Wednesday, October 29, 2008

Alcoholism: Long-term Effects and Withdrawal

So your character has a habit. A bad habit. And of course, writing fiction is all about making the characters day a little more difficult. What better time to go cold turkey off the booze than the middle of an action-filled, intensely stressful plot?

Alcohol consumption can be good for the body, in small regular doses. A glass of red wine a day has been proven to have protective benefits for the heart and contains many cancer-fighting anti-oxidants. A pattern of binge drinking or heavy consumption of alcohol, however, can have major negative impacts on social situation, health, and well-being. Alcohol withdrawal can cause life-threatening problems called DTs, or delirium tremens.

Long-term complications

Most of the long-term complications of alcoholism fall into two categories - damage from the drug itself and damage caused by the exceedingly poor nutritional status of most chronic alcoholics.

Probably the most well-known complication of alcoholism is cirrhosis of the liver. Basically, the liver fills up with scar tissue. Below, you'll find photos of both a healthy liver and a scarred liver with cirrhosis. Cirrhosis can also be caused by viral infections, including several strains of viral Hepatitis, an infection alcoholics and drug users are particularly prone to get. The healthy liver is on the right.


















Other direct complications of alcoholism include withdrawal (DTs), physical dependence, inability to abstain from drinking, tolerance (needing more and more alcohol to get drunk), or are primarily social complications like inability to hold a job, dysfunction of relationships, homelessness.

Indirect complications are sometimes worse for the body than the direct ones. Every system of the body is impacted by excessive alcohol intake. Just a few of the massive list of possibilities are below:

  • Altered brain function, including decreased ability to think and reason
  • Impaired judgment both when drinking and when sober
  • Ulcers of the stomach and intestines, bleeding from the intestines (coffee-grounds appearance to the poop)
  • Extreme malnutrition - alcohol has more calories per gram than sugar and carbohydrate foods (breads, cereals, fruits, vegetables), but none of the protein, vitamins or minerals the body needs to stay strong. Weight is not a predictor of nutritional health.
  • Brittle teeth and bones - I once took care of a fellow in the ICU who broke his neck by falling off a couch onto carpet after a bender and 20 years of hard drinking. He is now quadroplegic (unable to move arms or legs)
  • Bleeding - alcohol "thins" the blood, making blood clotting take longer from cut to clot, so chronic alcoholics bleed longer when cut, bruise easier, and are more prone to strokes and brain bleeding with head traumas
Cold Turkey: Delirium Tremens
Cutting the stuff out? If your character has been an addict for a while or has gone on a major binge (even just one if the blood alcohol level was super-high), they can suffer Delirium Tremens. These very uncomfortable physical signs of withdrawal can last for up to a week after the last drink and can get very suddenly worse. People have died from Delirium Tremens and for very chronic alcoholics or long-term very heavy drinkers, the best place to withdrawal is at an in-patient treatment facility. Symptoms of the DTs are below.

  • Tremors/shakes
  • Agitation, confusion, deep sleep for very long periods (a day or longer), stupor, inability to fully wake up,
  • Delirium - a loss of the ability to determine person, place, time, or situation - the person might not be able to remember what year it is, not recognize family members, not understand where he/she is or why things are happening
  • Hallucinations - seeing, hearing, smelling, feeling physical sensations, or tasting things that aren't really there
  • Fear, anxiety, restlessness, excitement, nervousness, irritability
  • Very sensitive to light, sound, touch, jumpy
  • Rapid changes of mood, depression
  • Seizures - usually full body large motor jerking (to see a seizure click HERE). Seizures of this type are very rhythmic and often involve eye rolling, teeth grinding, a bluish tinge to the face/lips and severe confusion and tiredness or feeling too heavy to move afterward. Seizures are most common in the first 1-2 days after the last drink
  • Pulsing headaches
  • Loss of appetite, nausea, vomiting, stomach pain
  • Pallor, heart palpitations (feels like your heart is doing cartwheels), chest pain
  • Heavy sweating (especially facial and on the palms)
  • Fever
After the physical withdrawal period, the patient is no longer physically dependent on alcohol, but they may continue to by psychologically addicted. They feel like they need alcohol to function, to escape, or just because. Psychological addiction can be a powerful enemy. Alcoholics Anonymous is a 12-step program to help people cope with alcohol addiction. It works. It also requires one to profess a belief in God or a higher power, which isn't something everyone can do. Cognitive-behavioral therapy and aversion therapy (where drinking is repeatedly associated with a very noxious stimulation, vomiting for instance) have also show to be very successful.

In severe cases where alcohol addiction has become life-threatening, controversial medications which cause the body to violently react to ANY alcohol consumption have been used. These include Antabuse and Disulfiram. Other medications are available for treatment of alcohol addiction, including anti-depressants and drugs to control cravings.

Recent studies suggest that alcoholics who continue to smoke while attempting to stay sober are more likely to relapse than those who quit smoking and drinking at the same time.

For more information on alcoholism, its symptoms, effects, treatments and complications, see:
As an added disclaimer, if you think you or someone you know has an alcohol addiction, seek professional help. Resources in your community can be found through Alcoholics Anonymous, your physician, the local health department, and at any hospital. Remember, information here is for fiction-writing purposes only.

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