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Binge Drinking and Blackouts

* Drinkers who experience blackouts typically drink too much and too quickly, which causes their blood alcohol levels to rise very rapidly. College students may be at particular risk for experiencing a blackout, as an alarming number of college students engage in binge drinking. Binge drinking, for a typical adult, is defined as consuming five or more drinks in about 2 hours for men, or four or more drinks for women.

Equal numbers of men and women reported experiencing blackouts, despite the fact that the men drank significantly more often and more heavily than the women. This outcome suggests that regardless of the amount of alcohol consumption, females-a group infrequently studied in the literature on blackouts-are at greater risk than males for experiencing blackouts. A woman's tendency to black out more easily probably results from differences in how men and women metabolize alcohol. Females also may be more susceptible than males to milder forms of alcohol-induced memory impairments, even when men and women consume comparable amounts of alcohol (4).

ARE WOMEN MORE VULNERABLE TO ALCOHOL'S EFFECTS ON THE BRAIN?

Women are more vulnerable than men to many of the medical consequences of alcohol use. For example, alcoholic women develop cirrhosis (5), alcohol-induced damage of the heart muscle (i.e., cardiomyopathy) (6), and nerve damage (i.e., peripheral neuropathy) (7) after fewer years of heavy drinking than do alcoholic men. Studies comparing men and women's sensitivity to alcohol-induced brain damage, however, have not been as conclusive.

Using imaging with computerized tomography, two studies (8,9) compared brain shrinkage, a common indicator of brain damage, in alcoholic men and women and reported that male and female alcoholics both showed significantly greater brain shrinkage than control subjects. Studies also showed that both men and women have similar learning and memory problems as a result of heavy drinking (10). The difference is that alcoholic women reported that they had been drinking excessively for only about half as long as the alcoholic men in these studies. This indicates that women's brains, like their other organs, are more vulnerable to alcohol-induced damage than men's (11).

Yet other studies have not shown such definitive findings. In fact, two reports appearing side by side in the American Journal of Psychiatry contradicted each other on the question of gender-related vulnerability to brain shrinkage in alcoholism (12,13). Clearly, more research is needed on this topic, especially because alcoholic women have received less research attention than alcoholic men despite good evidence that women may be particularly vulnerable to alcohol's effects on many key organ systems.

BRAIN DAMAGE FROM OTHER CAUSES

People who have been drinking large amounts of alcohol for long periods of time run the risk of developing serious and persistent changes in the brain. Damage may be a result of the direct effects of alcohol on the brain or may result indirectly, from a poor general health status or from severe liver disease.

For example, thiamine deficiency is a common occurrence in people with alcoholism and results from poor overall nutrition. Thiamine, also known as vitamin B1, is an essential nutrient required by all tissues, including the brain. Thiamine is found in foods such as meat and poultry; whole grain cereals; nuts; and dried beans, peas, and soybeans. Many foods in the United States commonly are fortified with thiamine, including breads and cereals. As a result, most people consume sufficient amounts of thiamine in their diets. The typical intake for most Americans is 2 mg/day; the Recommended Daily Allowance is 1.2 mg/day for men and 1.1 mg/day for women (14).

Wernicke-Korsakoff Syndrome

Up to 80 percent of alcoholics, however, have a deficiency in thiamine (15), and some of these people will go on to develop serious brain disorders such as Wernicke-Korsakoff syndrome (WKS) (16). WKS is a disease that consists of two separate syndromes, a short-lived and severe condition called Wernicke's encephalopathy and a long-lasting and debilitating condition known as Korsakoff's psychosis.

The symptoms of Wernicke's encephalopathy include mental confusion, paralysis of the nerves that move the eyes (i.e., oculomotor disturbances), and difficulty with muscle coordination. For example, patients with Wernicke's encephalopathy may be too confused to find their way out of a room or may not even be able to walk. Many Wernicke's encephalopathy patients, however, do not exhibit all three of these signs and symptoms, and clinicians working with alcoholics must be aware that this disorder may be present even if the patient shows only one or two of them. In fact, studies performed after death indicate that many cases of thiamine deficiency-related encephalopathy may not be diagnosed in life because not all the "classic" signs and symptoms were present or recognized.

Human Brain

Schematic drawing of the human brain, showing regions vulnerable to alcoholism-related abnormalities.

Approximately 80 to 90 percent of alcoholics with Wernicke's encephalopathy also develop Korsakoff's psychosis, a chronic and debilitating syndrome characterized by persistent learning and memory problems. Patients with Korsakoff's psychosis are forgetful and quickly frustrated and have difficulty with walking and coordination (17). Although these patients have problems remembering old information (i.e., retrograde amnesia), it is their difficulty in "laying down" new information (i.e., anterograde amnesia) that is the most striking. For example, these patients can discuss in detail an event in their lives, but an hour later might not remember ever having the conversation.

Treatment

The cerebellum, an area of the brain responsible for coordinating movement and perhaps even some forms of learning, appears to be particularly sensitive to the effects of thiamine deficiency and is the region most frequently damaged in association with chronic alcohol consumption. Administering thiamine helps to improve brain function, especially in patients in the early stages of WKS. When damage to the brain is more severe, the course of care shifts from treatment to providing support to the patient and his or her family (18). Custodial care may be necessary for the 25 percent of patients who have permanent brain damage and significant loss of cognitive skills (19).

Scientists believe that a genetic variation could be one explanation for why only some alcoholics with thiamine deficiency go on to develop severe conditions such as WKS, but additional studies are necessary to clarify how genetic variants might cause some people to be more vulnerable to WKS than others.

LIVER DISEASE

Most people realize that heavy, long-term drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body. But people may not be aware that prolonged liver dysfunction, such as liver cirrhosis resulting from excessive alcohol consumption, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy (20).

Hepatic encephalopathy can cause changes in sleep patterns, mood, and personality; psychiatric conditions such as anxiety and depression; severe cognitive effects such as shortened attention span; and problems with coordination such as a flapping or shaking of the hands (called asterixis). In the most serious cases, patients may slip into a coma (i.e., hepatic coma), which can be fatal.

New imaging techniques have enabled researchers to study specific brain regions in patients with alcoholic liver disease, giving them a better understanding of how hepatic encephalopathy develops. These studies have confirmed that at least two toxic substances, ammonia and manganese, have a role in the development of hepatic encephalopathy. Alcohol-damaged liver cells allow excess amounts of these harmful byproducts to enter the brain, thus harming brain cells.

Treatment

Physicians typically use the following strategies to prevent or treat the development of hepatic encephalopathy.

Treatment that lowers blood ammonia concentrations, such as administering L-ornithine L-aspartate.

Techniques such as liver-assist devices, or "artificial livers," that clear the patients' blood of harmful toxins. In initial studies, patients using these devices showed lower amounts of ammonia circulating in their blood, and their encephalopathy became less severe (21).

Liver transplantation, an approach that is widely used in alcoholic cirrhotic patients with severe (i.e., end-stage) chronic liver failure. In general, implantation of a new liver results in significant improvements in cognitive function in these patients (22) and lowers their levels of ammonia and manganese (23).

ALCOHOL AND THE DEVELOPING BRAIN

Drinking during pregnancy can lead to a range of physical, learning, and behavioral effects in the developing brain, the most serious of which is a collection of symptoms known as fetal alcohol syndrome (FAS). Children with FAS may have distinct facial features (see illustration). FAS infants also are markedly smaller than average. Their brains may have less volume (i.e., microencephaly). And they may have fewer numbers of brain cells (i.e., neurons) or fewer neurons that are able to function correctly, leading to long-term problems in learning and behavior.

Fetal Alcohol Syndrome

Children with fetal alcohol syndrome (FAS) may have distinct facial features.

Treatment

Scientists are investigating the use of complex motor training and medications to prevent or reverse the alcohol-related brain damage found in people prenatally exposed to alcohol (24). In a study using rats, Klintsova and colleagues (25) used an obstacle course to teach complex motor skills, and this skills training led to a re-organization in the adult rats' brains (i.e., cerebellum), enabling them to overcome the effects of the prenatal alcohol exposure. These findings have important therapeutic implications, suggesting that complex rehabilitative motor training can improve motor performance of children, or even adults, with FAS.

Scientists also are looking at the possibility of developing medications that can help alleviate or prevent brain damage, such as that associated with FAS. Studies using animals have yielded encouraging results for treatments using antioxidant therapy and vitamin E. Other preventive therapies showing promise in animal studies include 1-octanol, which ironically is an alcohol itself. Treatment with l-octanol significantly reduced the severity of alcohol's effects on developing mouse embryos (26). Two molecules associated with normal development (i.e., NAP and SAL) have been found to protect nerve cells against a variety of toxins in much the same way that octanol does (27). And a compound (MK-801) that blocks a key brain chemical associated with alcohol withdrawal (i.e., glutamate) also is being studied. MK-801 reversed a specific learning impairment that resulted from early postnatal alcohol exposure (28).

Though these compounds were effective in animals, the positive results cited here may or may not translate to humans. Not drinking during pregnancy is the best form of prevention; FAS remains the leading preventable birth defect in the United States today.

GROWING NEW BRAIN CELLS

For decades scientists believed that the number of nerve cells in the adult brain was fixed early in life. If brain damage occurred, then, the best way to treat it was by strengthening the existing neurons, as new ones could not be added. In the 1960s, however, researchers found that new neurons are indeed generated in adulthood-a process called neurogenesis (29). These new cells originate from stem cells, which are cells that can divide indefinitely, renew themselves, and give rise to a variety of cell types. The discovery of brain stem cells and adult neurogenesis provides a new way of approaching the problem of alcohol-related changes in the brain and may lead to a clearer understanding of how best to treat and cure alcoholism (30).

For example, studies with animals show that high doses of alcohol lead to a disruption in the growth of new brain cells; scientists believe it may be this lack of new growth that results in the long-term deficits found in key areas of the brain (such as hippocampal structure and function) (31,32). Understanding how alcohol interacts with brain stem cells and what happens to these cells in alcoholics is the first step in establishing whether the use of stem cell therapies is an option for treatment (33).

SUMMARY

Alcoholics are not all alike. They experience different degrees of impairment, and the disease has different origins for different people. Consequently, researchers have not found conclusive evidence that any one variable is solely responsible for the brain deficits found in alcoholics. Characterizing what makes some alcoholics vulnerable to brain damage whereas others are not remains the subject of active research (34).

The good news is that most alcoholics with cognitive impairment show at least some improvement in brain structure and functioning within a year of abstinence, though some people take much longer (35-37). Clinicians must consider a variety of treatment methods to help people stop drinking and to recover from alcohol-related brain impairments, and tailor these treatments to the individual patient.

Advanced technology will have an important role in developing these therapies. Clinicians can use brain-imaging techniques to monitor the course and success of treatment, because imaging can reveal structural, functional, and biochemical changes in living patients over time. Promising new medications also are in the early stages of development, as researchers strive to design therapies that can help prevent alcohol's harmful effects and promote the growth of new brain cells to take the place of those that have been damaged by alcohol.

References

Alcohol abuse and alcoholism. In: Nixon, S.J., ed. (1) Parsons, O.A. Neuropsychology for Clinical Practice. Washington, DC: American Psychological Press, 1996. pp. 175-201.(2) White, A.M. What happened? Alcohol, memory blackouts, and the brain. Alcohol Research & Health 27(2):186-196, 2003. (3) White, A.M.; Jamieson-Drake, D.W.; and Swartzwelder, H.S. Prevalence and correlates of alcohol-induced blackouts among college students: Results of an e-mail survey. Journal of American College Health 51:117-131, 2002. (4) Mumenthaler, M.S.; Taylor, J.L.; O'Hara, R.; et al. Gender differences in moderate drinking effects. Alcohol Research & Health 23:55-64, 1999.(5) Loft, S.; Olesen, K.L.; and Dossing, M. Increased susceptibility to liver disease in relation to alcohol consumption in women. Scandinavian Journal of Gastroenterology 22: 1251-1256, 1987. (6) Fernandez- Sola, J.; Estruch, R.; Nicolas, J.M.; et al. Comparison of alcoholic cardiomyopathy in women versus men. American Journal of Cardiology 80:481-485, 1997.(7) Ammendola, A.; Gemini, D.; Iannacone, S.; et al. Gender and peripheral neuropathy in chronic alcoholism: A clinical-electroneurographic study. Alcohol and Alcoholism 35:368-371, 2000. (8) Jacobson, R. The contributions of sex and drinking history to the CT brain scan changes in alcoholics. Psychological Medicine 16:547-559, 1986.(9) Mann, K.; Batra, A.; Gunther, A.; and Schroth, G. Do women develop alcoholic brain damage more readily than men? Alcoholism: Clinical and Experimental Research 16(6):1052-1056, 1992. (10) Nixon, S.; Tivis, R.; and Parsons, O. Behavioral dysfunction and cognitive efficiency in male and female alcoholics. Alcoholism: Clinical and Experimental Research 19(3):577-581, 1995.(11) Hommer, D.W. Male and female sensitivity to alcohol-induced brain damage. Alcohol Research & Health 27(2):181-185, 2003. (12) Hommer, D.W.; Momenan, R.; Kaiser, E.; and Rawlings, R.R. Evidence for a gender-related effect of alcoholism on brain volumes. American Journal of Psychiatry 158:198-204, 2001.(13) Pfefferbaum, A.; Rosenbloom, M.; Deshmukh, A.; and Sullivan, E. Sex differences in the effects of alcohol on brain structure. American Journal of Psychiatry 158:188-197, 2001. (14) National Academy of Sciences. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. 1999.(15) Morgan, M.Y. Alcohol and nutrition. British Medical Bulletins 38:21-29, 1982. (16) Martin, P.R.; Singleton, C.K.; and Hiller-Sturmhöfel, S.H. The role of thiamine in alcoholic brain disease. Alcohol Research & Health 27(2):134-142, 2003. (17) Victor, M.; Davis, R.D.; and Collins, G.H. The Wernicke-Korsakoff Syndrome and Related Neurologic Disorders Due to Alcoholism and Malnutrition. Philadelphia: F.A. Davis, 1989.(18) Martin, P. "Wernicke-Korsakoff syndrome: Alcohol-related dementia." Family Caregiver Alliance Fact Sheet, 1998. (19) Cook, C. "The Wernicke-Korsakoff syndrome can be treated." The Medical Council on Alcohol, vol. 19, 2000.(20) Butterworth, R.F. Hepatic encephalopathy-A serious complication of alcoholic liver disease. Alcohol Research & Health 27(2):143-145, 2003.(21) Mitzner, S.R., and Williams, R. Albumin dialysis MARS 2003. Liver International 23(Suppl. 3):1-72, 2003.(22) Arria, A.M.; Tarter, R.E.; Starzl, T.E.; and Van Thiel, D.H. Improvement in cognitive functioning of alcoholics following orthotopic liver transplantation. Alcoholism: Clinical and Experimental Research 15(6):956-962, 1991.(23) Pujol, A.; Pujol, J.; Graus, F.; et al. Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology 43:65-69, 1993. (24) Chen, W-J.A.; Maier, S.E.; Parnell, S.E.; and West, J.E. Alcohol and the developing brain: Neuroanatomical studies. Alcohol Research & Health 27(2):174-180, 2003. (25) Klintsova, A.Y.; Scamra, C.; Hoffman, M.; et al. Therapeutic effects of complex motor training on motor performance deficits induced by neonatal binge-like alcohol exposure in rats: II. A quantitative stereological study of synaptic plasticity in female rat cerebellum. Brain Research 937:83-93, 2002. (26) Chen, S.Y.; Wilkemeyer, M.F.; Sulik, K.K.; and Charness, M.E. Octanol antagonism of ethanol teratogenesis. FASEB Journal 15:1649-1651, 2001. (27) Spong, C.Y.; Abebe, D.T.; Gozes, I.; et al. Prevention of fetal demise and growth restriction in a mouse model of fetal alcohol syndrome. Journal of Pharmacology and Experimental Therapeutics 297:774-779, 2001. (28) Thomas, J.D.; Fleming, S.L.; and Riley, E.P. Administration of low doses of MK-801 during ethanol withdrawal in the developing rat pup attenuates alcohol's teratogenic effects. Alcoholism: Clinical and Experimental Research 26(8):1307-1313, 2002. (29) Altman, J., and Das, G.D. Autoradiographic and histological evidence of postnatal hippocampal neurogenesis in rats. Journal of Comparative Neurology 124(3):319-335, 1965.(30) Crews, F.T., and Nixon, K. Alcohol, neural stem cells, and adult neurogenesis. Alcohol Research & Health 27(2): 197-204, 2003.(31) Nixon, K., and Crews, F.T. Binge ethanol exposure decreases neurogenesis in adult rat hippocampus. Journal of Neurochemistry 83(5):1087-1093, 2002.(32) Herrera, D.G.; Yague, A.G.; Johnsen-Soriano, S.; et al. Selective impairment of hippocampal neurogenesis by chronic alcoholism: Protective effects of an antioxidant. Proceedings of the National Academy of Science of the U.S.A. 100(13):7919-7924, 2003.(33) Crews, F.T.; Miller, M.W.; Ma, W.; et al. Neural stem cells and alcohol. Alcoholism: Clinical and Experimental Research 27(2):324-335, 2003.(34) Oscar-Berman, M., and Marinkovic, K. Alcoholism and the brain: An overview. Alcohol Research & Health 27(2):125-133, 2003.(35) Bates, M.E.; Bowden, S.C.; and Barry, D. Neurocognitive impairment associated with alcohol use disorders: Implications for treatment. Experimental and Clinical Psychopharmacology 10(3):193-212, 2002.(36) Gansler, D.A.; Harris, G.J.; Oscar-Berman, M.; et al. Hypoperfusion of inferior frontal brain regions in abstinent alcoholics: A pilot SPECT study. Journal of Studies on Alcohol 61:32-37, 2000.(37) Sullivan, E.V.; Rosenbloom, M.J.; Lim, K.O.; and Pfefferbaum, A. Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: Relationships to changes in brain structure. Neuropsychology 14:178-188, 2000.(38) Rosenbloom, M.; Sullivan, E.V.; and Pfefferbaum, A. Using magnetic resonance imaging and diffusion tensor imaging to assess brain damage in alcoholics. Alcohol Research & Health 27(2):146-152, 2003.(39) Kensinger, E.A.; Clarke, R.J.; and Corkin, S. What neural correlates underlie successful encoding and retrieval? A functional magnetic resonance imaging study using a divided attention paradigm. Journal of Neuroscience 23(6):2407-2415, 2003.(40) Wong, D.F.; Maini, A.; Rousset, O.G.; and Brasíc , J.R. Positron emission tomography-A tool for identifying the effects of alcohol dependence on the brain. Alcohol Research & Health 27(2):161-173, 2003.(41) Porjesz, B., and Begleiter, H. Alcoholism and human electrophysiology. Alcohol Research & Health 27(2):153-160, 2003.(42) Porjesz, B., and Begleiter, H. Human brain electrophysiology and alcoholism. In: Tarter, R., and Van Thiel, D., eds. Alcohol and the Brain. New York: Plenum, 1985. pp. 139-182.(43) Begleiter, H.; Porjesz, B.; Bihari, B.; and Kissin, B. Event-related potentials in boys at risk for alcoholism. Science 225:1493-1496, 1984.(44) Polich, J.; Pollock, V.E.; and Bloom, F.E. Meta-analysis of P300 amplitude from males at risk for alcoholism. Psychological Bulletin 115:55-73, 1994.

Resources

Back issues of

Source material for this Alcohol Alert originally appeared in the journal Alcohol Research & Health, "Alcoholic Brain Damage" (Vol. 27, No. 2, 2003).

Alcohol Research & Health is the quarterly, peer-reviewed journal published by the National Institute on Alcohol Abuse and Alcoholism. Each issue of AR&H provides in-depth focus on a single topic in the field of alcohol research.
Alcohol Research & Health and additional resources can be downloaded from NIAAA's Web site, www.niaaa.nih.gov. Subscriptions are available from the Superintendent of Documents for $25. Write to New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954; or fax 202/512-2250 .

All material contained in the Alcohol Alert is in the public domain and may be used or reproduced without permission from NIAAA. Citation of the source is appreciated.
Copies of the Alcohol Alert are available free of charge from the
National Institute on Alcohol Abuse and Alcoholism Publications Distribution Center
P.O. Box 10686, Rockville, MD 20849-0686.
Prepared: October 2004

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Binge Drinking and Blackouts * Drinkers who experience blackouts typically drink too much and too quickly, which causes their blood alcohol levels to rise very rapidly. College students may be at particular risk for experiencing a blackout, as an alarming number of college students engage in binge drinking.

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The first issue with alcohol

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How do you get kicked out of a band for being a wild drunk when that very same band would give itself the nickname Alcoholica?

For Metallica's original lead guitarist, Dave Mustaine, the problem wasn't the quantity that he was consuming, it was how the booze affected him when he was hammered. His bandmates - James Hetfield, Lars Ulrich and Cliff Burton - were loud and stupid when they drank, but they were mischievous, but not malicious. Mustaine, on the other hand, could become volatile and unhinged after he'd had a few.

"When you're around a lot of people that like to drink and get silly, they just want to have fun," Mustaine explains. "I would drink and have fun until someone would refute something I had said. And then that was war, baby. I'd be aggressive and confrontational because I was a violent drunk. I lost all inhibitions when I was drinking, and that didn't go over to well in the end."

The end came on April 11, 1983, and for Mustaine it came without warning. Metallica had already hired Kirk Hammett as their new lead guitarist. At around 9AM that morning, Hetfield, Ulrich and Burton woke up Mustaine, who was suffering from an ugly hangover, and told him he was out of the band.

"The thing that really upset me was that they never gave me a warning and I never got a second chance," Mustaine says. "It was just, 'Hey man. You're out. See ya later."

When Mustaine asked what time his flight back to California was, he was told he wasn't flying. He was taking a four-day bus ride. Worse still, the bus was scheduled to depart from New York's Port Authority Bus Terminal one hour after he was fired. Perplexed, Mustaine scrambled to pack a travel bag and then Hetfield drove him from the Music Building in Queens to 42ndStreet and Eighth Avenue in Manhattan.

At the time, Mustaine was understandably furious. Not only had he been kicked out of a band he co-founded, but he was being sent away with a mere bus ticket while his former bandmates went on to record their debut album, Kill 'Em All - for which he wrote some of the best material - with another guitarist.

During the seemingly endless bus ride, he fumed for a while, and then decided to write some new lyrics. Since he didn't have any paper, he wrote on the back of a handbill from Senator Alan Cranston. A message on the front of the card, which referred to the stockpiling of nuclear weapons read, "The arsenal of megadeath can't be rid." After considerable thought, Mustaine decided the term megadeath would make a cool name for a metal band, especially if it was misspelled as Megadeth.

With decades of hindsight, Mustaine still feels he should have been warned before he was booted, but he has accepted his role in the events that transpired.

"I had been physically reckless, and there had been a lot of pushing and shoving on my part with everybody in the band," he says. "I was very unpredictable and I embarrassed everyone around me. I still look back on those times as mostly fun, but usually the time when I would start to get to the point where violence would occur was when I was heading towards a blackout. That continued long after I left Metallica and it was the main reason why, why in 1988, I decided I'm gonna stop. It just took a long f---in' time to get the train slowed down."
Loudwire contributor Jon Wiederhorn is the co-author of Louder Than Hell: The Definitive Oral History of Metal, as well as the co-author of Scott Ian's autobiography, I'm the Man: The Story of That Guy From Anthrax, and Al Jourgensen's autobiography, Ministry: The Lost Gospels According to Al Jourgensen and the Agnostic Front book My Riot! Grit, Guts and Glory. See Where Dave Mustaine + Kirk Hammett Rank Among the Top 66 Hard Rock + Metal Guitarists of All Time

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36 Years Ago: Dave Mustaine Fired From Metallica

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How do you get kicked out of a band for being a wild drunk when that very same band would give itself the nickname Alcoholica? For Metallica's original lead guitarist, Dave Mustaine, the problem wasn't the quantity that he was consuming, it was how the booze affected him when he was hammered.

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The effects of alcoholism

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The idea alcohol has negative effects on the brain isn't anything new. Previous studies, however, have only measured these effects through behavior and post-mortem studies - not scans of the actual brain. A new study published in Alcoholism: Clinical & Experimental Research, the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism, finally makes use of the technology to gain a deeper understanding of the long-term effects alcohol has on white brain matter.

"Frontal white matter tracts are the pathways that connect the frontal lobes to the rest of the brain," study co-author Catherine Brawn Fortier, a neuropsychologist and researcher at the VA Boston Healthcare System and assistant professor at Harvard Medical School, explained in a press release. "The frontal cortex is the integration center for all other parts of the brain that are important to behavior and cognitive function. These pathways support self-monitoring, planning, judgment, and reasoning." Not only that, but Fortier added these frontal pathways drive the ability to learn and change new patterns and behaviors.

By using high-resolution structural magnetic resonance (MR) scans to create and assess a 3D structure of "global and regional white matter," Fortier and her team could see reductions in middle-aged recovering alcoholics' white matter pathways compared to non-alcoholics. Recovering alcoholics included participants who were five years sober after 25 years of alcohol abuse. Damage to the brain's white matter was a result of higher quantity and exposure. Basically, the more you drink, the more damage you do to your brain.

Gray matter is negatively affected by years of heavy drinking, too. Gray matter is a major component of the central nervous system, and it's a large group consisting of neurons responsible for brain function. The structure of this group processes the information from our sensory organs and other gray regions of the brain. And like white matter, reduced gray matter worsens a person's planning, prioritizing, impulse, and memory.

The message is clear: The longer and more a person drinks, the worse their control and judgement is, lessening the chances of sobriety as they get older. Heavy drinking hurts the brain's ability to function and heal all at once. The time to get help for alcoholism is now.

"Our data demonstrated possible recovery of tissue of the left inferior frontal gyrus with maintained abstinence in those alcoholics who successfully stopped drinking prior to their fifth decade," Fortier said. "This finding is important because it demonstrates a possible critical threshold; excessive heavy drinking after a certain age - our data indicated age 50 - may lead to permanent brain changes, whereas earlier in life there may be more chance for brain recovery with sobriety."

Source: Frontier C, Keane TM, Leritz E, et al. Widespread Effects of Alcohol on White Matter Microstructure. Alcoholism: Clinical & Experimental Research.2014.

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International Society for Biomedical Research on Alcoholism

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Heavy Drinking Messes With Your Judgment Over Time

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The idea alcohol has negative effects on the brain isn't anything new. Previous studies, however, have only measured these effects through behavior and post-mortem studies - not scans of the actual brain.

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James Hetfield's Alcoholism, His Trip To Rehab And Metallica's Hard Time Waiting For Him

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Thanks for watching! Like us on facebook for nice rock pictures, rock memes, video tips and much more: https://goo.gl/m9CJRI

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Canadians have a reputation for being some of the nicest people on the planet, but even they have their limits. Just ask Guns N' Roses frontman Axl Rose.

The singer received a firsthand education in the boundaries of Canadian patience on Aug. 8, 1992, when the band's stop in Montreal for the Guns N' Roses/ Metallica Stadium tour ended with both headliners playing shortened sets. This led to a group of particularly frustrated audience members retaliating by starting a riot that ended with looting, smashed windows, fires, plenty of arrests, nearly half a million dollars in damages and GNR being banned from the city's Olympic Stadium for life.

Of course, it wasn't supposed to be this way. The tour represented the hard rock event of the summer, bringing together two of music's biggest acts at the peak of their commercial power. With Faith No More, Motorhead, and Body Count along for the ride as openers, ticket buyers were promised hours of heavy riffing and musical aggression, and on most of the 25 dates, that's exactly what they got. The Montreal show, however, was a disaster - in more ways than one.

The problems started during Metallica's set, when James Hetfield was horrifically injured in a scary pyrotechnics accident that sent him to the hospital with second- and third-degree burns. "During 'Fade to Black,' I'm up there playing the part, and all these colored flames are going off," he recalled during the band's Behind the Music episode. "I'm a little confused on where I should be. I walk forward, I walk back, the pyro guy doesn't see that I've walked back there, and [makes whooshing noise] colored flame goes right up under me."

Blasted by a column of fire in front of a live audience, Hetfield was in shock. "I'm burnt - all my arm, my hand completely, down to the bone," he continued. "The side of my face, hair's gone. Part of my back. ... I watched the skin just rising, things going wrong."

The band cut its set short and called for immediate medical attention, but Hetfield also remembers the journey to the hospital being less than ideal. "The security guys are kinda walking around, and one guy bumps into my hand. I just lost it; I screamed and punched him right in the nuts," he laughed. "This is pain I've never felt in my whole life and it won't go away. I'm freaking at this point, you know?"

Unfortunately, GNR's set took freaking to a different level. Rose's mercurial temper with concert crowds was already public knowledge. Shortly before the Montreal show, he'd been arrested for charges stemming from a 1991 riot that erupted after the band walked off the stage during a stop in St. Louis - and he'd been complaining of vocal problems since the tour with Metallica started. In fact, it was just getting back on track after a handful of canceled dates. Slash had warned the Montreal Gazette that Rose had a hole in a vocal cord, but promised that the "typhoon of chaos" surrounding the group wouldn't derail the show.

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According to the Gazette, GNR took more than two hours to take the stage after Metallica's premature departure, and things went downhill from there. According to the New York Times, Rose lasted 55 minutes before ending the set, although the Seattle Times timed it at a far less charitable 15 minutes. Either way, after standing around waiting to rock only to hear Rose say "This will be our last show for a long time" and walk off the stage, the crowd turned to violence.

"The PA fed back the entire time, the monitors fed back the entire time, the crowd was like, nonexistent," Slash later told MTV. Added Rose, "We had just stopped the tour because I had throat problems. Came back, and I realized, 'I'm gonna hurt myself.' I told Slash, 'Two more songs, if we can't get it fixed, I gotta go.' We did more than two more songs, and finally I was just, like, 'I don't know what to do.' I looked over and Gilby was like, 'Dude, I can't hear. And Duff [McKagan] was like, 'I can't hear either.' We had a little huddle, and we were like, 'We're outta here.'"

Added Slash: "Montreal was just really creepy. Nothing against the people of Montreal; we had a great time hanging out there. I think it was the building itself."

Ultimately, out of the 53,000 or so in attendance, only an estimated 2,000 were involved in the riot, and aside from grotesque levels of property damage - which reportedly included an uprooted street lamp and an overturned police cruiser - the whole thing was kept from spiraling too far out of control by Montreal police, who showed up in riot gear, sealed off the area and used tear gas to quell the violence. When the dust settled, there were " at least three police officers and 10 rioters injured" and "at least a dozen arrests."

The whole mess made headlines around the world, giving Rose's list of detractors more ammunition and furthering the band's growing reputation for bad behavior. The Montreal Gazette recalls that when U2 visited the city a few weeks later, Bono cracked a veiled joke at Rose's expense from the stage, pausing a few songs into the set and quipping, "What time is it? We gotta go."

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Between Hetfield's injuries and Rose's vocal woes, the Montreal catastrophe left the tour in temporary limbo until Aug. 25, when things were finally able to resume in Arizona. Hetfield, eager to get Metallica back on the road, had to stick to vocals, temporarily turning his guitar duties over to John Marshall of Metal Church - an experience that he later admitted was awkward, and not just because of the arm-length bandage he was sporting. "It sucks," Hetfield told the Columbus Dispatch. "You're up there and you're singing, but a lot of our songs have some pretty long instrumental bits; it's like, 'What the hell am I going to do here? Head back stage, do some laundry?' You can only be a cheerleader for so much, and it looks kind of silly."

Fortunately, the tour was able to make it through the rest of its dates - which concluded on Oct. 6 at the Kingdome in Seattle - without further property damage, and all things considered, still turned out to be a solid moneymaker. According to Slash, however, the members of Guns N' Roses ended up barely breaking even, thanks partly to habitual tardiness and partly because, as he claimed in his self-titled autobiography, Rose insisted on throwing expensive backstage theme parties in an effort to impress their co-headliner. "Metallica was earning the exact same paycheck as we were every night, but while they pocketed the whole thing, we were blowing 80 percent both on union dues for all of the overtime we cost ourselves going on late and on these stupid theme parties. It was just bad."

Still, there's at least one person who was on the payroll that summer who has fond memories of the tour: Rose's former personal manager Craig Duswalt, who looked back on Montreal and its aftermath in his book Welcome to My Jungle. With the band temporarily off the road and Rose in the mood for a trip to New York, Duswalt tagged along - and on the trip, he ended up connecting with his future wife. As he put it, "I am married to Natasha because James Hetfield, the lead singer/guitarist of Metallica, stood on top of a flash pot during their set and suffered second-degree burns on his arms and hands on Aug. 8, 1992, in Montreal, Canada."
See Guns N' Roses and Other Rockers in the Top 100 Albums of the '80s Slash Explains How Guns N' Roses Got Together
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23 Years Ago: Guns N' Roses / Metallica Concert Ends in Montreal Riot

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Canadians have a reputation for being some of the nicest people on the planet, but even they have their limits. Just ask Guns N' Roses frontman Axl Rose. The singer received a firsthand education in the boundaries of Canadian patience on Aug.

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How alcohol affect the band from Lars Ulrich and James Hetfield's point of view

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The major cause of alcoholism with James Hetfield

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Metallica's official site

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"Some Kind of Monster - Metallica Documentary

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Ex-guitarist Dave Mustaine (Megadeth) wrote this song about Cliff Burton after hearing about his death

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YouTube

Metallica were on top of the metal world in 1986, having just signed their first major label deal and releasing their commercial breakthrough album. But the band's year ended with a crushing blow after bassist Cliff Burton died in a bus accident while touring overseas.

The group had cemented their position as the kings of thrash metal with the release of Master of Puppets, their third overall LP and first for a major label, Elektra Records. The record heavily featured Burton's signature playing style, which expanded the bass from its traditional role as an anchor rhythmic element and into melodic territory usually reserved for the lead guitar. It became Metallica's first gold album, eventually selling more than six million copies, and the group toured extensively to promote it all over the world, including extensive dates in Europe. Those concerts would prove to be Burton's last with Metallica.

On the night of Sept. 26, 1986, Metallica were traveling between tour dates in Sweden when Burton and guitarist Kirk Hammett drew cards to decide who would get to choose a bunk. The bassist drew the Ace of Spades, and chose the bunk Hammett had been occupying. "I said fine, take my bunk," the guitarist recalled in VH1's Behind the Music. "I'll sleep up front; it's probably better anyway."

In the early morning hours of Sept. 27, 1986, shortly before 7 a.m., the band members were awakened abruptly when the bus began to careen from side to side. The driver later told authorities that he lost control of the bus after hitting a patch of black ice. The bus left the road and flipped over on its side, and Burton - who had been asleep in the preferred top bunk - was thrown through the window. As the bus came down, it landed on top of the 24-year-old musician. Reportedly, attempts were made to rescue him from underneath the bus by lifting it with a crane, but the crane slipped, and the bus crashed down on top of Burton a second time. Band members and onlookers have given different accounts of whether Burton died upon first impact or when the bus came down again, but the promising young star died at the scene.

Metallica front man James Hetfield has said he walked up and down the road in his socks and underwear looking for black ice and found none, and the musicians have speculated off and on over the years about whether drinking or drugs could have played a role in the accident, or whether the driver fell asleep at the wheel. An investigation cleared the driver of any wrongdoing.

Cliff Burton was cremated, and his ashes were scattered at the Maxwell Ranch in California. Metallica's "Orion" was played at the ceremony, and lyrics from "To Live Is to Die" are engraved upon his memorial stone: "Cannot the Kingdom of Salvation take me home." Former Metallica guitarist Dave Mustaine wrote Megadeth's "In My Darkest Hour" after hearing of Burton's death, and fellow thrash pioneers Anthrax dedicated their Among the Living album to him.

Cliff Burton was posthumously inducted into the Rock and Roll Hall of Fame on April 4, 2009 as a member of Metallica.
Metallica Discuss Cliff Burton's Death on 'Behind the Music'
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Metallica: Worst to Best You Think You Know Metallica & Guns N' Roses?
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Best You Think You Know Metallica & Guns N

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29 Years Ago: Metallica Bassist Cliff Burton Dies in a Bus Accident

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Metallica were on top of the metal world in 1986, having just signed their first major label deal and releasing their commercial breakthrough album. But the band's year ended with a crushing blow after bassist Cliff Burton died in a bus accident while touring overseas.

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Buzz

James Hetfield lived the rock 'n' roll lifestyle for much of his career as the frontman of Metallica. His drug and alcohol addiction reached a boiling point right around the time the band was documenting the recording process for their eighth studio album, St. Anger. Some Kind of Monster, which hit theaters in 2004, showed a band at a crossroads, and Hetfield, in order to save himself and his career, entered rehab. In a new interview, Hetfield credited music as what helped save his life.

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Speaking to Road Recovery, the singer explained that his low points as an addict were extremely dark, Revolver notes.

"You wouldn't really like me if you knew my story, if you knew what horrible things I've done," he says in the video below. "I'm coming to grips with that, 'cause I have groups of people that I'm able to share all my horrible stuff with. Shameful, extremely shameful, dark stuff. Some of it is things I've taken from my parents and carried it a little further. Other ones, I've been able to drop some of that. Other ones I've picked up on my own and created. Shame's a big thing for me."

Hetfield spent seven months getting clean, and he's been living a sober life ever since. Five years after St. Anger the band came back with a monster album, Death Magnetic. It hit number one on charts all over the world and is considered one of the best albums from 2008. The music and process helped keep the frontman clean, and it still does.

"Playing music saves my life. Every day it saves my life," he said. "When I'm able to write a riff, write some lyrics, stuff like that. It's a way I connect with the world."

According to the organization's website, Road Recovery helps young people kick their drug habits with the help of professionals who have been through the process of getting clean.

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Metallica's James Hetfield Talks About His Drug Addiction and How Music Helped Save His Life

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James Hetfield lived the rock 'n' roll lifestyle for much of his career as the frontman for Metallica. His drug and alcohol addiction reached a boiling point right around the time the band was documenting the recording process for their eighth studio album, St. Anger.

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Lars Ulrich

Metallica drummer Lars Ulrich is buried in deepest south London rehearsing for the band's headline set at Glastonbury tonight.

Perhaps more importantly, he's also weighing up which alcoholic beverage he'll down first after he steps off the hallowed pyramid stage.

It's unsurprising he's looking forward to a glass of the strong stuff - the announcement heavy metal veterans Metallica were to headline Somerset's traditionally indie festival hasn't gone down well.

"I had heard something..." laughs Lars, with a hefty dose of sarcasm.

What does surprise me is Lars' beverage choice. Not that I assume all metallers drink the blood of bats, but...

"A glass of champagne, that's probably what I'll have," says Lars. "Before the gig we'll be like a sports team back stage doing all our stretching. We won't be shooting Tequilas. But afterwards, yes I'll have a drink. Champagne - maybe tequila, vodka. I like clear drinks, I don't really do beer."

Not even West Country cider? "No," says Lars.

Metallica roar into Download

From the man whose band's 1983 debut studio album was titled Kill 'Em All, who's talked of groupies, fans begging him to sleep with their girlfriends, and a cocaine habit, a flute of bubbles was the last thing I was expecting. As was what comes next.

"I'll have a hangover on Sunday but we're going to stay on and chill out. I want to see The Horrors, The Black Keys - and Dolly Parton. I'm a big fan. We all bow to the alter of Dolly," he says.

Lars isn't immediately what you'd expect from a hard rock drummer, but then, as he reminds me, he is now 50 - "or something like that".

Back home, just north of San Francisco, his life focuses very much on his stunning model fiancée Jessica Miller, 29, and his children Miles, 15, Layne, 12, and Bryce, seven - the latter from his long-term relationship with actress Connie Nielsen and the older two from his second marriage, to Skylar Satenstein. His first marriage was to British woman Debbie Jones in the late 80s.

"I live in my car - I put my taxi cab light on to drive the kids around," he admits. "I have three kids in three schools with three sets of friends. That 3pm-6pm slot with playdates and taking them to activities - that's mad. I'm up at 6.30am, doing breakfast, lunch boxes, the school run."

And rock and roll? "I get to the studio for 8.30am and stay there until the end of school. It is possible to play rock and roll at 8.30am," he chuckles.

It's a pretty healthy life the thrash metaller lives now. When I ask if he has a guilty pleasure - bar Dolly of course - he says: "I live and breathe hummus".

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Lars Ulrich, Kirk Hammett, James Hetfield, and Robert Trujillo of Metallica

He runs on the treadmill every morning for 30 minutes and adds: "We tend to eat a lot of chicken, turkey, fish and salad - I've some hereditary cholesterol issues, so I don't eat meat from four-legged animals."

"Alcohol is now something that is associated with the end of the day, once all the work is done. If I have anything to drink at home, it's maybe only once every week or two, and it's always after the kids have gone to sleep - I don't like to drink around them."

He quit his cocaine habit ten years ago - and bizarrely, credits good mate Noel Gallagher for it.

He's recalled: "In the early days, I'd always get drunk way faster than the other guys. I realised that if there was a little bit of cocaine involved I could stay up longer, instead of ending up face down in the corner passed out three hours before the party ended. I loved the social elements of cocaine. I loved the danger of it.

"Then about 10 years ago, I read an interview with Noel Gallagher, in which he said: "I just stopped doing cocaine." I thought that was really cool: it felt so fresh, so honest, so pure - I love that side of him. I've never had an addictive personality, so I woke up one day and said: "enough.""

But Lars doesn't want to come across too holier than now. He does have an image to maintain, after all.

"We haven't turned into priests," he says, wanting to set the vinyl straight. "We can still rock and roll with the best of them. It's just more selective these days."

And Saturday night, at Glastonbury, is going to be one of those selections.

"We'll get up to no good, take part in the shenanigans," he says, sounding surprisingly sheepish for Lars Ulrich.

Although he doesn't answer when I ask if Noel Gallagher might be responsible for showing him a good time, he laughs: "Who knows what will happen?"

Metallica

But ultimately it sounds like the festival will be a family affair. Jessica - who prefers Massive Attack to Metallica - and his oldest son, who also loves metal (Lars has banned One Direction and raised his kids on Black Sabbath and ACDC) will be accompanying him, and Michael Eavis has offered to give them a tour of the farm.

Lars insists he and the band aren't in any way nervous about playing at a gig with so many doubters in the crowd.

"Bring it on," he says. "Let's have some fun. Thirty years into this business the fact we can still elicit responses of any kind is good.

"Perhaps it's because I'm Danish, and all Danes have a bit of mischief in them. I just stand in the middle of it and everyone else winds themselves up about it.

"I understand the heritage of Glastonbury and I respect that, but I just step back."

It's not just the nature of Metallica's music that has caused a backlash though. A petition has been set up to stop them playing after it was revealed front man James Hetfield, an avid bear hunter and member of America's National Rifle Association, is set to narrate a series called The Hunt on the History Channel, which focuses on the killing of Kodiak brown bears in Alaska.

Lars doesn't hunt - but he refuses to bow down to the pressure to condemn James. And despite admitting fans once chucked a pig's head at the band as they played - why, he doesn't know - he isn't worried about what protesters might throw at them.

"It's run in James' family for generations, it's stuff he grew up with. It's a traditional thing close to his heart and I respect that. I give him the space to do his thing. We give each other space."

If Lars is sounding like he's just stepped off a psychologist's couch it's because he did - albeit a decade ago.

Back then the band - founders Hetfield and Ulrich, longtime lead guitarist Kirk Hammett and bassist Robert Trujillo, who joined the band in 2003 - were going through a rocky time (pun not intended) and hired a group therapist to help sort them out, as well as patch up differences with former lead guitarist Dave Mustaine, who was sacked early doors because of his problems with alcohol and violent behaviour.

The whole business was filmed in a 'warts and all' documentary, Some Kind of Monster.

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But now, Lars says relations are better than ever.

"We don't hang out all the time, but when we go away on tour we enjoy dinner, normal things.

"There's a balance between us. Everyone does their thing and we know each other's limits and how far we can push each other.

"Rather than fight we go with the person who is most passionate. We compromise."

It sounds like he's talking about a love affair - and it must be, in a way.

Metallica formed in LA in 1981 after Hetfield responded to an advert 17 year old Lars put in a local newspaper looking for other metal musicians to jam with. He'd arrived in the US a year earlier from his native Denmark with his family.

In early 1982, Metallica recorded its first original song Hit the Lights. The following year they recorded their debut album, Mustaine was kicked out and Hammett joined.

Now, over 120 million records sold worldwide later, they're finally playing the one festival that always eluded them. "It's the right time because this is when we were asked," says Lars quickly, brushing off questions about his reported repeated requests to Eavis to let Metallica play.

He insists he hasn't especially designed a set for the Glasto crowd - but he will divulge he's picked classics that will 'work well at a festival'.

He's clearly relishing it all - both the positive and the negative. And once Glastonbury's done? Before the band locks themselves away to work on their new album, it'll be on to that other great British tradition - Wimbledon.

Few know, but Lars was once nearly a tennis star.

His father Torben Ulrich was a pro, as was his grandfather, and Lars showed promise until his grandmother gave him a drum kit at 12 and the family moved to the US.

"I was the first one in the family to f*** it all up," he says. "The discipline wasn't for me."

Fans would agree it was a good thing he decided to make a racket instead. But will Glastonbury?

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Metallica drummer Lars Ulrich talks drink, drugs and rock and roll ahead of Glastonbury set

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Metallica drummer Lars Ulrich is buried in deepest south London rehearsing for the band's headline set at Glastonbury tonight. Perhaps more importantly, he's also weighing up which alcoholic beverage he'll down first after he steps off the hallowed pyramid stage.

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Documentary * Metallica - Some Kind Of Monster (2004)

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A documentary crew followed Metallica for the better part of 2001-2003, a time of tension and release for the rock band, as they recorded their album St. Anger, fought bitterly, and sought the counsel of their on-call shrink.

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We're celebrating Record Store Day in the best possible way we could think of... playing live! We'll be traveling back to our roots by setting up at the legendary Berkeley, CA mainstay Rasputin Music on Saturday April 16, 2016 for an extremely unique RSD live performance. As this year's Record Store Day Ambassadors we will also be celebrating the release of remastered and deluxe versions of Kill 'Em All and Ride The Lightning, getting loud, noisy and sweaty, shaking up the East Bay old-school style.

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We're celebrating Record Store Day in the best possible way we could think of... playing live! We'll be traveling back to our roots by setting up at the legendary Berkeley, CA mainstay Rasputin Music on Saturday April 16, 2016 for an extremely unique RSD live performance.