Rock and roll and intoxicating substances have been inextricably linked since the dawn of the genre. But a fast-paced, drug-addled lifestyle is not a recipe for a long life.
The death of Pogues singer and infamous party boy Shane MacGowan, on Thursday, at the age of just 65, is the latest victim of this phenomenon.
The Irish punk rocker had suffered a severe brain infection for the past year, which slowly robbed him of his independence.
But the musician – who famously sported crooked, rotten teeth – is no stranger to ill health.
In fact, MacGowan has spent most of his adult life battling one ailment or another as a result of chronic substance abuse.
Over the years, he’s been pictured drunkenly stumbling out of bars and seen slurring words in interviews – or misremembering his song lyrics.
By age five, Mr MacGowan was drinking two beers before bed. Three years later, he was introduced to whiskey. The early introduction to alcohol permanently rewires circuits in the brain, according to neuroscientists
On one occasion, he was reported to have taken 100 tabs of acid and proceeded to eat a Beach Boys record – causing his mouth to bleed profusely.
In 2000, MacGowan spent several months in rehab for heroin addiction.
The tragedy that marred his life is perhaps not surprising given that he was introduced to Guinness by his parents at the age of five.
An uncle gave him whiskey at the age of eight. And the Fairytale of New York singer first checked himself into rehab after over-doing a concoction of drugs at 17.
But what happens in the body when it’s exposed to toxic substances for so long, and at such high volumes?
We put the question to top experts in a quest to understand if MacGowan’s health was doomed before he left high school.
Firstly, experts say using substances for such long periods – despite numerous health scares – is evidence that MacGowan was suffering substance use disorder.
MacGowan, born to Irish parents, became involved with the burgeoning punk movement in 1970s England
Dr Erin Calipari, a pharmacologist and addiction researcher at Vanderbilt University, told DailyMail.com: ‘We see this all the time, we say, you almost died, why would you do this again? But that is the disorder.
She added: ‘They have these experiences but don’t change behavior in the same way that you or I would. And that’s why it’s so difficult to treat.’
In a 2001 interview, MacGowan said his family believed that exposing children to alcohol early would mitigate their risk of becoming overly dependent on booze in later life.
‘All the kids who weren’t allowed to have a drink turned into raging alcoholics,’ He told the Guardian.
Medical research says differently. Adolescents who start drinking before age 15 are four times more likely to develop alcohol dependence in their lifetime than those who start drinking after age 20, studies show.
The developing brain is acutely sensitive to the effects of alcohol.
A young brain undergoes significant structural changes in response to experiences in a way that older brains do not.
This is called brain plasticity, and explains why children and teens are more vulnerable to the short- and long-term effects of alcohol than adults.
Dr Calipari said: ‘The developmental period is a really plastic time, meaning things can change really easily.
‘But once you’re out of that period, cells in your brain can change more subtly and are not that adaptive anymore.’
Essentially, there is a crucial window in which the brain can change – and after this time the structures remain largely set.
‘Altering the brain’s wiring with alcohol and drugs at that age change how your brain helps you make decisions.’
Drinking bottle after bottle for 60 years straight would almost certainly have altered Mr MacGowan’s brain structure and volume.
Dr Calipari said: ‘Brain scans of people who’ve been drinking for long periods of time show that the size of the brain is significantly reduced, compared to others.
‘It’s not something that just grows back overnight.’
Chronic alcohol use interrupts the normal functioning of the dopamine reward pathway in the brain.
The chemical also governs motivation and positive reinforcement.
Dr Calipari added: ‘People think of it as a reward molecule, but it’s actually a little more complicated than that.’
The feeling of pleasure that comes with the release of dopamine is the brain’s way of identifying and reinforcing beneficial, healthy behaviors, such as eating delicious food, having sex, getting a good workout, and being social with friends.
But addictive drugs pack a more potent reward punch. Experts liken the difference to hearing a shout bellowed through a microphone, as opposed to a soft whisper.
It often also leaves a person wanting more of whatever good thing they have.
Chronic drug and alcohol use may cause the brain to adapt to the elevated levels of dopamine.
As a result, it reduces the natural amount of the substance that is produced, resulting in feelings of depression, anxiety and hopelessness, as well as problems with movement.
In the late 70s, MacGowan was photographed at a Clash concert kissing his girlfriend. When they were pulled apart, she’d bitten his earlobe and his face was smeared with blood.
A deficient amount of dopamine also robs a person of their ability to recognize and think through the negative consequences of their drinking or drug use. All that matters is getting that next dopamine boost.
Dr Calipari added: ‘And so what you get is this kind of lack of dynamic decision-making that biases all of your behavior toward getting and taking the drugs.’
In his later years, MacGowan’s physical health took a nosedive. He had gastroenteritis in 2012, and a bad fall while dancing and allegedly drunk in 2015 left him with a broken pelvis, and he was confined to a wheelchair. H
Dr Calipari said: ‘Alcohol affects nutrient absorption, your gut microbiome, and these things are affecting your bones, your muscles, your metabolism.
‘And so all of those things can change your general health.’
Chronic alcoholism is known to degrade bone mineral density, making osteoporosis and fractures more likely.
Alcoholism also causes disruptions to the endocrine system, which includes elevated levels of the stress hormone cortisol, a reduction in testosterone, and a dysfunctional thyroid.
Alcohol is also known to hamper a heavy drinker’s immune system, making them more vulnerable to infections.
Chronic alcoholism can lead to fatty liver, or the accumulation of fat cells in the liver, alcoholic hepatitis, cirrhosis, and liver cancer.
His latest health battle was fought against viral encephalitis, or inflammation and swelling in the brain that can be life-threatening.
There may not be a direct link between alcohol and drug addiction and viral encephalitis, but a weakened immune system brought on by years of substance use may have increased his risk.
He had been diagnosed nearly a year ago and was in and out of the hospital in Dublin for treatment before being discharged last week ahead of his upcoming birthday on Christmas Day.