Chronic alcohol use affects the brain in a multitude of ways, causing cognitive impairment, short-term memory loss, difficulty concentrating, confusion, and problems with learning and thinking. Long-term drinking, even at a moderate level, can cause damage to the brain, creating symptoms that mimic accelerated aging and present similarly to dementia, complicating proper diagnosis. But unlike progressive dementias like Alzheimer’s disease, alcohol-related brain disorders (ARBD) do not inevitably worsen. If diagnosed and treated properly, there is a chance of recovery.

Early diagnosis of alcohol-related brain damage improves the likelihood that it can be undone, restoring some of the lost brain function. Some studies have shown that when abstinence is begun before age 50, the chances for healing alcohol-related brain damage are even greater.

Physicians may be under-diagnosing alcohol-related brain changes and doing so comes at a cost.  One study found that of about 2,000 brains studied at autopsy, 25 were found to have Wernicke-Korsakoff’s Syndrome (WKS), a severe brain disorder that can occur due to a thiamine deficiency associated with long-term drinking. Only four of those 25 cases had been diagnosed while the patients were living. WKS is associated with advanced alcohol use disorder and not very common, but less severe drinking can also cause damage.

ARBD is not necessarily confined to those with alcohol use disorder, as many people vacillate between healthy and unhealthy alcohol use throughout their lives, and can accumulate damage without forming a dependence. Because sensitivity to alcohol varies greatly from person to person, experts have been hesitant to say exactly how much alcohol use puts one at risk for ARBD. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) guidelines say the risk of serious health issues is low for men who have no more than 14 drinks a week, or 4 on a single day, and women who have no more than 7 drinks a week or 3 on a single day. Some people, though, can experience severe effects at lower levels.

Calling into question recent thinking that moderate drinking (one drink per day for women and two for men) can have cardiovascular and other benefits, some researchers caution that the risks may outweigh the benefits.

“Low levels of alcohol may improve blood flow to the brain—but there’s a tension between that and reduced white matter,” said Iain Lang, a dementia expert and senior lecturer in public health at the University of Exeter Medical School in England, in a recent Wall Street Journal article. “At some levels, there may be a tipping point where the harmful effects outweigh the benefits.”

ARBD is diagnosed when impaired memory, thinking, or reasoning is severe enough to affect daily life, accompanied by a recent history of alcohol misuse spanning multiple years. To differentiate ARBD from progressive dementias, the person should be monitored to see whether their condition stabilizes when drinking is stopped. If so, a progressive dementia can be ruled out and treatment for ARBD (including normalizing vitamin levels, improving diet and exercise patterns) can begin.

Symptoms of ARBD include confusion about time and place, poor concentration, difficulty processing new information, depression, irritability, problems with physical coordination, numbness or pins and needles in extremities, difficulty with planning and problem-solving, difficulty understanding implications of decisions, and disruptive behavior.

Long-term alcohol use affects the brain’s ability to regulate emotion and manage stress and is correlated with disrupted sleep patterns and depression. People with alcohol-related brain damage can experience severe states of anxiety that are similar to post-traumatic stress disorder (PTSD).

Early diagnosis and treatment is key to recovering brain function. Older drinkers show greater alcohol-related cognitive changes and are less likely to regain lost brain function once they stop drinking [study]. However, for those who stop younger and earlier, even short periods of abstinence can resolve some of the cognitive deficits caused by heavy drinking. With sustained abstinence, further recovery can continue for many years.

“It is clear that alcohol-related brain damage, in its various forms, is poorly understood by the public and many professionals, and that it is underdiagnosed and undertreated,” states a report from the London-based charity Alcohol Concern. The report recommends “raising awareness of ARBD and its symptoms, which can often become clouded from stereotypes, as well as controlling the availability of alcohol and training doctors to better recognize ARBD symptoms. “

Studies have shown that for people who aren’t dependent, talking to a doctor about the risks of drinking for five minutes can reduce problem drinking by about 25%.