Alcohol consumption is one of the most common forms of substance use worldwide, with profound neuropsychological implications. In this article, psychologist Rafael A. Salas Muriel explains, from a neuropsychological perspective, what alcohol is, its effects on the brain, the risks associated with its consumption, and how neuropsychological assessment and intervention can contribute to the treatment of individuals affected by this type of consumption.
What is alcohol?
Ethanol, commonly known as alcohol, is a psychoactive substance that acts as a central nervous system depressant. When consumed, it crosses the blood-brain barrier and affects various areas of the brain, particularly those associated with motor control, judgment, and decision-making (Waisman and Benabarre, 2021).
Chronic alcohol consumption can lead to a range of neurological disorders, with consequent cognitive and psychological deficits due to its impact on brain structures.
Neuropsychological alterations associated with alcohol consumption
Prolonged and excessive alcohol consumption can produce multiple neuropsychological alterations, especially in individuals who develop alcohol dependence (Courtney et al., 2019). Below are some of the main neuropsychological effects that can be observed in people who consume alcohol chronically:
1. Memory impairment
Alcohol significantly affects memory, particularly the ability to form new memories. The hippocampus, a key brain structure for information storage, is affected, leading to difficulties in recalling recent events. In cases of chronic abuse, individuals may develop Korsakoff syndrome, characterized by severe amnesia and confabulation (Akhouri et al., 2023).
2. Attention deficits
Individuals who consume alcohol may have difficulties concentrating and filtering irrelevant stimuli, affecting their ability to stay focused on specific tasks (Cabé et al., 2018). In the long term, these attentional deficits can seriously compromise performance in daily tasks and work contexts.
3. Executive dysfunction
Executive functions, such as decision-making, planning, and impulse control, are particularly sensitive to excessive alcohol consumption. Individuals with alcohol dependence may display impulsive behaviors, difficulty organizing themselves, and making appropriate decisions (McPhee and Hendershot, 2023), which can severely affect their personal and professional lives.
4. Emotional disturbances
Alcohol can cause significant changes in emotional regulation, leading to states of euphoria or, conversely, to episodes of depression and anxiety. Individuals who abuse alcohol often present a greater vulnerability to affective disorders (McHugh and Weiss, 2019), due to its effect on neurotransmitter systems.
5. Thought disorders
Chronic alcohol consumption can induce disorganized thoughts and difficulties in following a coherent line of thought. In severe cases, individuals may develop delirium tremens or psychotic episodes, characterized by hallucinations and confusion.
It is important to note that acute conditions such as delirium tremens, caused by abrupt withdrawal after high alcohol consumption (Rahman and Paul, 2023), can lead to death if not treated properly in a hospital setting.
6. Slowed processing speed
Alcohol can slow down the brain’s ability to process information, negatively affecting the ability to respond quickly to stimuli (Czapla et al., 2016). This is especially problematic in situations like driving, where reaction speed is crucial.
7. Impact on motivation
Like other substances, alcohol can reduce motivation to engage in activities that were once rewarding. People who abuse alcohol may experience apathy, lack of energy, and difficulties in initiating and completing tasks (Pavkovic et al., 2018), significantly affecting their quality of life.
Neuropsychological assessment
Neuropsychological assessment in patients with alcohol consumption is essential to identify and quantify the cognitive and emotional deficits associated. This process begins with a detailed clinical interview to explore consumption history, current symptoms, and the impact on the patient’s daily life. Various neuropsychological tests are then administered to evaluate key cognitive functions.
Among the most commonly used tests are the Stroop Test, which measures inhibitory control and attention, and the Test of Verbal Learning Spain-Complutense (TVLSC), which evaluates verbal memory and learning. These tests help neuropsychologists obtain a detailed cognitive profile of the patient, identifying areas affected by alcohol consumption.
Another commonly used set of tests is the Halstead-Reitan Neuropsychological Battery, which evaluates cognitive flexibility, processing speed, and abstract reasoning. Additionally, the Trail Making Test, which assesses attention and executive function, and the Wisconsin Card Sorting Test (WCST), which measures the ability to adapt to new patterns or rules, can be employed.
Neuropsychological assessment is essential not only for identifying deficits but also for guiding personalized interventions that help patients rehabilitate their affected cognitive functions.
Neuropsychological Intervention
Neuropsychological intervention in patients with alcohol consumption focuses on rehabilitating impaired cognitive functions through cognitive rehabilitation and cognitive-behavioral therapy (CBT) strategies. Cognitive rehabilitation includes exercises designed to improve memory, attention, and executive functions.
In this regard, NeuronUP is particularly useful for addressing deficits in areas such as memory, attention, and executive functions, which are often severely affected by chronic consumption of this substance. By providing personalized exercises tailored to each patient’s individual needs, this tool allows systematic and progressive work on cognitive recovery, facilitating improvements in specific skills such as planning, decision-making, and impulse control.
Additionally, NeuronUP enables neuropsychologists to closely monitor the patient’s progress over time. This is essential in treating alcoholism, as the neuropsychological effects of alcohol can vary significantly from patient to patient. The platform offers constant feedback, allowing for the adjustment and adaptation of exercises based on the evolution of the patient’s cognitive abilities. In this way, NeuronUP not only optimizes neuropsychological intervention but also increases the chances of long-term success, improving the patient’s quality of life and functional reintegration into their social and work environments.
On the other hand, cognitive-behavioral therapy is a complementary tool that helps patients identify thought and behavior patterns related to alcohol consumption. CBT teaches strategies to control cravings and manage stress, facilitating abstinence and improving quality of life (Cohen et al., 2022).
Another important component of the intervention is psychoeducation, where the patient is educated about the effects of alcohol on their brain and how to manage triggers that may lead to consumption. Family intervention can also play a key role by providing support to the patient and improving family dynamics through therapy. Having the support of the patient’s loved ones is crucial, especially in cases of chronic abuse.
To illustrate everything discussed about the neuropsychology of alcohol, a clinical case example is presented below.
Clinical Case
A 45-year-old male comes to the consultation with a history of chronic alcohol consumption since the age of 25. Despite having attempted to reduce his consumption on several occasions, he has found himself in a situation of severe dependence over the past five years, experiencing episodes of heavy drinking, mainly during stressful situations. What pushes him to seek help the most is his perception of some difficulties in his day-to-day life. He reports difficulties remembering where he has placed certain objects, as well as intense irritability when things do not go as he wants. He also describes other situations that cause him clinically significant distress in his daily life.
During neuropsychological evaluation, significant deficits were identified in short-term memory and executive functions, such as planning and decision-making. The patient showed difficulties remembering recent events and had problems organizing his daily life and fulfilling work responsibilities. Emotionally, he alternated between states of anxiety and depression, which exacerbated his alcohol consumption as a coping mechanism.
Tests such as the Stroop Test revealed reduced inhibitory control, and the TVLSC confirmed problems in verbal memory consolidation. In the Trail Making Test, his processing speed was notably decreased.
The intervention plan included a cognitive rehabilitation program with exercises to improve memory and executive function. All exercises were conducted through the NeuronUP platform in several weekly sessions, some of which, as the treatment progressed, were performed from the patient’s home. The patient’s progress was later verified through the graphs displayed by NeuronUP on its platform.
At the same time, cognitive-behavioral therapy was implemented to help him manage stress and reduce the desire for consumption, complemented by psychoeducation sessions on the effects of alcohol on his brain and relapse prevention strategies (Harada et al., 2016). A pharmacological treatment was also established by Psychiatry to support maintaining alcohol abstinence.
Future Perspectives and Research
Future perspectives in alcohol neuropsychology focus on gaining a deeper understanding of the neurobiological mechanisms underlying the effects of chronic alcohol consumption on the brain. Current research is exploring how alcohol-induced brain damage, such as cortical atrophy and disruptions in neural circuits, affects critical cognitive functions like memory and executive function (Egervari et al., 2021). Advances in neuroimaging and neuromodulation techniques, such as transcranial magnetic stimulation (TMS), are expected to provide a more precise understanding of alcohol’s impact on specific brain structures and open new treatment avenues that are more personalized and based on neuroplasticity (Diana et al., 2019; Fein and Cardenas, 2015), facilitating more effective cognitive rehabilitation.
On the other hand, future research in alcohol neuropsychology is also moving toward multidisciplinary approaches that combine neuropsychological treatments with more advanced pharmacological therapies. For example, drugs are being developed that could protect the brain from alcohol’s neurotoxic effects or even reverse some of the damage (Witkiewitz et al., 2019). At the same time, combined digital therapeutic approaches are being studied, such as mobile applications that integrate behavioral and neuropsychological interventions (Staiger et al., 2020).
These innovations have the potential to improve access to high-quality treatments, offering continuous rehabilitation outside traditional clinical settings and increasing the chances of sustained recovery.
References
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