Alcohol is one of the most popular drugs in the world, with millions enjoying the buzz produced by a cocktail of pharmacology and social ingredients.
The 2024 National Survey on Drug Use and Health found that almost 80 percent of Americans older than 12 years of age reported that they had had at least some alcohol at some point in their lives.
But there is “no free ride in the brain,” said George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health.
Research shows that over time, alcohol can change the brain, leading to decreases in gray matter volume. And even relatively low levels of alcohol may worsen feelings of anxiety and depression, disrupt sleep, and, over time, increase dementia risk, in addition to upping other health problems, such as breast and colorectal cancer risk.
But there is now increasing evidence that the brain can recover to an extent when drinking is reduced or stopped.
“The remarkable thing about the brain is that it is an incredibly plastic organ, and that we see neuroplasticity in the development of addiction and neuroplasticity in the ability to achieve recovery,” said James MacKillop, a clinical psychologist and the Peter Boris chair in addiction research at McMaster University. “And that’s a really important and powerful story that I think isn’t always communicated as widely as it should be.”
Here’s what alcohol does to the brain, its health effects, and what happens when we reduce and abstain.
What alcohol does to the brain
Alcohol causes a “stew of pharmacological effects” that can be first stimulating and then sedating, MacKillop said.
With the first drinks, alcohol can produce “a euphoric intoxication,” Koob said. Alcohol causes the release of endorphins, which are our brain’s natural opioid molecules, which in turn activate the dopamine neurons in our reward circuitry.
At the same time, alcohol cranks up neurons that inhibit activity while dampening neurons that activate — which, in the short term, reduces stress and anxiety. But “when the alcohol wears off, those stress systems come back with a vengeance,” Koob said.
The “brain adapts to the persistent presence of alcohol,” leading to changes in brain chemistry and structure, said MacKillop, who wrote a 2022 review on hazardous drinking and alcohol use disorders.
As people consume more alcohol over time, they need more of it to get the same level of pleasure as the reward systems become less sensitive to the alcohol. And worse, the stress systems in our brain, including the amygdala, get recruited and become persistently activated, and people experience a chronic negative emotional state, MacKillop said.
As a result, “people stop drinking as much to feel good and start drinking more to feel less bad,” he said.
With repeated consumption, temporary changes go from being short-term to long-term to potentially permanent.
Studies show that people with alcohol use disorder, the preferred clinical term for alcoholism, have reduced gray matter volume in frontal cortical regions important for perception, emotion and executive functioning. The most severe cases of the disorder, with years or decades of heavy drinking, can cause alcohol-related dementia and an inability to form new memories.
With prolonged excessive drinking, “you can actually destroy neurons in the frontal cortex,” which is important for higher-order executive functioning, including inhibiting cravings for alcohol, said Koob, who wrote a 2024 review about treatments for alcohol use disorder.
Even relatively low levels of alcohol consumption had an effect on the brain. One 2022 study of over 25,000 participants found smaller total gray matter volumes for people who had seven or more drinks a week compared with those who consumed fewer drinks. A 2024 systematic review of 27 neuroimaging studies found that low-to-moderate drinking was linked to smaller brain volume and cortical thickness, though to a lesser extent compared with heavy drinking.
“A fair rule of thumb is that there’s a dose-dependent relationship between the amount of drinking and the amount of brain change,” MacKillop said.
How reducing alcohol changes the brain
The good news is “there is increasing evidence that there is restoration of brain function and improvements in each of these domains too,” said MacKillop, whose lab is researching the neuroscience of recovery, a relatively new area of the field.
Just as alcohol can change the brain, reducing or abstaining from it can as well.
A 2024 systematic review of 16 studies found that people with alcohol use disorder who abstained from alcohol experienced a recovery in many of their cognitive functions, including attention, memory and executive function, generally after 6 to 12 months.
In people with alcohol use disorder who stopped drinking, there was a general recovery in frontal brain regions with increases in gray matter, according to a 2022 review of neuroimaging studies. Greater changes occurred relatively early in abstinence, within the first month.
Even reducing alcohol consumption to low levels without full abstinence increased cortical brain volume, research shows.
Whether there can be full recovery from alcohol use disorder is not clear, but there is also evidence that the brain may “develop compensatory strategies and functioning,” MacKillop said. The same brain areas that become dysregulated or dysfunctional because of alcohol appear to be where there is recovery.
“That’s the good news: The brain is changed by alcohol, but it also can recover,” MacKillop said.
There is less research on how the brain recovers from light drinking since the harms are not as great, if drinking is done responsibly.
But people who participate in alcohol abstinence or reduction challenges, such as Dry January or Sober October, report that they feel better after reducing their alcohol consumption. Researchers found that participants reported increases in their overall well-being, including losing weight, sleeping better, saving money, and having heightened energy and concentration.
How to self-assess and manage alcohol consumption
Understanding the brain and health consequences of drinking alcohol doesn’t necessarily mean cutting it out completely — both Koob and MacKillop still enjoy a drink on occasion.
“There are lots of reasons to enjoy the pleasure from drinking alcohol,” including as a social lubricant or a complement to a meal, MacKillop said. “It’s not a vitamin, but that doesn’t mean that people are crazy for drinking.”
But experts say to check in with yourself on how alcohol is affecting your life — is it getting in the way of school, work, relationships or your health?
It can also be valuable to step further back and think about your values and how your drinking relates to them, MacKillop said. “Is it highly compatible with your highest-held values, or is drinking getting in the way of realizing the person that you want to be?”
If you are wondering about your drinking, “that’s actually a sign that it may be that you’re drinking at a problematic level,” and you should speak with a health care provider, MacKillop said.
The good news is that there are many evidence-based strategies for managing alcohol use across the spectrum of use, including psychological therapies and medications.
Signing up for Dry January or Sober October, or other manifestations of the “sober curious” movement, can be a way to reduce alcohol consumption and reap health benefits even beyond the challenge month, studies show.
Alcohol reduction apps like Sunnyside or Reframe can help send daily reminders and connect you with a larger community of people trying to cut back on drinking.
The National Institute on Alcohol Abuse and Alcoholism has additional resources on its Rethinking Drinking website, and its Alcohol Treatment Navigator can help people find treatment facilities near them.
“If you stop drinking and you feel better, what I always say is listen to your body, because it’s trying to tell you something,” Koob said.
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