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After abusing alcohol for a length of time, the brain undergoes changes. The brain actually loses volume ie: it becomes physically smaller. This is not believed to be from cell death because alcohol and it's metabolites don't actually kill cells in general - contrary to common belief.
The volume loss is usually in the brains white matter although grey matter volumetric deficits have been recorded. This volume change begins to reverse as shortly after abstinence begins, with gains in volume of between 2 and 6 percent occurring in the first two months. This process can probably continue for up to 2 years depending on the severity and lenght of abuse.
While the matter is undergoing remodeling cognition is distorted, sometimes severely as the white matter is responsible for communication between different brain regions which creates your world. While the rewiring is going on all sorts of temporary breaks in different areas of communication cause emotinal and cognitive problems.
These problems in recently detoxified alcoholics are often severly complicated by a physical (hypercortisolemia (low cortisol)) inability to deal with stress. The underlying nature of this hypercortisolemia is not well understood but could possibly be related to a sodium deficiency (hyponatremia) which gradually corrects itself. (rapidly correcting a sodium deficiency in recently detoxified alcoholics is dangerous and can lead to irreversible brain damage).
A psychological correlate to the physical course of extended detoxification (6 - 18 months) would be PAWS or Post Acute Withdrawal Syndrome. Anxiety can be severe during paws but gradually abates.
Thiamine, vitamin C (on waking and before bed), plenty of protein whilst AVOIDING strenous physical exercise may accelerate physical and cognitive rehabilitation. Cognitive behavioral therapy or pschodynamic therapy would be the preferred treatment for psychosocial dysfunction which may have precipitated Alcoholism and/or be caused subsequently by alcholism.
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