Does Your Brain Fully Recover from Substance Use?

We’ve all heard someone say something like, “He’s fried his brain,” referring to someone whose drug or alcohol use has gotten out of control. If you have struggled with substance use, or someone you love has, you’ve no doubt seen changes in personality and cognition and wondered “Is this permanent?” It’s a distressing thought.

So much of who we are – our thoughts, memories, skills, and personalities – is encoded in the roughly three pounds of neurons in our skulls. Drugs and alcohol obviously have some effect on our brains, which is why people use them in the first place, and too much can have a pretty bad effect.

The belief that alcohol kills brain cells is widespread, but it doesn’t appear to be true. However, some drugs like methamphetamine, cocaine, and MDMA do appear to kill brain cells. While losing a few neurons among billions is not a big deal, it does add up over time. Heavy substance use can cause cognitive impairment, personality change, and behavioral change. If you’re worried that you or someone you love might suffer permanent effects from substance use, here are some things to consider.

Some effects fade quickly.

Most of the psychoactive effects of drugs and alcohol are temporary but if you’re using them all the time, you may not notice. In order to know what effects are temporary and which are longer-lasting, you actually have to go through withdrawal and get completely sober. This may sound obvious but a lot of people forget what their baseline even is after a period of continued substance use.

For example, alcohol is a depressant. If you are a heavy drinker, you may have depressive symptoms that are mainly caused by your drinking. These may include depressed mood, poor concentration, and poor memory. It’s possible that your depressive symptoms will abate once the alcohol is out of your system.

However, you may also have an underlying mental health issue to deal with too. The main point is that substance use interferes with the normal functioning of the brain and the first step in assessing your degree of impairment is to get the drugs and alcohol out of your system.

Some effects may last a year or more.

Unfortunately, the direct effects of drugs and alcohol on your brain are only part of the picture. Another part consists of the adaptations your brain makes to counter the effects of drugs and alcohol over time – in other words, you build a tolerance.

In the case of alcohol, for example, your brain gradually makes less of the inhibitory neurotransmitter GABA and more of the excitatory neurotransmitter glutamate. This is why you may feel like you need alcohol to relax and why you may experience irritability, shakiness, and even seizures when you quit drinking.

The worst of these symptoms – acute withdrawal symptoms – typically only lasts a week or two but other symptoms may last weeks or months. These are sometimes referred to as post-acute withdrawal syndrome, or PAWS. These symptoms may include emotional numbness, inability to concentrate, lack of interest in pretty much everything, and depressed mood.

This is thought to be the result of your neurotransmitters slowly returning to pre-addiction levels. Another factor likely has to do with changes in the limbic system. After months or years of using drugs and alcohol, your brain has gotten used to artificially elevated levels of dopamine so getting excited about having a nice dinner or going to the beach is pretty hard. It may take more than a year for that baseline to reset.

Some structural changes may never fully go back to normal.

As noted above, drugs and alcohol mainly mess with the brain’s limbic system, which is involved in pleasure, reward, and goal-seeking behavior. There appear to be three main brain structures involved with addiction: the basal ganglia, the extended amygdala, and the prefrontal cortex.

Areas of the basal ganglia are involved with motivation, reward, and creating habits. The extended amygdala regulates the brain’s reaction to stress and negative emotions like anxiety and irritability. The prefrontal cortex is responsible for “executive” functions like planning, prioritizing, and organizing – or “go” functions – as well as self-control and emotional regulation – or “stop” functions.

When we say addiction “hijacks” the brain, what we mean is that the massively disproportionate reward of substances causes the basal ganglia to tell the prefrontal cortex to organize its efforts in a way that prioritizes getting drugs and alcohol. At the same time, it undermines the “stop” functions of the prefrontal cortex, which get weaker from disuse.

This is the main area of debate when it comes to whether the brain ever fully recovers from addiction. On one hand, you have this miscalibrated basal ganglia that only goes back to normal very slowly and on the other hand, you have this impaired “stop” function in the prefrontal cortex.

The latter is much more malleable, which is why treatment strategies tend to focus on tools to regulate emotions and control behavior. There is also good news in that the urge to use drugs and alcohol typically declines the longer you stay sober. Most people say their cravings get noticeably weaker after one year and five years sober.

The brain is much more adaptable than we used to think.

If you’re concerned about whether your brain can ever fully recover from addiction, there is plenty of room for optimism. It has only been in the past decade or so that neuroscientists have come to believe that the brain keeps making new neurons in adulthood. We’ve also known for a long time that the brain has significant powers of adaptation.

Even people who have had strokes or experienced traumatic head injuries are often able to regain most or all of their cognitive functions. New technologies like transcranial magnetic stimulation may help heal brains even faster. The key is that your brain will adapt to whatever you consistently ask it to do. Your concentration, willpower, and memory will get stronger the more you use them, even after years of substance use.

Steamboat Springs, located in the Rocky Mountains, provides a setting for the natural stimulation of mind and body, allowing for a return to our innate senses and a new foundation from which to build. Foundry Treatment Center’s vision was formed through personal experiences and continues to grow through the dedicated compassion of the Foundry team. We share a commitment to provide a comprehensive, whole-body treatment program that encourages each to seek their values and beliefs through innovative and evidence-based treatment modalities. For more information on how we can help you or a loved one, call us today at (844) 955-1066.

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