Life's big question: How long after a concussion can you drink alcohol?
How long after a concussion can you drink...?
... Is a question that I get from a lot of athletes. Surprised?
Many folks want to know when they can enjoy a beer on Sunday or drinks (plural) on their night out. And, while I think many folks already know the answer, everyone asks anyway: "Hey doc, when would it be safe to have alcohol again?"
The concise (and often reluctantly received) answer is: You should not drink alcohol after a concussion until you are 100% cleared. Even then, take it easy on the bottle there, pal.
That said, there are no guidelines that say what I just said to you right there. So, why do I say that? Because I've got good reason to - follow me on this.
What do the concussion guidelines say?
I just picked two recent sport concussion statements to illustrate my point: there is no mention of alcohol use after concussions.
This (very major) guideline only mentions that we should be sure that your acute concussion symptoms are not coming from alcohol intoxication. There's no mention of alcohol, good or bad, in your recovery.
American Medical Society for Sports Medicine position statement on concussion in sport
This guideline, again, reminds us that your symptoms should be checked against alcohol intoxication. Additionally, they mention (among many things) that alcohol use may be associated with chronic traumatic encephalopathy (CTE). But no advice on alcohol in acute or PCS recovery.
So, what's the deal with alcohol and mTBI, anyway? It's complicated.
While there are no standardized guidelines on approaching alcohol after a concussion (mTBI), there are quite clear correlations with alcohol being involved in the mTBI injury itself.
For example, it's estimated that up to 50% of US and 65% of UK head injuries are alcohol-related injuries. And, we know that among university athletes, alcohol consumption is associated with concussion risk. That risk also carries down to younger adolescents who engage in "risky behaviors" (e.g., alcohol consumption).
It's complicated, though, because alcohol may or may not confer some protection in more severe TBI forms. In a few studies, folks who were intoxicated on their day of injury were found to have better recovery outcomes. The alcohol (ETOH) may inhibit the NMDA receptor involved in TBI excitotoxicity, which explains the potential benefit of same-day inebriation. Other research has not necessarily found alcohol to be a protective predictive factor.
Context check: These folks still experienced a TBI and had to go through the injury, symptoms, and recovery. Before you think, "alcohol sounds like a potentially good thing here." Remember, alcohol may have promoted the damage and offered mild-to-no benefits after the fact, like your high school boyfriend/girlfriend.
Is there research for alcohol impacting recovery?
I actually did a post all about that here where I reviewed a study that looked at cannabis, alcohol, and cigarettes in concussion recovery.
The takeaway was that alcohol consumption neither hurt nor helped the recovery in concussion patients.
Where do I get off telling you not to drink alcohol?
There are two big reasons:
Alcohol increases your risk of concussion. Repeat concussions pose significant risks.
Alcohol is just not good for you. I'll discuss more how that can impact your overall health and recovery below.
Alcohol increases your risk of concussion.
As stated above, alcohol consumption is correlated with concussions. Alcohol may impair normal inhibition, alters motor control, impairs normal sleep, and - bing, band, boop - your concussion risk goes up.
A standard concussion timeline looks something like this:
Injury day.
About 3-5 days later, your symptoms reach their peak (worst).
Within 7-10 days, your symptoms should be resolving.
Then, within 21-33 days, your brain metabolism should be back to normal.
The redline is a look at what your brain metabolism would look like if you sustained a second concussion early (5-6 days) after your first injury.
Symptom recovery does not equate to metabolic recovery in mTBI. A second, concussive impact before full metabolic recovery could lead to more severe damage (e.g., second-impact syndrome) and significantly delay your recovery. Whether you're an athlete looking to return to your teammates or a mother merely looking to return to an everyday work and family life, you want to optimize a healthy recovery.
Alcohol is not a part of the optimal recovery plan.
Alcohol is just not good for you.
Even 1-2 drinks per day can increase how fast your brain atrophies (shrinks). Is that what we want when we're still unsure about the correlations between concussion and chronic traumatic encephalopathy (CTE)? Probably not.
More and more research is showing that no amount of alcohol intake is "safe." And before you say, "Well, I don't drink every day. I save my drinks for the weekend." Understand that consuming 4-5 drinks in a confined period is considered "binge drinking." Binge drinking is associated with high blood pressure, high cholesterol, atrial fibrillation, stroke, cancer, etc...
From a more functional perspective, chronic alcohol intake (dependence) is associated with a "leaky gut" and persistent inflammation. Suppose you've followed my social media or blog over the past year. In that case, you'll have heard me discuss the significant role that your gut-brain axis likely plays in your concussion/PPCS recovery. Alcohol also disrupts normal blood sugar regulation and regular sleep cycles. None of this is "good" for your recovery.
I don't want to keep belaboring this. Still, I do hope that it's clear at this point: alcohol is not going to promote optimal health and recovery for you following a concussion.
Wrapping it all up.
How long after a concussion can you drink?
It's up to you. There's no strong argument that alcohol is genuinely beneficial for you, and it's a coin toss as to whether it will directly impact your concussion recovery or not.
If you ask the "doctor who treats concussions for a living" for advice... I'd say: “Do not drink alcohol during your concussion rehab and minimize your alcohol intake after recovery. Your brain and your body will thank you.”
Dr. Mark Heisig is a licensed naturopathic doctor with continuing mTBI education from The American Academy of Neurology (AAN), Complete Concussion. Management (CCMI) and The Carrick Institute. His office is located in Scottsdale, AZ.