Binge drinking is a growing public health crisis – neurobiologist explains how alcohol use disorder research has changed

With the new Amy Winehouse biopic “Back to Black” in US theaters as of May 17, 2024, the late singer’s relationship with alcohol and drugs is once again under scrutiny. In July 2011, Winehouse was found dead in her north London flat from “accidental death” at the age of 27. It is the official British term for accidental death by voluntary risk.

Her blood alcohol concentration was 0.416%, more than five times the US legal drunkenness limit – which led to her cause of death being later adjusted to include “alcohol toxicity” after a second inquest coroner.

Almost 13 years later, alcohol consumption and binge drinking has become a major public health crisis, not only in the UK but also in the US.

About 1 in 5 US adults report binge drinking at least once a week, with an average of seven drinks per binge episode. This is far more than the amount of alcohol considered to produce legal intoxication, which is commonly defined as a blood alcohol concentration above 0.08% – on average, four drinks in two hours for women, five drinks in two hours the clock for men.

Among women, “heavy drinking” days increased 41% during the COVID-19 pandemic compared to pre-pandemic levels, and adult women in their 30s and 40s are rapidly increasing their rates of binge drinking, with no evidence of these trends are slowing down. . Despite efforts to understand the overall biology of substance use disorders, scientists’ and physicians’ understanding of the relationship between women’s health and binge drinking has lagged.

I am a neurobiologist focused on understanding the chemicals and brain regions that underlie alcohol addiction. I study how neuropeptides – unique signaling molecules in the prefrontal cortex, one of the key brain regions in decision-making, risk-taking and reward – are changed by repeated exposure to alcohol binges in animal models.

My lab focuses on understanding how things like alcohol change these brain systems before addiction is diagnosable, so we can better inform our prevention and treatment efforts.

Full color cross-sectional side view of a child's brain with labels.

The biology of addiction

Although problematic alcohol consumption has likely existed as long as alcohol existed, the American Association of Addiction Medicine did not recognize substance addiction as a brain disorder until 2011 – the same year as Winehouse’s death. A diagnosis of alcohol use disorder is now used over outdated terms such as labeling a person as an alcoholic or having alcoholism.

Researchers and clinicians have made great strides in understanding how and why drugs – including alcohol, drugs – change the brain. Often, people consume a drug like alcohol because of the positive rewarding feelings it creates, such as enjoying drinks with friends or celebrating a milestone with a loved one. But what begins as moderate alcohol consumption can quickly degenerate into cycles of excessive alcohol consumption and subsequent drug withdrawal.

While drinking all forms of alcohol comes with health risks, binge drinking appears to be particularly dangerous because of the effects of repeatedly cycling between high and withdrawal states on the brain. For example, for some people, the use of alcohol can lead to “hangxiety”, the feeling of anxiety that can accompany a hangover.

Repeated episodes of drinking and intoxication, as well as withdrawal, can lead to relapse and re-use of alcohol. In other words, alcohol use shifts from being gratifying to trying to prevent feeling bad.

It makes sense. With repeated alcohol use over time, the areas of the brain involved in alcohol can shift from those traditionally associated with drug use and reward or pleasure to brain regions normally associated with stress and anxiety .

All these stages of drinking, from enjoying alcohol to withdrawal to craving cycles, constantly change the brain and its communication channels. Alcohol can affect several dozen neurotransmitters and receptors, complicating understanding of its mechanism of action in the brain.

Work in my lab focuses on understanding how alcohol consumption changes the way neurons within the prefrontal cortex communicate with each other. Neurons are the brain’s main communicator, sending electrical and chemical signals within the brain and to the rest of your body.

What we have found in animal models of binge drinking is that certain subtypes of neurons lose the ability to talk to each other appropriately. In some cases, binge drinking can permanently reshape the brain. Even after a long period of abstinence, conversations between the neurons do not return to normal.

These changes in the brain can appear even before there are significant changes in behavior. This may mean that the neurobiological basis of addiction may be well established before a person or their loved ones suspect that they have an alcohol problem.

Researchers like us do not yet fully understand why some people may be more susceptible to this change, but it is likely to be related to genetic and biological factors, as well as the patterns and circumstances under which alcohol is consumed.

Image of hormone receptors in the prefrontal cortex of the brain, lit up in different colors.Image of hormone receptors in the prefrontal cortex of the brain, lit up in different colors.

Work in the author’s laboratory examines how alcohol use can change the way neurons communicate in the brain region of the prefrontal cortex. Estrogen receptors are labeled in purple and receptors for somatostatin, a key regulatory hormone, in blue. Victoria Nudel

Women are forgotten

Although researchers are increasingly understanding the combination of biological factors that underlie addiction, there is one population that has been largely overlooked until now: women.

Women may be more likely than men to experience some of the more devastating health consequences of alcohol use, such as liver issues, cardiovascular disease and cancer. Middle-aged women are now most at risk of binge drinking compared to other populations.

When women consume even moderate levels of alcohol, their risk increases for various cancers, including digestive, breast and pancreatic cancer, among other health problems – and even death. So the declining rates of alcohol use disorder among women necessitates a greater focus on women in research and the search for treatments.

However, women have long been underrepresented in biomedical research.

It was not until 1993 that women were required to be included as research subjects in clinical research funded by the National Institutes of Health. In fact, the NIH did not even want federally funded researchers to consider sex as a biological variable until 2016. Excluding women from biomedical research leaves doctors and researchers with an incomplete understanding of health and disease, with -includes alcohol addiction.

There is also growing evidence that addictive substances can interact with cyclic sex hormones such as estrogen and progesterone. For example, research has shown that when estrogen levels are high, such as before ovulation, alcohol may feel more valuable, which may drive higher levels of binge drinking. Currently, researchers do not know the full extent of the interaction between these natural biological rhythms or other unique biological factors associated with women’s health and susceptibility to alcohol addiction.

Adult woman facing away from the camera, holding a glass of white wine in one hand and pressing her left hand against her neck.Adult woman facing away from the camera, holding a glass of white wine in one hand and pressing her left hand against her neck.

Looking ahead

Researchers and lawmakers recognize the need for more research on women’s health. Large federal investments in women’s health research are a critical step in developing better prevention and treatment options for women.

While women like Amy Winehouse may have had to struggle privately and publicly with substance and alcohol use disorders, the increased focus of research will open up new avenues of treatment for those suffering the effects on addiction to alcohol and other substances as a brain disorder.

For more information on alcohol use disorder, causes, prevention and treatments, visit the National Institute on Alcohol Abuse and Alcoholism.

This article is republished from The Conversation, a non-profit, independent news organization that brings you reliable facts and analysis to help you make sense of our complex world. Written by: Nikki Crowley, Penn State

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Nikki Crowley receives funding from the National Institutes of Health, the Brain and Behavior Research Foundation, and Penn State Huck Life Sciences Institutes endowment funds.

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