On a lesser part of the Internet people were joking that keeping liquor stores open during the current situation was important because alcoholics would die if suddenly cut off. Is that the case?
I am aware Alcohol Withdraw is nasty, and in extreme cased needs to be medially supervised. It takes some up to a week to dry out. During that time they can suffer from hallucinations, panic, arrhythmia and blood pressure problems. I am not aware it can directly kill.
As a side issue, would keeping liquor stores open be a good idea to keep people out of the hospitals during this critical time?
Untreated alcohol withdrawal in actual addicts has a fatality rate of around 20%
Fortunately, medical support can bring that down to 1-5%
Yes, someone who is alcohol dependent would have the problem of either stocking 14 days worth of alcohol for a quarantine or risking a serious medical crisis. On top of whatever virus might be prompting the quarantine.
Here’s a recent thread on the topic. There are plenty more. And yes, alcohol withdrawal can be deadly. As can barbiturate withdrawal. Opioid withdrawal is rarely life threatening unless on is already in horrible shape from other co-morbidities.
I’m sure the percentages can be infinitely tweaked, depending on how various terms are defined, but the underlying message remains, “Withdrawal can be deadly; you’re much better off with medical support.”
Wikipedia offers these statistics:
In the Western world about 15% of people have problems with alcoholism at some point in time. About half of people with alcoholism will develop withdrawal symptoms upon reducing their use, with four percent developing severe symptoms. Among those with severe symptoms up to 15% die.
Those three sentences come with three footnotes to references (registration required to read).
Can they afford to pay for 14 days of alcohol in advance?
If they are locked in a house with all that alcohol, can they resist drinking it all in just the first few days?
I wonder if the virus-caused disease progresses to the stage where they need breathing support, can or will the hospital administer alcohol, too?
We do not treat alcohol withdrawal with alcohol, that’s what benzodiazepines are for. Librium is the gold standard for that, but valium, xanax, and most of the others work just fine for managing it too.
Otherwise, alcoholics around alcohol tend to consume all the alcohol far, far faster than they planned to.
Of the two hospitals I knew about, one administered drugs to short-term inpatient alcoholics, because it works better and because it’s not alcohol. The other administered low-alcohol beer to inpatient alcoholics, because that’s what they wanted, and because it’s easier than dealing with restricted drugs.
In both cases, intake was limited by not giving the patient more drugs/alcohol.
The other cases I’ve read about, there is a significant population of dead-beat alcoholics who are willing to give up that lifestyle in exchange for a regular low dose of their drug of choice, similar to methadone substitution (I don’t know the failure rate)
Are you wondering about alcoholics stuck at home without enough booze? I would think it would be hard for an alcoholic to ration their liquor.
But if you are just asking a medical question, that almost certainly varies from person to person. I mean, I do just fine with no alcohol at all. I have to assume there’s some sort of continuum, depending on how much the person is accustomed to consuming.
But that’s the question I was asking. Is it dose related, is it a continuum, is it what? There isn’t any reason to assume that it’s related to how much alcohol you normally consume, or linearly related to your weight, or simply related to your clearance rate: it could be any of those things, or it could be something different, like “about 1 oz a day for humans”.
I’m gonna mention the phrase “evidence based medicine” here. It’s not the same as guessing or folklore.
So, you are just asking the medical question, and you are not wondering about the fate of alcoholics with all the PA liquor stores closed. Thank you for clarifying.
You and I both know it’s not “1oz per day for humans” because we both know lots of people who don’t need to consume any alcohol. We also know that alcoholics are successfully weaned off alcohol (or treated with other drugs to control withdrawal someone until they abate) all the time.
No, I don’t know what initial dose a doctor a doctor might prescribe to an alcohol-dependant person to forestall symptoms, or how that might be calculated. It was my understanding that they usually administered non-alcohol drugs. (I know that was the practice where my father, a liver doctor who sometimes oversaw patients “drying out”, worked.) But perhaps there’s a doctor here who has dealt with the issue and can answer your question.
Also anecdotally, my father was addicted to caffeine, and when he was recovering from abdominal surgery, and couldn’t eat or drink, it took his medical team a while to realize that some of his symptoms were caffeine withdrawal, and I remember him telling us that they did treat him by giving him caffeine. I never asked what dose, or how they picked that dose.
I doubt anyone’s done the research on ‘how little alcohol it takes to keep someone from dying of alcohol withdrawal’. Tough study to do, needing to give certain groups placebos, other groups varying amounts, also splitting the groups according to body size, degree of liver dysfunction, total amount of adipose tissue, how much they actually drank (alcoholics tend to be significantly less than honest when reporting their alcohol consumption to authority figures), etc.
Especially since there’s no real need to do that sort of research. If one has better drugs like benzos, one uses those. If one lacks benzos, one gives whomever is in front of them withdrawing from alcohol enough alcohol to stop the withdrawal, and continues to taper from there.
And “evidence based medicine” is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information. If the best available research information includes the experts doing some guessing, or even falling back on folklore, then that’s what is used until we get better info. IF that better info is actually needed. At present, we don’t urgently need to know the info you’re asking for, because we don’t need to treat people by that method. We have better methods.
My son ended up in ICU numerous times because of seizures from alcohol withdrawal. Once he fell down the basement stairs. The last time he went in, he was having seizures and hallucinations. He never came out again. This is why it makes me angry when TV shows have the hero be a raging alcoholic with few consequences (Jessica Jones, Lethal Weapon, for example).
I once was experiencing severe alcohol withdrawal to the point of having visual hallucinations. A ~4oz shot of gin and later 2 glasses of red wine each gave me about a 2 hour break from the symptoms. I finally accepted reality and went to the ER where I was receiving Ativan intravenously in my thigh about 5 minutes after walking through the door and spent the next four days in an ICU, of which I remember almost nothing. Leading up to that, I was probably averaging a handle of vodka every 48 hrs.
I take it that the original question had already been answered:
And just to clarify, I’m not asking about treatment of withdrawal, which I already understand. I’m asking about avoidance of withdrawal:
I also already know that avoidance of withdrawal symptoms is possible using other drugs:
I thought that it was possible that someone might know the answer to the question I asked, since, as I’ve written above, some hospitals and other organizations do avoid withdrawal with small doses of alcohol.