How Does Alcohol Influence Mental Health?

Sarah R. Dash


October 29, 2015

Alcohol and the Brain: The Bad and the Good

Using alcohol within the recommended boundaries, compared with drinking to excess, affects the body and brain in different ways. For instance, moderate drinking may have anti-inflammatory health benefits and has been linked to enhanced memory, reduced disease risk, and longevity,[14] though research suggests that there is no such safe level of consumption in terms of cancer.[15] Chronic heavy drinking, however, has been shown to be disruptive to the stress response system, inflammatory response, and gut microbiome and to promote oxidative stress—all known risk factors for a variety of physical and mental health conditions.[16,17] Researchers now understand the inflammatory nature of some mental disorders and the connection between this inflammation and the health of the gut.[18] Heavy drinking is disruptive to the healthy balance and structure of the gut microbiome, and binge drinking has been shown to cause endotoxemia—also known as "leaky gut."[19] New research points to gut health as an important determinant of overall health.[20]

Damage from chronic alcohol use is observed also in the brain, with studies showing less white matter and smaller hippocampal volume in the brains of adults with a history of alcohol abuse, indicating neural loss or dysfunction.[21] Additionally, heavy alcohol consumption promotes a heightened stress response via cortisol pathway deregulation and overactivation of the hypothalamic-pituitary-adrenal axis[22] and may also disrupt the dopaminergic and serotonergic systems.[23] These structural and signaling effects can be problematic on their own but also increase risk for dementia, Alzheimer disease, decreased cognitive function, and mood disorders.[10,24] It is difficult to discern whether alcohol consumption is cause or consequence of a mental condition, and more research is required to understand the direction of this relationship.[25]

The Good News

The reasons for why and how individuals consume alcohol are complex, and establishing steadfast rules of consumption appears equally so. Of course, there is great individual variability in how consumers respond to and manage drinking alcohol; however, there is evidence to support the old adage of "the dose makes the poison." While the literature on excessive and chronic drinking is well agreed upon, it's worth noting that some of the healthiest cultures in the world are moderate drinkers, where alcohol is an integral part of daily life. Drinking within low-risk guidelines may attenuate some of the harmful effects of free radicals and oxidative stress, which is shown to be protective against some chronic illnesses. Further, social drinking often offers individuals a sense of perceived support, a factor known to be strongly linked to mental well-being.[26]

"Low-risk" guidelines for alcohol consumption have been developed in many countries to encourage the moderate and sensible consumption of alcohol within the general population. While these guidelines aim to be suitable for most people, there is still a need for more cohesive and feasible international guidelines. Some of the evidence provided here suggests that there may be individuals who—for a range of demographic, genetic, and social reasons—are particularly vulnerable to the negative consequences of excessive alcohol consumption and may be particularly at risk for co-occurring substance use and mental health problems.

Future studies should investigate the individual variability in responses to alcohol. While some may chose to abstain for a variety of reasons, the alcohol guidelines aim to promote the tried-and-true lifestyle advice of moderation as part of a lifestyle that cultivates overall health and well-being.


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