With the new Amy Winehouse biography “Back to Black”, which will be released in the USA on May 17, 2024, the late singer’s relationship with alcohol and drugs is being put under the spotlight again. In July 2011, at the age of 27, Winehouse was found dead in her North London flat from “death by misadventure”. This is the official British term for accidental death resulting from voluntary risk.
His blood alcohol concentration was 0.416%; this was more than five times the legal intoxication limit in the United States; This led to his cause of death being later adjusted to include “alcohol poisoning” following a second coroner’s inquest.
Nearly 13 years later, alcohol consumption and binge drinking remains a major public health crisis not only in the UK but also in the US
Approximately 1 in 5 U.S. adults report binge drinking at least once a week; drinks an average of seven drinks per binge episode. This is well above the amount of alcohol considered to cause legal intoxication, which is generally defined as a blood alcohol concentration above 0.08%; On average, four drinks in two hours for women and five drinks in two hours for men.
Days of “heavy drinking” among women have increased by 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, but there is no evidence that these trends are slowing. Despite efforts to understand the general biology of substance use disorders, scientists’ and doctors’ understanding of the relationship between women’s health and binge drinking has lagged behind.
I am a neurobiologist focused on understanding the chemicals and brain regions underlying alcohol addiction. In animal models, I study how neuropeptides, unique signaling molecules in the prefrontal cortex, one of the brain regions important in decision-making, risk-taking, and reward, are altered by repeated exposure to excessive alcohol consumption.
My lab focuses on understanding how things like alcohol alter these brain systems before diagnosable addiction, so we can better inform both prevention and treatment efforts.
The biology of addiction
While problematic alcohol consumption has likely continued as long as alcohol has existed, it wasn’t until 2011, the same year of Winehouse’s death, that the American Society of Addiction Medicine recognized substance abuse as a brain disorder. The diagnosis of alcohol use disorder is now used in outdated terms such as labeling a person as an alcoholic or suffering from alcoholism.
Researchers and clinicians have made great progress in understanding how and why drugs, including alcohol and opiates, change the brain. People often consume a drug like alcohol because of the rewarding and positive feelings it creates, such as drinking with friends or celebrating a milestone with a loved one. But what begins as manageable alcohol consumption can quickly turn into cycles of binge drinking and subsequent drug withdrawal.
While all alcohol consumption carries health risks, binge drinking appears to be particularly dangerous because of how the repeated cycle between a high and a state of withdrawal affects the brain. For example, for some people, alcohol use can lead to “drunkness,” the feeling of anxiety that can accompany a hangover.
Repeated episodes of drinking and inebriation, combined with withdrawal, can spiral and lead to alcohol relapse and reuse. In other words, alcohol use ceases to be rewarding and becomes merely a way to prevent feeling bad.
Logical. With repeated alcohol use over time, the areas of the brain engaged in alcohol may shift from regions traditionally associated with drug use, reward, or pleasure to areas of the brain more typically engaged during stress and anxiety.
All these stages of drinking, from alcohol enjoyment to withdrawal and craving cycles, continually change the brain and its communication pathways. Alcohol may 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 in the prefrontal cortex communicate with each other. Neurons are the brain’s primary communicators, sending both electrical and chemical signals into the brain and to the rest of your body.
What we find 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 long-term abstinence, conversations between neurons do not return to normal.
These changes in the brain may occur even before visible changes in behavior occur. This may mean that the neurobiological underpinnings of addiction may take root long before the person or their loved ones suspect an alcohol-related problem.
Researchers like us don’t yet fully understand why some people might be more sensitive to this change, but it likely has to do with genetic and biological factors, as well as the patterns and conditions in which alcohol is consumed.
women are forgotten
While researchers are increasingly understanding the various biological factors underlying addiction, there is one population that has been largely overlooked until now: women.
Women may be more likely than men to suffer some of the most devastating health effects caused by alcohol use, such as liver problems, cardiovascular disease and cancer. Middle-aged women are now at the highest risk of binge drinking compared to other populations.
When women consume even moderate amounts of alcohol, their risk of developing various types of cancer, including digestive, breast and pancreatic cancer, and even death, among other health problems, increases. Therefore, the worsening rates of alcohol use disorder in women create the need to focus more on women in research and treatment searches.
But women have long been underrepresented in biomedical research.
Until 1993, clinical trials funded by the National Institutes of Health were not required to include women as research subjects. In fact, the NIH did not even require sex to be considered as a biological variable by federally funded researchers until 2016. When women are excluded from biomedical research, doctors and researchers have an incomplete understanding of health and disease, including alcohol addiction.
There is also growing evidence that addictive substances may 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 can be more rewarding, leading to 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 related to women’s health and propensity for alcohol abuse.
Look ahead
Researchers and lawmakers recognize the vital need to increase research on women’s health. Major federal investments in women’s health research are a vital step toward developing better prevention and treatment options for women.
While women like Amy Winehouse have had to struggle with substance use disorders and alcohol both privately and publicly, the increasing focus on studying alcohol and other substance abuse as a brain disorder will open new avenues of treatment for those suffering from its consequences.
For more information about alcohol use disorder, its causes, prevention and treatments, visit the National Institute on Alcohol Abuse and Alcoholism.
This article is republished from The Conversation, an independent, nonprofit news organization providing facts and authoritative analysis to help you understand our complex world. Written by: Nikki Crowley Penn State
Read more:
Nikki Crowley receives funding from the National Institutes of Health, the Brain and Behavior Research Foundation, and the Penn State Huck Institutes for Life Sciences endowment.