Most of my drug and alcohol education came from the worst of the DARE program where one sip of coffee was considered a dangerous drug.
I do remember hearing about mental and physical addictions. Marijuana is supposedly a mentally addicting drug, you might crave it but your body isn’t in any physical danger should you quit it. But alcohol and heroin were physically addicting and immediate cessation of those drugs could cause physical symptoms up to death.
Is this true? Or is it more like the slightly unpleasant feeling I get when I give up caffeine.
Again, don’t need answer fast, this just came up with a discussion with my friends last night and one of them was going to do Dry January and abstain from alcohol.
Googling brings up a bunch of scare stories as well as doom and gloom stuff from rehab centers. I’ll probably have those ads on my social media for at least a week!
I don’t know about heroin, but suddenly stopping alcohol, depending on how much you drink to begin with, can cause withdrawal symptoms. IIRC, seizures are one of the symptoms. I have an alcoholic friend who was having surgery a few years ago and thought it was amused the doctor asked him to bring in a some alcohol so they didn’t have to worry about him detoxing for the day or so that he was there.
In my non-professional research and experience people differ with their response to suddenly abstaining from alcohol, with most people having mild to moderate symptoms, and a smaller number suffering severe symptoms.
I had the common mild physical symptoms of shakiness, trouble sleeping, and sweating at night. They were fairly easy to tolerate, and in most cases it only takes 1 week for them to go away.
After that you no longer feel physically weird but have to watch out for the common mental trap your mind plays where tells you “gee, that was pretty easy and I proved I can do it so it won’t hurt to have just a little…” Also during the process mentally you feel restless and bored, because you can actually think and aren’t focused on keeping your buzz going. So you need to get through that and do something productive rather than just sitting around being bitter about feeling normal.
There are always a handful of people who experience terrible symptoms but the above is more common. Don’t know anything about heroin. That seems to be a lot worse.
I am not a doctor, nor a health care professional. This question really needs Qagop to pop in and dose us with knowledge, but the answer for opiate withdrawal appears to be yes. See, e.g., this 2018 opinion piece in Medpage Today: Opioid Withdrawal Not Deadly? Wrong.
Albeit it’s rare—hence the conventional wisdom that addicts don’t die from opiate withdrawal, unlike alcohol or barbiturate withdrawal. Further, the addict may be addicted to substances besides opiates. They can also have extensive co-morbidities, such as diabetes, hypertension, other cardiovascular issues, where the stress of opiate withdrawal exacerbates their underlying illness(es) and causes their demise. Finally, common symptoms of opiate withdrawal include diarrhea and nausea. Severe occurrences of those symptoms may lead to dehydration, which can be fatal.
There was a man featured on a medical mystery TV show many years ago who had died suddenly. It turned out that he was an alcoholic and had gone on a vacation with an old friend (a woman). He had tried to be “good” while on this vacation and had quit cold turkey, and the withdrawal had killed him.
So yes, alcohol withdrawal can definitely be fatal.
Opioid withdrawal is often compared to the 'flu. Because it’s similar. Mild withdrawal = mild flu like symptoms. Severe withdrawal = sever flu like symptoms. Opiate use can make you constipated: opiate withdrawal can give you diarrhoea. The diarrhoea and vomiting can give you fluid imbalance, and the fluid imbalance can kill you.
Alcohol withdrawal can kill you the same way, although the path is different. Fluid imbalance, then death.
You will notice that most people who have opiate or alcohol abuse problems don’t die in withdrawal. One reason is because it’s not that common: the other reason is that anyone in life-threatening withdrawal is pretty obviously sick.
This can happen when you are arrested, can’t get your next, and can’t even get fluid replacement. In my state, anyone who was obviously sick would eventually either be bailed, or see a doctor. Death mostly only happens in police custody, on the first night. Death from fluid imbalance typically takes longer than that, unless you are already dying. If you are in jail here, and see a doctor, and are dying from severe opiate withdrawal, you’d get fluids and methadone treatment.
Places that don’t have decent medical care and methadone programs in jails, sometimes do see opiate withdrawal deaths. It’s fairly rare.
Alcohol withdrawal can kill you, yes. That’s well documented. I’ve gotten into quite a few arguments about whether heroin withdrawal can be fatal. I take the pro side–yes, it can–but most of the online cites I’ve seen say no.
I base my opinion on two friends who died in police custody. Both were early-to-mid 20s and in as good of health as hardcore homeless junkies can be. As I understand it, one shit himself to death and the other curled up in a ball and was found that way the next morning, dead of a heart attack.
I worked at a methadone clinic for four years, where I learned more about addiction than I ever really wanted to. (And I’m still very grateful that addiction has not been one of my problems)
Heroin/opiate withdrawal is rarely fatal. Very rarely. It certainly is unpleasant to go through, but for healthy people it’s tolerable.
The key here is healthy people.
We had our clients undergo a physical prior to starting a detox just to make sure there wasn’t something going on with them that would increase risk but really very few people fell into that category.
If someone in their early-to-mid 20’s dies of a heart attack you have to suspect some sort of underlying disease process. I’m sure when Qadgop checks in he’ll fill out the list of possibilities. I suppose dying of dehydration (“shit himself to death”) could also happen.
On the other hand, going cold-turkey off alcohol certainly CAN kill you. It is definitely more likely to kill you than opiate withdrawal. Ditto for barbiturates or anything else addictive that depresses the central nervous system. Heavy users should not attempt cold-turkey withdrawals and ideally should be under medical supervision for maximum safety.
Quitting an addiction is probably not the best choice for a DIY project.
I once went through severe alcohol withdrawal to the point where I was experiencing visual hallucinations and my blood pressure had spiked way up. Within minutes of arriving at the ER I was receiving Ativan intravenously through a catheter in my thigh and basically spent the next 5 days in the ICU heavily sedated to the point where I have almost no recollection of my time there. I was told that I could have died if I had waited much longer before seeking treatment.
There’s no doubt whatsoever that alcohol withdrawal can kill.
I haven’t seen anyone die from alcohol withdrawal (yet) but I’ve treated dozens who’ve come close - people with intractable seizures, severe life-threatening hypertension, arrhythmias, acute muscle breakdown, and the like. As I say, there’s no doubt that untreated alcohol withdrawal kills.
The quoted mortality for untreated DTs is at least 10 percent. It is not surprising to see that the optimal management of it, and alcohol withdrawal more generally, are both still very much reviewed, discussed and researched today.
Heroin/narcotic withdrawal, as noted above, will not kill an otherwise healthy person. The trick is to know who’s otherwise healthy.
The common knowledge on the topic is that only alcohol and benzodiazapene withdrawal can kill you. I’m not surprised that heroin withdrawal could kill a person in poor health. Not a doctor.
Barbiturate withdrawal can also kill, far far more often than benzo withdrawal will. It can take months and months to detox successfully from long-term barb use. I saw a dentist who took barbiturates for over 30 years still having life-threatening withdrawal symptoms 8 months into his detox regimen. He was still requiring daily barb doses to stave off seizures.
I saw a couple patients die of alcohol withdrawal back in the early 80’s in east Baltimore. They presented rather late to the ER, too late to save.
Death from opioid withdrawal is extremely uncommon and pretty much limited to those with one foot in the grave and the other on a banana peel.
People who have hit bottom with their addictions MAY be otherwise relatively healthy, but probably not. One hospital I worked with included, as part of the detox protocol, a multivitamin/multimineral ,100mg of thiamine, and 1mg of folic acid 3 times a day for the first 3 days, and then daily after that. One of my techs asked me, “Why do they stuff these people so full of vitamins?” and I replied “Malnutrition, and detox is really hard on your body on top of this.”
In addition to weaning people off opiates (and this did include newborns, some of whose mothers did use opiates legitimately but the babies became physically addicted), we gave them all sorts of other drugs to make life a little easier for them. Chlordiazepoxide, diazepam, lorazepam, clonidine, you name it.
Not really on thread, but you can also get life-threatening withdrawal symptoms by stopping more than alcohol, barbiturates, and benzos cold turkey.
Although not common, it can occur when someone suddenly stops beta-blockers, clonidine (!), steroids (e.g. prednisone), and even meds for Parkinson’s Disease (i.e. levodopa et al)
I had to step down from clonidine 5 mg 3x very carefully … clonidine is actually used as a light sedative in some cases, and I have done a prednisone taper a few times for allergic reactions [mrAru does it once a year at least, he is amazingly allergic to poison ivy and seems to get it every spring whether he needs it or not. We joke he can get it from looking at a picture of it online]