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Drinking to Blackout: What Happens When Young Brains get Boozed

It’s a fairly common practice: you get good news, and you go out and celebrate. Getting married? Make a toast. Having a party? Take a shot. Whether it’s a wedding, a 4th of July getaway, or a summer vacation, more often than not, celebrations are likely to include some alcohol.

Though alcohol has become an integral part of many social functions, especially holidays, few people truly understand the damage that too many drinks can do to your body and your brain. Well beyond a buzz and a hangover, research shows that drinking too much alcohol too fast could lead to a blackout. In fact, years of chronic alcohol use can actually contribute to a person developing a serious brain disorder that affects cognition, movement, and memory.

The two types of alcohol-induced blackouts, en bloc and fragmentary, are very different from one another and are not to be confused with passing out — an experience of falling asleep or going unconscious after drinking alcohol. In en bloc blackouts, a person experiences a complete loss of memory for the drinking episode; they are often awake and functioning but have no memory of their actions the next day. Perhaps even more frightening is the fragmentary blackout, which involves partial memory loss, sometimes retrieved with cues; leaving a drinker to piece together bits and pieces of hazy information from the night before.

Blackouts occur at high rates among social drinkers and binge drinkers, alike; but one of the largest groups impacted by blackouts is college students. Regan Wetherill, PhD, a research assistant professor of Psychology in Psychiatry at Penn, has spent more than 15 years studying drugs of abuse, alcohol, and the effects each have on the human brain. According to Wetherill, approximately one out of every two college drinkers experiences a blackout.

In her early years studying the effects of alcohol consumption, Wetherill sought to understand why people often fail to set limits when drinking and why, even when they do set limits, they tend to drink more than expected. She and a team of researchers conducted a study focusing on a rite of passage for consuming alcohol in the U.S.: the 21st birthday. After interviewing first-time college students a week before, one day after, and one week after their 21st birthdays, the researchers found that despite the participants’ plans to consume minimal amounts of alcohol, many of the students reported having dangerous blackout experiences.

“Many of them planned to do typical 21st birthday celebration things,” Wetherill recalled. “But when they came in to talk to us afterward, many of them reported having no recollection of how they’d gotten home; they’d woken up in their apartment or in a stranger’s apartment and didn’t know if they’d taken a cab or if they’d driven, or any of that.”

In addition to alcohol’s effect on memory, Wetherill says it impairs a person’s ability to inhibit behaviors and make sound decisions.

“Alcohol really makes a person’s attention focus in on just the most immediate environment without really thinking about long term consequences, and that’s typically where bad decisions are made,” she said.

Measuring anticipated alcohol use, actual alcohol use, and situational factors, Wetherill’s study found that 68 percent of students consumed more alcohol than intended, consuming a total of 10 drinks, roughly five more than anticipated. In addition, several students reported having unintended sex; some consensual, some nonconsensual, but certainly not described as planned. The study also found that peer pressure played a key role in how many drinks students consumed.

While intermitted memory loss is a scary short term effect of alcohol abuse, long term users run the risk of developing two debilitating illnesses: Wernicke's encephalopathy and Korsakoff psychosis, more commonly known as Wernicke-Korsakoff syndrome (WKS). WKS is a brain disorder caused by a lack of the vitamin b1 (thiamine). WKS can arise due to diet deficiencies or other medical conditions that impair vitamin B-1 absorption, but chronic alcohol abuse is the most common cause of the syndrome. People with Wernicke’s encephalopathy experience bleeding in the lower sections of the brain; including the thalamus and hypothalamus. These areas of the brain control the nervous and endocrine systems. The bleeding causes brain damage that presents symptoms involving vision, coordination, and balance.

According to Wetherill, recent studies have also found negative similarities in the brains of adult chronic alcohol abusers and developing adolescents.

“With long term alcohol abusers, we see similar vulnerabilities in that the pre frontal control isn’t fully developed or has been modified to where you have these reward structures that are on board in go-go-go mode without a break,” she explained. “It’s very interesting to look at the fact that a person who has a substance use disorder or a history of chronic use and a developing adolescent have similarities in brain development; it’s like the person’s brain has been high jacked.”

Wetherill is one of many researchers seeking to better understand and prevent alcohol addiction and abuse by way of intervention at an early age. Two major research initiatives currently underway, the Longitudinal Study of Adolescent Brain and Cognitive Development (ABCD Study) in the National Institute on Drug Abuse and the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) in the National Institute on Alcohol Abuse and Alcoholism are working to “increase understanding of the environmental, social, genetic, and other biological factors that affect brain and cognitive development,” and “identify neurobehavioral vulnerabilities that may place an adolescent at risk for the subsequent development of alcohol use disorders.”

“Previous research has really been focused on individuals who already have alcohol related disease. Now we are trying to figure out what we can do to identify individuals at risk for alcohol and substance use disorders before they initiate any type of use,” Wetherill said.

“We know that it’s during this adolescent period when the brain is developing that you see an increase in alcohol and substance use. And we know that those substances more or less hijack the brain. That’s a big health concern and an area that needs to be focused on.”

Despite the nature of her life’s work, Wetherill says she does drink alcohol; typically a glass of wine or two a week accompanied by water and food. But knowing what alcohol does to the brain makes her take a pass on hard liquor and shots. Her advice to drinkers: take it slow.

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