BOOZE AND OUR BRAINS
Experts tackle our love of alcohol
The worst part was the noise and vibration of the drill burrowing into his skull.
But Frank Plummer’s main worry, after undergoing deep brain stimulation for alcohol use disorder, “was whether or not my hair would grow back.”
It did. So did his joy for life.
The former scientific director of Canada’s national microbiology laboratory is one year out from becoming the first person in a North American trial to undergo deep brain stimulation, or DBS, for chronic and compulsive heavy drinking.
Plummer, 67, went public with his experimental surgery in December. “A family history of liver disease plus alcohol was my undoing,” the renowned scientist wrote in a first-person essay released by Toronto’s Sunnybrook Health Sciences Centre, the world’s only centre currently testing DBS for alcohol use disorder, or AUD, a brain disease colloquially known as alcoholism that afflicts more than one million Canadians in any given year.
Plummer was addicted to booze, scotch in particular, and was “waiting to die” — all sorts of rehab, counselling and group meetings having ultimately failed to keep him from drinking, and a transplanted liver that was giving out — when doctors drilled two nickel-sized holes in his head in December 2018 and planted electrodes deep inside his brain.
He no longer craves alcohol. He still drinks a little, though not every day. “I maybe have two or three drinks if I do drink,” he said in an interview. “And I can stop.”
That it sometimes requires having electrodes embedded in your brain to dull the desire for alcohol speaks to the pull booze can have on the mind.
Word of Plummer’s near resurrection comes as a new study shows alcohol accounts for more lost productivity in Canada than any other substance, and as “Dry January” looms, which lulls people into believing 30 days of sobriety is sufficient to reboot their livers. If only it were true.
Alcohol is a not-insignificant part of many Canadian lives, just as it was for Plummer. Nearly 15,000 deaths per year can be attributed to alcohol, according to a recent policy paper from the Centre for Addiction and Mental Health, and the sobering stats go on and on. More Canadians (77,000 annually) are hospitalized for booze-related illnesses or injury than for heart attacks. Forty per cent of Ontarians consume more alcohol than they believe to be safe. Collectively, we drink 10 litres of pure alcohol per capita annually, 3.6 litres more than the world average.
Booze has been associated with an increased risk of stroke and heart disease. It’s been causally linked to the development of cancers of the digestive tract, nasopharynx, liver, rectum and breast. It’s been classified a Class 1 carcinogen by the International Agency for Research on Cancer, meaning that it’s known to promote cancer in humans. In the U.S. the American Public Health Association and other groups are pushing to have cancer-warning labels pasted on beer, wine and liquor, arguing few people are aware of the connection.
It’s debatable whether it would make a difference. As the CAMH paper notes, “people seem prepared to accept more risk for alcohol consumption than they do for other risky activity.”
And our drinking is costing the economy billions. A study appearing in this month’s issue of the Canadian Journal of Public Health estimates that the total cost of lost workplace productivity due to premature death, long-term disability, “presenteeism” (showing up at work sick, or hung over) and absenteeism due to substance use was $15.7 billion in 2014, up eight per cent from 2007. Alcohol clocked in as the substance responsible for the greatest economic costs (38 per cent of per capita costs), followed by tobacco (37 per cent), and opioids (12 per cent).
What explains our coziness with booze? “There’s the accessibility of it, the social acceptance nature of it,” said Dr. Nir Lipsman, director of Sunnybrook’s Harquail Centre for Neuromodulation.
In many ways we drink a lot less than we once did. In the ’70s, “it was normal to go for a drink every lunchtime, and then go out for a drink after work,” said Dr. Kevin Moore, a consultant hepatologist based at University College London and Royal Free Hospital.
We used to drink more, but the drinks were weaker. A pint in the pub contained three per cent alcohol. The average alcohol content of today’s craft beer is closer to six per cent. Wine was bottled at 10 or 11 per cent alcohol. “Today, when you go to an off-licence it’s hard to find a wine that’s only got 12 per cent,” Moore said.
People drink for different reasons. For those with a history of abuse or trauma, it’s one way of forgetting, Moore said. “But quite a lot of people use it for anxiety, actually — it’s one way of getting rid of their anxiety.” And the idea of stopping — even for 30 consecutive days — can be seriously alarming. “I had one subject who said, ‘I’ve drunk every day for 10 years. I’m terrified of stopping,” Moore said.
The U.K. has revised downward its weekly drinking guideline limits, and public health campaigns encouraging “non-dependent drinkers” to commit to short-term abstinence are increasingly common, Moore and colleagues wrote in a study published last year in BMJ Open.
But does a month-long stint of sobriety make a true difference in health?
To find out, Moore and colleagues recruited 94 moderate-heavy drinkers representing the 25 per cent of the population that drinks above recommended guidelines. After a month of abstinence, volunteers saw significant improvements in insulin resistance, blood pressure and body weight. They also saw a decrease in circulating concentrations of two cancer-related growth factors, both of which are thought necessary for tumours to grow.
The researchers hastened to add that the idea that a brief “detox” is all that’s necessary to “refresh” the liver or reap other health benefits is “clearly untrue, since the durability of the observed biological effects remains to be established.” And some of the volunteers were “desperate to go back to drink,” Moore said. They felt socially isolated. “Some of them felt like they were pariahs at dinner parties because they were the only ones who weren’t drinking or were sober.”
However, people didn’t drink as much when they went back to drinking. Among other reasons, they liked how their sleep, focus and concentration improved. “For many people, stopping can be quite liberating,” Moore said.
Still, there are economic and social benefits of modest drinking. One study found that social drinkers have more friends and deeper bonds. In moderate amounts, booze enhances our psychosocial well-being. “Alcohol is known to trigger the endorphin system, and the social consumption of alcohol may thus have the same effect as the many other social activities, such as laughter, singing and dancing, that we use as a means of servicing and reinforcing social bonds,” the researchers wrote.
Plummer drank to unwind from the pressures of running a research operation in Nairobi during the AIDS epidemic, and then a 400-person national microbiology lab in Winnipeg. “I think in some ways it also helped me, relaxing me enough to the point where I could think, and contemplate,” he told the Post. But after leaving the NML, things got “really bad.” He was drinking in the morning, and could polish off 20 ounces of scotch a night. “It got to be the main focus of my life.” And so the scientist went in search of a more “robust” medical solution.
The idea that doctors could intervene locally, in a key structure in the brain, was borrowed from the movement disorder literature, from people with treatment-resistant Parkinson’s disease or tremors. Conditions that have been linked to disordered circuitry in the brain.
Deep brain stimulation is a kind of pacemaker for the brain. An electrode in the brain is attached to a battery implanted in the chest wall underneath the collarbone. In this case, researchers are targeting dysfunctional wiring in the nucleus accumbens, a cluster of nerve cells involved in pleasure and motivation.
The skull itself doesn’t have that much in the way of nerve supply. Still, Plummer, his head fixed in a halo apparatus, was given lots of local freezing before surgeons made an incision in his scalp. The noise and vibration “was like putting your home hand drill up to your head,” he said. “It wasn’t painful, just not pleasant.”
DBS for alcohol use disorder is highly experimental. Sunnybrook is testing it on just six patients. People typically go back home after a day or two in hospital, but it takes several weeks and months to find the optimal electrical dose. It’s not a onesize fits all program setting. The electrical stimulation is always on, firing day and night.
“We’re not turning on a light switch and something will change dramatically,” Lipsman said. It’s more like a dimmer. The surgery also carries small but real risks, including bleeding, swelling, infection and implant failure. And it’s not for social drinkers, or people still responsive to conventional medical and rehab treatments. “These are people who are truly treatment resistant,” Lipsman said.
Today, Plummer’s life has changed. Alcohol doesn’t interest him anymore. What does interest him is writing his book, taking his dog out for walks, cooking and “just enjoying life for the first time in a very long time.”
“My life is full of lots of other things than alcohol,” he said.
ALCOHOL IS KNOWN TO TRIGGER THE ENDORPHIN SYSTEM, AND THE SOCIAL CONSUMPTION OF ALCOHOL MAY THUS HAVE THE SAME EFFECT AS THE MANY OTHER SOCIAL ACTIVITIES ... THAT WE USE AS A MEANS OF SERVICING AND REINFORCING SOCIAL BONDS. — U.K. RESEARCHERS
WE DRINK 10 LITRES OF PURE ALCOHOL PER CAPITA ANNUALLY, 3.6 LITRES MORE THAN THE WORLD AVERAGE.