Neuroscience of Recovery: The Brain in Recovery
Some good news, some not-so-good news about brain recovery from alcohol use disorders.
According to a recent article on recovery of behavior and brain function after abstinence from alcohol, individuals in recovery can rest assured that some brain functions will fully recover; but others may require more work.
First, the good news; studies show improvement or even complete recovery to the performance level of healthy participants who had never had an alcohol use disorder in many important areas, including:
- short-term memory
- long-term memory
- verbal IQ
- verbal fluency
Even more promising, not only behavior, but the structure of the brain itself may recover; an increase in the volume of the hippocampus, a brain region involved in many memory functions, was associated with memory improvement.
In a separate study, results indicated that after 6 months of abstinence, alcohol-dependent participants showed a reduction in a “contextual priming task” with alcohol cues; in day to day terms, this could mean that individuals in early recovery from alcohol dependence may be less likely to resume drinking when confronted with alcohol and alcohol-related cues in their natural environment because these alcohol-related triggers are eliciting less craving.- a good thing for someone seeking recovery!
Still other studies showed that sustained abstinence was associated with tissue gain in the brain; in other words, increases in the volumes of brain regions such as the insula and cingulate cortex, areas which are important in drug craving and decision-making, were seen in abstinent alcoholics. This increase is a good thing, because more tissue means more recovery from alcohol-induced damage. A greater volume of tissue in these areas may be related to a greater ability to make better decisions
Now, the not-so-good news: these studies reported no improvement in visuospatial skills, divided attention (e.g. doing several tasks at once), semantic memory, sustained attention, impulsivity, emotional face recognition, or planning.
This means that even after abstinence from alcohol, people in recovery may still experience problems with these neurocognitive functions, which may be important for performing some jobs that require people to pay attention for long periods of time or remember long lists of requests. These functions may also be important for daily living (i.e. assessing emotions of a spouse, planning activities, etc.).
Importantly, there were many factors that influenced the degree of brain recovery; for example, the number of prior detoxifications.
Those with less than two detoxifications showed greater recovery than those with more than two detoxifications. A strong family history of alcohol use disorder was associated with less recovery. Finally, cigarette smoking may hinder recovery, as studies have shown that heavy smoking is associated with less recovery over time.
Recovery of brain function is certainly possible after abstinence, and will naturally occur in some domains, but complete recovery may be harder in other areas.
Complete recovery of some kinds of behavior (e.g. sustained attention, or paying attention over long periods of time) may take more time and effort! New interventions, such as cognitive training or medication (e.g. modafinal, which improved neurocognitive function in patients with ADHD and schizophrenia, as well as in healthy groups), may be able to improve outcomes even more, but await further testing.
Schulte, M. H., Cousijn, J., den Uyl, T. E., Goudriaan, A. E., van den Brink, W., Veltman, D. J., … & Wiers, R. W. (2014). Recovery of neurocognitive functions following sustained abstinence after substance dependence and implications for treatment. Clinical psychology review, 34(7), 531-550.
Taken together, the data here suggest, particularly for individuals with greater severity, it may behoove third-party payers to conceptualize recovery from addiction in context of an overall management plan that often includes multiple episodes of treatment and ideally includes support for post-treatment continuing care.
Grahn, R., Chassler, D., & Lundgren, L. (2014). Repeated addiction treatment use in Sweden: A national register database study. Substance use & misuse, 49(13), 1764-1773.