EXPLORE THE IMPACTS
Alcohol Use During Pregnancy
Alcohol use during pregnancy can have far-reaching effects that go well beyond what’s visible at first glance. While the physical risks are often discussed, the neurological, behavioral, and emotional challenges can be just as significant—and often more difficult to understand. These impacts can influence everything from how a person processes information, to how they manage emotions, to how they respond in everyday situations. By breaking down what happens in the brain and body, and how these changes show up in behavior, we can better understand the lived experience of those affected and the kinds of support that truly make a difference.
Brain
Affects verbal, visual-spatial, attention, reaction time & executive function skills. Verbally, they will learn words more slowly and have access to fewer words for self-expression. This decrease in verbal communication skills causes frustration & can result in aggression or other physical means of acting out one’s feelings.
Visual-spatial challenges limit one’s ability to put something back the way it was. The person is not trying to be messy or disorganized. Their brain just cannot track where something was and return it to that location. This makes cleaning up after yourself & the organization needed to keep track of one’s belongings quite challenging, causing frustration that can result in aggression.
According to the National Institute of Health (NIH): “Attention difficulties related to alcohol exposure are often incorrectly diagnosed as Attention Deficit Hyperactivity Disorder (ADHD) & treated inappropriately.”
Alcohol exposure attention problems are not with maintaining focus but are with shifting focus. Individuals will struggle with transitions, even familiar or apparently “irrelevant” ones. Simple shifts in conversation are difficult for them to follow, so individuals can become agitated when too many words are used, more than one direction or expectation is given at a time, following a conversation or identifying mixed feelings. They will be very concrete, black & white thinkers. Change will be especially difficult & without assistance can result in frustration & aggression.
Reaction time and processing speed will be slower and they will need more time, space and quiet to process. They cannot process if it is too noisy or if someone is rushing them or talking. An inability to keep up because of slow processing will appear (or be covered by) oppositional-defiance. They may be able to “get the job, but then can’t keep it” or the individual will “start things and just not finish.”
Executive function challenges will limit abstract thinking, problem solving & ability to perceive treachery. Executing action, which is turning thoughts into action, will be hampered & often look like lack of compliance or oppositional defiance. Individuals will be able to tell you what they are supposed to do, but struggle to turn those words into actions. This is frustrating, confusing & embarrassing for the individual experiencing it & for the caregiver or person making the request. Again often resulting in frustration & aggression.
For physicians:
Abnormal T3:T4 ratio - Blocks dopamine receptors needed for learning. Correction accompanied by shame (not guilt) increases cortisol response further blocking dopamine receptors needed for learning. Decreased GABA activity - Blocks anti-anxiety receptors.Increases Glutamate and endorphins, which shuts down left side of brain, resulting in dissociation and depersonalization symptoms).
Body
A disconnection between visceral (felt in the body) memory and the biographical memory that would provide a reason for the unpleasant physical sensations.
The cortex is offline, and the left side of the brain is shut down. Life feels unreal. They feel disconnected from the world. They may describe floating out of their body and watching things happening to you. They feel numb and have a decreased ability to feel pain. If in a rage, this makes them abnormally strong and have no memory of aggressive outbursts.
Behavioral Patterns
Fear-based visceral memory replays as if the trauma is really happening again, which can look like hallucinations and accusations.
Power struggles become lose-lose. If you win it, you now "feel like" (visceral memory) the perp to them. If you lose it, you now "feel like" the person who did not protect them.
Oppositional-defiant behaviors connected with an inability to complete multiple step directions, sequence, and other executive function skills. May complete work but cannot find it once completed.
The fear cascade is set off often from a visceral memory, so aggression looks like it comes "out of nowhere." Actions do not make sense.
They look "spaced out, blank, not all there." They can shut down (freeze) or they fly into a violent rage (fight) or bolt (flee) or become hypersexual (flock or submit) or start pleading with those around them to stop doing something or accuse them of doing something (fight).
Supports
They will need assistance learning and using words to express themselves, especially their feelings. They will do better if they can show you (on themselves or a Person in a mandala) where they are feeling their feelings and what the feelings look like and feel like in the body. Using music to help show emotions is also helpful.
They will need cues and reminders, long term, to help them remember where things belong, where they can be found later or how to clean up after themselves. These tasks should be done with another person making them as interesting as possible & with many positive visual cues for when they need to perform them on their own. For example, pictures of the person or those they care about showing where objects go to help them remember where to put things or find them.
Give one step directions.
Plan for & help with all transitions.
Visual cues are crucial.
15, 10 & 5 minute warnings will be needed.
Reminding them when they can return to an activity that is ending, especially preferred ones.
Saying pause instead of stop.
First- then and Yes…when statements.
Time & physical space to process requests or information.
Visual cues & sparse verbal cues
One step at a time directions
Patience & ways to represent their ideas or track things in concrete visual ways like drawing to help with problem solving or expression.
Visual schedules
They will need help with problem solving.
Making images of the challenges & exploring with someone how to address them.
Visual cues, schedules & checklists
Pros & cons lists to help discern treachery
Much practice for new skills, tasks, behaviors.
Cues to help them complete tasks – motivation alone is not enough.
If in flock, flee or fight (sympathetic response) ask: "How can I help you feel safe?" Engage in grounding activities and co-regulation activities with a safe other. Once calm, set limits using the safety script.
If in a freeze or submit (parasympathetic) response, use grounding practices. Tell them who you are, that they are safe and where they are. Repeat slowly and calmly.