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Substance Use and Cognitive Function

Psychoactive substance use and cognitive functions: how alcohol and drugs reprogram the brain, what true recovery means, and why professional help is essential

From a festive glass of champagne to prescription painkillers after surgery – psychoactive substances have permeated modern life. However, repeated or risky use changes brain chemistry, reduces gray matter in critical regions, and slows our mental abilities – memory, attention, problem-solving skills. Understanding how alcohol and drugs change the brain – and how evidence-based treatment can restore significant damage – enables safer choices and earlier help-seeking.

  • Part 1: The neurobiology of substance-induced cognitive changes
  • Part 2: The effects of alcohol on neurotransmitters and brain health
  • Part 3: Illegal and prescription drugs – stimulants, depressants, cannabis
  • Part 4: Addiction and effective recovery resources
  • Part 5: Legal and health conditions – why professional care is essential

Contents

  1. Why substance use affects the mind
  2. Neurobiology: neurotransmitters, circuits, and plasticity
  3. Alcohol: from the GABA spike to hippocampal shrinkage
  4. Drugs and the brain: stimulants, depressants, cannabis
  5. Structural and functional brain changes
  6. Addiction and recovery: effective pathways
  7. Legal and health aspects
  8. Personal recovery plan
  9. Conclusion
  10. "Used sources"

1. Why substance use affects the mind

Almost all psychoactive substances affect the brain's reward system – especially the mesolimbic dopamine circuit. Repeated use creates neuroadaptations (tolerance, sensitization) that reprogram synapses and alter neurotransmitter release, making simple tasks like recalling names or maintaining attention more difficult.[1]

2. Neurobiology: neurotransmitters, circuits, and plasticity

  • Dopamine: The basis of reward prediction. Stimulants (cocaine, amphetamine) cause massive dopamine release and "hijack" motivation circuits.[5]
  • GABA and glutamate: Alcohol enhances GABA inhibition and suppresses glutamate signaling, slowing reaction time but initially producing a calming effect.[1], [3]
  • Serotonin: Affected by MDMA, psychedelics, and some antidepressants; its imbalance impacts mood and executive functions.
  • Endogenous opioids: Drugs from the opioid group bind to μ receptors, relieve pain, and cause dopamine release; chronic use reduces the sensitivity of these receptors, leading to withdrawal symptoms.

Over time, these neurotransmitter changes alter structural plasticity: dendritic reduction in the prefrontal cortex, decreased hippocampal neurogenesis, loss of white matter – all associated with noticeable cognitive impairments.[4], [6]

3. Alcohol: from the GABA spike to hippocampal shrinkage

3.1 Acute effects

Alcohol enhances GABA (inhibitory) and suppresses glutamate (excitatory) signaling, causing relaxation, poor decision-making, and slowed reaction. fMRI shows reduced prefrontal cortex activation after just minutes, explaining poor self-control.[3]

3.2 Chronic effects

  • Neurotransmitters: Continuous use decreases GABAA receptor levels and increases NMDA glutamate receptor activity, raising seizure risk during withdrawal.[3]
  • Brain structure: Long-term heavy drinkers have smaller hippocampal and cerebellar volumes and weaker white matter, associated with poorer memory, coordination, and information processing.[1], [2]
  • Cognitive functions: Meta-analyses link alcohol use disorder (AUD) with poor verbal memory, executive control, and visuospatial reasoning – these impairments partially improve after abstinence but may persist if use began in adolescence.[1]

4. Drugs and the brain: stimulants, depressants, cannabis

4.1 Stimulants: methamphetamine and cocaine

Methamphetamine. Chronic use causes oxidative stress and excitotoxicity, destroys dopamine terminals in the striatum and prefrontal cortex; imaging studies show volume reduction and microglial activation, associated with long-term attention and executive function impairments.[4]

Cocaine. Increases dopamine levels in synapses by blocking reuptake; over time, lower frontal cortex activation and poor working memory appear. Neuroimaging studies link long-term use with reduced parietal and prefrontal cortex activity during tasks.[5]

4.2 Depressants: opioids and benzodiazepines

Long-term opioid use reduces gray matter density in reward and pain centers, decreasing natural sensitivity to pleasure. Benzodiazepines, which enhance GABA activity, are associated with higher dementia risk in older adults and slower thinking in younger people.[7]

4.3 Cannabis and psychedelics

THC acts on CB1 receptors, disrupt gamma waves important for working memory. Large-scale studies have found noticeable, though often temporary, impairments in attention and verbal memory among heavy or early users; some effects disappear after cessation.[6]

Classical psychedelics (psilocybin, LSD) temporarily enhance 5‑HT2A receptors, causing perceptual changes. Initially, data show minor cognitive damage when used rarely and under supervision, but data are still lacking.

5. Structural and functional brain changes

Substance Visual findings Most affected cognitive functions
Alcohol Smaller hippocampal volume; cerebellar atrophy Memory, gait, information processing
Methamphetamine Loss of dopamine terminals in striatum; PFC thinning Executive functions, attention
Cocaine Frontal cortex reduction; white matter damage Working memory, impulse control
Benzodiazepines Higher risk of β-amyloid accumulation (preclinical data); reduced cortical thickness Processing speed, prospective memory
Cannabis Functional network changes (DMN, fronto-parietal) Sustained attention, verbal memory

Good news: many of these disorders improve after stopping use and undergoing rehabilitation – the brain can recover.[1], [4], [6]

6. Addiction and recovery: effective pathways

6.1 Addiction – a chronic brain disease

NIH and PSO agree: addiction is a relapsing brain disease characterized by compulsive use despite harm. Stigma delays help; recognizing biological bases promotes treatment.[1], [2]

6.2 Main support measures

  • Medication-assisted treatment (MAT): Methadone, buprenorphine, and naltrexone reduce opioid overdose mortality by ~50% and improve treatment retention.[9]
  • Cognitive-behavioral therapy and motivational interviewing: Strengthen skills, reduce cravings, increase motivation.
  • 12-step and mutual aid groups: Alcoholics Anonymous (AA), Narcotics Anonymous (NA), SMART Recovery provide community and accountability.
  • Harm reduction measures: Naloxone distribution, safe consumption sites, fentanyl test strips reduce the risk of fatal overdoses.[15]

6.3 Where to seek help?

  • USA: SAMHSA national line 1‑800‑662‑HELP (24/7, confidential).[8]
  • UK: NHS alcohol support pages, local addiction services, AA (0800‧9177‧650).[10]
  • Worldwide: WHO Mental Health Atlas, many countries already have 988-type helplines.[11]
  • For older adults: "Over 50s Alcohol Line" (UK) 0808
801
0750.[14]

Legal status varies. Possession or use of some substances may result in fines, imprisonment, or prosecution. Even "legal" alcohol has age and driving limits. The UK advertising authority warned about deceptive helplines that redirect callers to expensive private clinics – always verify the reliability of help sources.

Medical supervision is essential. Sudden alcohol or benzodiazepine withdrawal can be life-threatening; opioid detox without support leads to high relapse and overdose risk. Always consult licensed specialists before changing use or treatment.

8. Personal recovery plan

  1. Recognize the problem: Use validated tests (AUDIT-C for alcohol, DAST-10 for drugs) and honest self-reflection.
  2. Seek medical evaluation: A family doctor or addiction specialist will assess risk and comorbidities.
  3. Choose evidence-based treatment: If needed, combine MAT, therapy, self-help.
  4. Create a relapse prevention plan: Identify triggers, prepare a list of measures, have naloxone (if opioids are used).
  5. Monitor cognitive function recovery: Perform neuropsychological tests or use apps every 6 months, track memory and attention.
  6. Strengthen the foundations of life: Sleep hygiene, physical activity, balanced nutrition, and schedule accelerate brain recovery.
  7. Be socially active: Meet with a support group at least once a week or help others in recovery.

"9. Conclusion"

"Alcohol and drugs alter neurotransmitters in ways that weaken memory, attention, and decision-making – but the story doesn't end there. The same brain that adapts to substances can adapt to abstinence or safer use with professional help. If you or your loved ones suffer from addiction – help is not only recommended but vital. Do not delay, seek reliable help and take advantage of the extraordinary brain plasticity."

"Warning: The True Horror Side of Alcohol"

"Alcohol, being a strong depressant, terribly affects the structures of the human brain, turning them powerless and uncontrollable. By suppressing GABA and glutamate activity, alcohol not only relieves anxiety and causes a deep sedative effect but also destroys cognitive abilities, pushing into irreversible darkness. The increase of dopamine in the reward circuit creates a spiral of addiction, forcing a person to constantly seek short-term pleasure."

"When the effect of alcohol reaches its peak, the human brain stops functioning: rationality and thinking disappear, and body movements become automatic, involuntary reflexes. The brain's control center weakens so much that a person loses self-control and intellectual activity. Thus, alcohol turns people into almost zombies, wandering hopelessly for a new dose of dopamine, no longer caring about their own or others' health or even life."

"Lost chemical control turns people into instinctive consumers who no longer care about mind or conscience – only the constant need. Such people destroy their own and others' lives, spreading the contagion of chaos and degradation. Alcohol, as a skillfully crafted chemical tool, systematically undermines the foundations of society, leaving only exhausted vessels of addiction."

"Mass alcohol consumption eventually leads to irreversible social, economic, and psychological degradation, often ending in the collapse of nations and the extinction of humanity. Such substance abuse is the closest source of the world's ruin, capable of destroying societies and ensuring human slavery and exhaustion. Therefore, it is necessary to recognize the horror of alcohol as soon as possible and take effective measures to stop its use to preserve human consciousness, health, and well-being."

"This is not a game of pleasure or self-destruction – this is the current reality: genetic damage to future generations, irreversible mental and physical decline of children, deterioration of health, permanent loss of abilities, degradation of children, and the extinction of humanity forever."

"Used sources"

  1. National Institute on Alcohol Abuse & Alcoholism. "Neuroscience: The Brain in Addiction and Recovery"
  2. World Health Organization. "Alcohol – Health Topic Overview"
  3. NIAAA. "Alcohol and the Brain: An Overview"
  4. Tandfonline Review. „Methamphetamine and the Brain: Emerging Molecular Targets“
  5. Moreno‑López et al. „Cognitive Dysfunction in Cocaine Use Disorder“
  6. JAMA Network Open. „Brain Function Outcomes of Recent and Lifetime Cannabis Use“
  7. Meta‑analysis. „Benzodiazepine Use and Dementia Risk“
  8. SAMHSA. „National Helpline 1‑800‑662‑HELP“
  9. US Nat. Library of Medicine. „Effectiveness of Medication‑Assisted Treatment for Opioid Use“
  10. NHS. „Alcohol Support“
  11. SAMHSA. „988 Suicide & Crisis Lifeline“
  12. The Guardian. „Addiction Helplines Paid Secret Commissions“
  13. CT News. „Methadone Works to Save Lives“
  14. With You. „Over‑50s Alcohol Helpline“
  15. [Papildykite savo žalos mažinimo šaltiniu]

Disclaimer: this information is provided for educational purposes only and is not a substitute for professional medical, legal, or mental health advice. Never start or stop treatment, detox, or substance use behavior without consulting a doctor. In case of emergency – seek help by calling emergency services.

 

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