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:

• The Mayo Clinic
• The US National Library of Health

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.

If a character gets an overdose of pain meds, what will modern medicine do for him?

Pain medications are classified as narcotic or non-narcotic. There are numerous drugs in each class. Non-narcotic pain meds are often used for purposes other than just pain relief. There are also quite a few drugs out there used to help pain that are known as "adjunct therapies" - helpers, basically that work with narcotics to control severe pain. I'll cover a few of the most common drugs to cause overdose and their effects and treatment.

Narcotics

Opiates - this class is composed of drugs like morphine, demerol, codeine, laudinum, opium, and vicodin. It also contains drugs that are mixed with non-narcotic medications, like percocet, tylenol 3, tylenol with codeine, and darvocet. Opiate overdose can cause respiratory depression to the point that someone just stops breathing altogether and then, well... you know what comes next. To counteract that, a hospital would initiate hand-bagging (see photo at left) by putting a mask with a bulb and special valve on the end to force air into the person's lungs. They would then do one of the meanest things you can do to someone - "slam the Narcan". Narcan is an IV drug that completely counteracts opiates, almost instantaneously. What that means is, the person who took opiates for pain relief is going to be in a hell of a lot of pain, real fast. And because opiates mimic the body's own endorphins (brain chemicals that increase pain tolerance), those don't work anymore either. The person who took opiates to get mellow is going to wake up hurting, too, and severely pissed off. It's best to have several muscular coworkers standing by when slamming Narcan into someone.

Fentanyl is a drug used to treat pain in the hospital setting. The trouble with this drug is that if it is administered to quickly via IV, it can cause your muscles to lock solid. Including your diaphragm. Even hand-bagging won't save you, as your chest is too rigid to force air into or let air out. The only way to manage this type of situation is to administer a paralytic - a drug that literally causes temporary muscle paralysis (Vecuronium, called "Vec" by health care workers, is a common one) but not unconsciousness or pain relief. The paralyzed person would then be hand-bagged or more likely have a tube put into his/her airway and be hooked up to a ventillator until the paralytic and the fentanyl wore off. Meanwhile, the person would be awake to experience the whole thing but completely helpless, unable to move or talk, unless the dose of fentanyl was big enough to put them out.

Non-Narcotics

Tylenol (acetaminophen) - overdosing on this might not sound like a horrible thing. It's over the counter, right? So taking a couple extra shouldn't be a problem? WRONG. Tylenol overdose is one of the worst things you can do to your body with over-the-counter meds. Tylenol is safe in the dosages recommended by the manufacturer, but in large doses or prolonged cases of taking just a little more than recommended for several days, it can be extremely toxic to the liver. What this means is that while most people who overdose on tylenol are ok afterwards, there's a chance that you've just managed to kill your liver. Liver failure, let me tell you, is a horrible way to die. A person overdosed on tylenol will usually start feeling ill pretty quickly - nausea, vomiting, looking pale. The bigger the dose, the more likely the symptoms. They may go into a latent (silent) phase for the next two days with no symptoms. Some people never progress to the third stage, which involves necrosis (death) of the liver. While most people who overdose on tylenol eventually resolve without dying, the third stage can progress to death, even if treated. Symptoms includes right upper abdominal pain, prolonged bleeding times, low blood sugar, bleeding, and brain damage. 3-4% of the people who experience large or prolonged small overdoses of tylenol die from complications associated with necrotic liver. Treatment consists of inducing vomiting, stomach pumping (removing stomach contents through a tube), giving activated charcoal through a tube (see photo at right. Yes, it's as gross as it looks, and it's probably going to come back up the hard way), and in cases of high doses or prolonged moderate doses, giving the antidote drug acetylcysteine, which is effective in most but not all cases.