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Substance Abuse at Young Age

Q. When I was approximately 12 years old, I would occasionally binge drink. I binged about 10-15 times in total from age 12-14. I am 18 years old now and would like to know if damage caused by doing that would still be present and be irreversible? Would that have had a serious effect? If so, would it have repaired itself by now?

Also my sister at one point gave me Ritalin as a joke. I have read numerous articles on the internet suggesting it causes permanent manipulation of the brain cells and I was wondering if this one dose was sufficient to cause such an effect?

A. I can't say what effect, if any, the binge drinking had on you, but judging from the sophistication of your question, your brain seems to be in pretty good shape! However, you are raising an important, and rather controversial question: the role of alcohol-induced brain damage.

To quote from a recent review [C. Harper, : J Neuropathol Exp Neurol. 1998 Feb;57(2):101-10]: "There is still debate as to whether alcohol per se causes brain damage. The main problem has been to identify those lesions caused by alcohol itself and those caused by other common alcohol-related factors, principally thiamine deficiency. Careful selection and classification of alcoholic cases into those with and without these complications ...[suggests that]... there is brain shrinkage in uncomplicated alcoholics which can largely be accounted for by loss of white matter. Some of this damage appears to be reversible. However, alcohol-related neuronal loss has been documented in specific regions of the cerebral cortex..."

Most of our data on alcohol and brain damage comes from studies of long-term alcohol abuse and dependence; e.g., the daily drinker of twenty years. There is much less experimental evidence in humans pertaining to binge drinking. We do have some animal data (Obernier et al, Alcohol Clin Exp Res. 2002 Apr;26(4):547-57) showing that brief, intense exposure to ethanol [alcohol] can cause degeneration of brain cells within 2-4 days. But I'm not aware of any data in humans confirming this.

There is also some evidence that alcohol-induced cognitive impairment may be at least partially reversible, with cessation of alcohol use. In one study (Bergman et al, Lakartidningen. 1998 Sep 23;95(39):4228, 4231-6) alcoholic patients underwent MRI (magnetic resonance imaging) of the brain and neuropsychological tests shortly after discontinuation of heavy drinking. A subgroup underwent repeat MRI scans and neuropsychological assessment one year later. The reduction in drinking habits was associated with cognitive improvement, even though there was no significant difference in MRI findings.

Regarding methylphenidate [Ritalin], there is, to my knowledge, no credible evidence that this agent (used to treat ADHD) causes any damage or even permanent change to brain structure or function. In fact, there are data showing that methylphenidate actually enhances brain function on a short-term basis (see Mehta et al, J Neurosci. 2000 Mar 15;20(6):RC65). It is extremely unlikely that a single dose of Ritalin could have done any damage to you at all, assuming you ingested a pure product.

If you are truly worried about how your brain is functioning, you could have comprehensive neuropsychiatric testing done--but if your usual level of cognition is similar to that seen in your question, your money might be better spent in other pursuits. And of course, stay away from alcohol!

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November 2003

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