did you know that prolonged liver dysfunction, including liver cirrhosis resulting from excessive alcohol consumption, can harm the brain? Actually, it can lead to a serious and potentially fatal brain disorder known as hepatic encephalopathy.

Hepatic encephalopathy can cause changes in sleep patterns, mood, and personality; psychiatric conditions such as anxiety and depression; severe cognitive effects such as shortened attention span; and problems with coordination such as a flapping or shaking of the hands (called asterixis). In the most serious cases, patients may slip into a coma (i.e., hepatic coma). Certainly, this can be fatal.

Brain research using new imaging techniques has enabled researchers to study specific brain regions in patients with alcoholic liver disease. In turn, this has given them a better understanding of how hepatic encephalopathy develops. These studies show that at least two toxic substances, ammonia and manganese, play a role in hepatic encephalopathy’s development. Actually, the alcohol–damaged liver cells allow excess amounts of these harmful byproducts to enter the brain, in turn causing brain damage.

Alcoholism and Neurogenesis

At one time, scientists believed that the number of nerve cells in the adult brain was fixed early in life. However, we now know that isn’t true. Rather, new neurons are generated in adulthood through a process called neurogenesis. These new cells originate from stem cells. Stem cells can divide indefinitely, renew themselves, and give rise to a variety of cell types.

Animal studies show that high doses of alcohol lead to a disruption in the growth of new brain cells. And actually, scientists believe it is probably this lack of new growth that results in the long–term deficits found in key areas of the brain (such as hippocampal structure and function). However, by understanding how alcohol interacts with brain stem cells, as well as what happens to these cells in alcoholics, it might be possible to determine whether the use of stem cell therapies is an option for treatment.

Final Comments for  You & Your Alcoholic Spouse

All alcoholics are not all alike. They experience different degrees of impairment. Also, the disease has different origins for different people. Consequently, researchers haven’t discovered conclusive evidence that any one variable is solely responsible for the brain deficits found in alcoholics. Therefore, trying to delineate what makes some alcoholics vulnerable to brain damage, while others don’t seem to suffer any at all, remains the subject of active research.

There is some good news that perhaps isn’t obvious from this article thus far. Thus, let me state it now: Most alcoholics with cognitive impairment show at least some improvement in brain structure and functioning within a year of abstinence. Certainly, though, some people take much longer.

Let me also offer a word of warning, however. If your spouse is currently an active alcoholic, you must realize he might never enter a treatment program—especially if you don’t force the issue through an intervention, for example. Even if he does go through a treatment program and becomes sober, there is often the problem of relapse. Then, in addition to that, there could be permanent brain damage because of the effects of the alcohol on the brain. Well, and even if there are not, you might be facing challenging behaviors for quite some time nonetheless. After all, his problems or challenging behaviors probably never stemmed totally from the alcoholism anyway. Narcissistic Personality Disorder (NPD), some other personality disorder, or some other mental health problem might have played a significant role, too.

Disclaimer: This how-to and self-help relationship advice and information for women about narcissism, addictions and abuse should be considered educational or inspirational—a guide or directory to things to consider and inform questions to ask a professional you contact for sound advice. It is not a substitute for marriage counseling, individual therapy, or legal advice. Women coping with domestic violence such as emotional abuse, verbal abuse, and/or sexual abuse—even where no physical abuse is present—are encouraged to seek professional help for treatment of depression, anxiety, self esteem, and other likely associated issues.

© 2007, Benefiting Women, LLC.

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