What happens if u drink with a concussion

doi: 10.1017/S1355617716000692. Epub 2016 Aug 18.

Affiliations

• 1 1Division of Physical Medicine & Rehabilitation,University of British Columbia,Vancouver,Canada.
• 2 5British Columbia Neuropsychiatry Program,University of British Columbia,Vancouver,Canada.
• 3 3Department of Physical Medicine and Rehabilitation,Harvard Medical School,Boston,Massachusetts.
• 4 8Department of Emergency Medicine,University of British Columbia,Vancouver,Canada.
• 5 9Department of Radiology,University of British Columbia,Vancouver,Canada.
• 6 6Department of Psychiatry,University of British Columbia,Vancouver,Canada.

Alcohol and post-concussion syndrome: to drink or not to drink?">

Alcohol and post-concussion syndrome form a combination that many of us aren’t sure of. You may wonder about the influence that alcohol has on your recovery path. 

If you have already tried to drink alcohol during your recovery, you may have experienced a spike in symptoms and you are now wondering what that really was.

The combination of alcohol with post-concussion syndrome hasn’t been researched as much as we would want, but there are enough publications to shed light on the issue from several angles. 

In this post, I’ll help you understand the effect on post-concussion recovery, so that you can make your own decision on whether you want to take the occasional sip or not.

Table of contents:
How a concussion works
Effects of alcohol on the brain
Alcohol and post-concussion syndrome
Can you drink with a concussion?

How a concussion works

Let’s start at the beginning. A concussion happens when your brain moves around inside your skull. There are at least 3 main effects that arise after sustaining a concussion.

Diffuse axonal injury

Moving around, your brain is like jelly in a jar. At the moment of sustaining a concussion, our brains get shaken in such a way that the underlying tissue is bruised against your skull and possibly even torn apart at places. This is called diffuse axonal injury. 

As you can imagine, it’s harder for your brain to function the way it did before if the neural networks are broken. Let’s make that somewhat easier to imagine. 

Suppose you were driving on a road from A to B. Normally, you know the route by heart and driving is as easy as pie. Suddenly, roads are washed away and damaged. You have to use all your brain power to improvise and try to get to point B. Trying as hard as you can, it may not even be possible to reach B at this time. 

This is diffuse axonal injury on the road. Messages can’t travel and therefore, it’s harder or even temporarily impossible for you to execute a certain task (e.g. reach point B). 

Neuroinflammation

Another thing we know happens after sustaining a concussion, is that inflammation arises from inside your brain. This is because our brains activate immune cells right after injury and these immune cells release those inflammatory molecules. 

This process is called neuroinflammation and we know it is one of the causes of the cognitive and behavioral troubles many of us have after a concussion. (Cognitive and behavioral changes basically just mean that you have trouble functioning like you used to do.)

Neurovascular coupling (NVC)

The third thing that happens after a concussion is the disregulation of neurovascular coupling (NVC). Neurovascular coupling is just a difficult set of words for the mechanism between brain signals and the blood flow in your brain. 

After sustaining a concussion, blood-oxygen level dependent (BOLD) signals are distorted. This means that there are local changes in brain blood flow and blood oxygenation. 

You can imagine the avalanche of problems you may experience when your brain doesn’t get the blood and oxygen it needs at specific locations and times. 

Examples of the post-concussion symptoms this can provoke are: dizziness, headaches, fatigue, irritability, visual problems, memory problems, sleep-wake cycle disturbances, lack of concentration, confusion, depression, and anxiety. 

Effects of alcohol on the brain

To understand the effect of alcohol on post-concussion syndrome recovery, let’s first have a look at some of the most important effects of alcohol on a healthy brain. 

(Brain) blood flow and inhibitory control

Almost all of us grow up with the idea that alcoholic drinks are an accepted way to socialize and even de-stress after a hard day’s work. And alcohol certainly has those effects because of its interaction with the brain.

It is a vasodilator: it relaxes blood vessels in your extremities, increasing that relaxed and warm sensation in your body. Also, it impairs inhibitory control, which is why we feel more “free” in social interactions. These are effects that a lot of us experience as pleasant and relaxing.

Alcohol is a direct neurotoxin

Aside from these initial effects of alcohol on the brain (and from there, on our bodies and behavior), it has injurious effects on healthy brains in higher quantities. 

Alcohol (or “ethanol” in medical science) has many drastic effects on cognition and is a direct neurotoxin that can result in lasting dementia. It doesn’t do that right away, but if it causes this in the long term after a lot of use, you can imagine it does do harm in the short term as well.

Slow-down of neurovascular coupling

One of the ways to analyze how brain functions change after the use of alcohol, is with a special fMRI scanning method. It’s called Blood-oxygen-level-dependent imaging. Pfew, that’s a mouthful!

Let’s make that easier to understand. Do you remember the neurovascular coupling we discussed above? It’s responsible for decreased blood flow and oxygen levels in your brain after sustaining a concussion.

The BOLD fMRI scan shows a slow-down of neurovascular coupling after alcohol. This means that the signals of your brain telling where blood flow should go and how much oxygen is needed, get weak or even are lost in translation. 

This has direct cognitive, behavioral and physical effects like blurred vision, slurred speech, impaired motion, and brain fog.

Alcohol and neuroinflammation

Another relevant effect that long-term alcohol use has on healthy brains, is that it causes neuroinflammation and neuronal damage. This, again, is a similar reaction to the damage and inflammation following a concussion, as we discussed above.

Let’s make 1 thing clear. This chapter is here to analyze the known effects of alcohol on a concussed brain. As you probably already expect, the gleaming positive effects are hard to find. 

We will list an honest range of scientifically proven effects that are – without intention – all negative. This isn’t judgment time yet nor is it the whole verdict. We will discuss all considerations in the final chapter, so that you can make your own choice. And it doesn’t have to be all or nothing!

Let’s discuss the known effects alcohol has on people with a concussion.

Neurovascular coupling decreases even more

As you discovered earlier in this article, your neurovascular coupling has probably slowed down since your brain injury. This means that the blood-oxygen-level-dependent signal doesn’t come through that well anymore, which causes your brain to have too little blood flow and oxygen in certain regions at certain times. 

You can imagine that this explains your problems with functioning like you normally did. If you drink alcohol, we just learned, this also reduces neurovascular coupling. Thus, you worsen the blood flow and oxygen communication even more. Drinking alcohol directly worsens your post-concussion symptoms.

Neuroinflammation and neural damage increase

We learned in the chapters above that a concussion is typically followed by diffuse axonal injury as well as neuroinflammation. Similar neural damage as well as neuroinflammation are caused by drinking alcoholic beverages. 

Therefore, there is no way around the fact that drinking alcohol post-concussion increases or adds to neural damage as well as inflammation in your brain. 

Risk of sustaining another concussion

When we have a concussion, we are at significant risk of sustaining another concussion. Understanding why is easy if you imagine the trouble you have probably had focusing while moving in traffic, or the small motoric accidents you experienced. 

Alcohol impairs your balance and coordination skills, thereby increasing the risk of sustaining another concussion even more.

Quality of sleep decreases

While recovering from post-concussion syndrome, a stable sleep cycle and the quality of sleep are of the utmost importance. While you sleep, your brain is able to do work innumerable repair processes. Another benefit of sleep is that you don’t eat for many hours on end, so that your cells have a chance to regenerate. 

When you drink alcohol, it affects your sleep negatively. The amount of hours you sleep as well as the quality of sleep are decreased. Another negative side effect for brain injury recovery is that it disturbs the sleep cycle. All in all, alcohol hinders post-concussion syndrome recovery in this way, too.

Post-concussion depression intensifies

Depression is a side-effect a lot of post-concussion syndrome patients experience. This is something that I experienced as well. If you feel depressed, please know that you’re definitely not the only one and you’re not doing anything wrong. Read our depression guide on everything you want to know and that you can do.

Alcohol is classified as a Central Nervous System Depressant. This means that it slows down brain functioning and neural activity. If you already experience depression or depressive episodes, this is one of the most important reasons not to touch alcohol. 

This is harder to do, though, because when we feel depressed, alcohol can numb our feelings and this may make you feel better at first. In the long run, however, you increase the probability that you spiral down in severe post-concussion syndrome depression. 

Can you drink with a concussion?

So, can you drink with a concussion? This question has 2 answers. The first answer is the direct answer: of course you can. It is your decision. 

I drank alcohol during post-concussion syndrome

Did I drink during my post-concussion syndrome recovery? I did. I drank way less often than I used to, because I felt it intensified my symptoms. But in the first 3 years, I did drink the occasional glass of red wine or half-a-liter Erdinger beer. 

And let’s shine some perspective on this: it didn’t kill me. So I could and I did. Sometimes I (ab)used alcohol to relax myself. At other times I drank it with someone else to enjoy the taste together. I didn’t know better. 

I didn’t know better

Then I discovered everything I just shared with you, and I practically stopped right then and there. You can count the sips I had during the last 4 years of my post-concussion recovery on 2 hands. 

During all my research and observation of patients’ cases, I discovered that the keys to my recovery were in my hands. I could work for my healing or I could work against it. Clearly, alcohol was working against it. 

Mental reframing

I wanted my life back and drinking alcohol wasn’t helping. So everytime I wanted to take a drink, I told myself that it was my fault that I would recover later. Maybe that sounds harsh to you and I’m not telling you to say this to yourself. 

It’s just what I needed to tell myself to reframe what alcohol meant in my mind. And whatever you need to tell yourself: the more you reframe, the easier it gets to stay away.

The 90-10 rule

The thing I applied during concussion recovery was the 90-10 rule. I don’t know if these numbers are a thing, but they worked for me. I decided I would train myself to do everything that was helping and withhold any behavior that was working against my recovery for 90% (helping) and 10% (destructive) of the time. 

It’s nothing you can really measure, but you know in your gut when you’re not doing it. In the end, it became the 99-1 rule for me, because I find behavioral training the hardest when I’m still allowed to do tempting things a little bit of the time. 

Give yourself grace

But the point is: leave a little room for flexibility for living. In the end, you’ll get more life back because of withholding destructive behavior. But sometimes, you need that breathing room to gather strength and move on. You’re human. 

Give yourself grace for the incredibly difficult journey that you’re on – but try to keep your dreams alive and thus your standards high. Refraining from or reducing the intake of alcoholic drinks will give room to recovery processes and will eliminate or lessen the chances of setbacks and further injury to your brain.

3 things to speed up your recovery

Do you want to take more steps that will help you speed up your recovery right now? I’ve created the free guide “3 Ways To Speed Up Your Concussion Recovery Right Now.” Feel free to leave your comment below this post, so I can read what you think!

Can you drink if you have a concussion?

How long after a concussion can I drink?