‘I Want To Stop Drinking Alcohol But I Can’t’: Alcohol Abuse and Alcoholism
By Dr. Natan Schleider, M.D.
July 29th, 2017
‘I need you over here quick doc, I want to stop drinking alcohol NOW but I can’t.’
Among the most common house call requests I get is from the loved one or family member of an alcoholic–and sometimes the patient themselves–who needs to quickly sober up. While the drinking has been heavy for years, a situation has presented itself where the patient is ready and willing to stop drinking alcohol but cannot.
Why after years of drinking is the patient asking for treatment so quickly?
The answer is simple: fear of going into alcohol withdrawal. This is the fancy medical terms for signs and symptoms related to cessation or reduction in use of drinking alcohol after heavy use characterized by sweating and high heart rate, hand tremors, insomnia, nausea or vomiting, anxiety, and, when things get bad auditory and visual hallucinations and seizures.
Of note, you may have heard the term delirium tremens or ‘DTs.’ This is somewhat synonymous with the later stages of alcohol withdrawal, normally occurring days 3-5 after the alcoholic has stopped drinking. Imagine not sleeping for 3-5 days and being deprived of your alcoholic elixir. Mix in some nausea, vomiting, and dehydration. I give you the perfect cocktail for psychosis ready to happen, meaning the alcoholic will literally begin to hear and see things, act nuts, and start shaking or trembling–hence the term delirium tremens.
Now since alcohol withdrawal happens within hours for most alcoholics, time is of the essence to treat the patient or risk of relapse to drinking alcohol is high. In fact, even with treatment and appropriate alcohol detoxification, the sad truth is, the majority of alcoholics with less than one year sober will return to drinking alcohol, regardless or the medical treatments, twelve step programs, and other resources available.
That said, even the longest road toward recovery and long term sobriety begins with a single step. That First Step of Alcoholics Anonymous (AA) is “We admitted we were powerless over alcohol–that our lives had become unmanageable.” Being an addiction medicine doctor, I am a big advocate of 12 step programs like AA. The ‘Big Book’ of Alcoholics Anonymous has a lot of good stuff and even if you don’t believe in all that God-Stuff, it is full of information that is relevant in 2017, despite the fact that it was written in 1939. Another fundamental point made on p.30 4th edition of the Big Book is “We learned that we had to fully concede to our innermost selves that we were alcoholics. This is the first step in recovery.” I n my experience, those patients who readily admit that they are alcoholics and say they are alcoholics have a higher chance of recovery than those who have called me just to sober up for a while so they can drink like a gentleman or a lady. As they say in AA, ‘once a pickle, never a cucumber.’ That is, once your drinking of alcohol has spiraled out of control, the chance of returning to normal drinking is extremely low.
While advocating for AA, from a medical and practical standpoint, small chance that an alcoholic who is trembling and vomiting in alcohol withdrawal will delve straight into any sort of non-medical treatment program or 12 step program like AA until their alcohol withdrawal has been safely treated.
So what to do if you can’t stop drinking, the craving are bad, and as soon as you try to stop on your own, you start feeling anxious, shaky, sweaty, and crave alcohol?
Good question. The answer is alcohol detoxification also called alcohol detox or just detox. I often get asked for intravenous (IV) fluids to rid the patients body of all the evil chemicals that have accumulated from heavy drinking of alcohol. While it is true that heavy alcohol abuse can damage the liver and cause certain compounds in the blood to accumulate which we find on blood tests like elevated liver functions tests (LFTs) or elevated bilirubin, the value of IV fluids is highest if the patient is dehydrated and/or cannot eat or drink. While I am a spiritual doctor and do believe in God, I do not know of any evil spirits or toxins that accumulate as a result of drinking alcohol. So to eliminate the confusion, when we detox a patient, alcohol is the actual toxin–or poison so to speak–that the addiction doctor is addressing and treating.
Now I suppose the hardcore alcoholics have succeed in locking themselves in a room or being chained to a bed. Others may have found success going to some ‘dry’ region and I’m not talking the desert. I mean going or flying somewhere where alcohol does not exist–yes there are such place, even counties and towns in the USA in which it is illegal to buy and sell alcohol dating back from prohibition-era America.
If you are trying an at home detox without help and hunted around on the internet for home remedies, you have probably read that you should taper down you alcohol use, perhaps by using beer in lesser amounts. While I should admonish you as a physician, let’s be real. Addiction medicine doctors use tapers all the time to wean patients off other habit forming drugs and substances of abuse. While I do not condone this, if you are going to do this on your own, I would take a multivitamin, Vitamin B Complex, and Thiamine (which is Vitamin B1). Do your best to stay hydrated, eat nutritious foods, and go to an AA meeting as soon as possible.
If you are seeking medical help, what to expect? Well, the mainstay of therapy for treatment of alcohol withdrawal are the benzodiazepenes (the family of Valium medicines also called ‘benzos’). That’s right, addiction medicine doctors substitute one habit forming medicine for another. Unfortunately, these are the best tool in out tool box and they work.
While many benzodiazepene exist, chlordiazapoxide (Librium) is FDA approved for treatment of alcohol withdrawal. Lorazepam (Ativan) is one of my favorites to use as well. Why? Both are short-acting and allow flexibility of dosing. Sometimes I need to improvise if the patient is vomiting and cannot swallow pills in which case some orally dissolving formulation of clonazepam and alprazolam are available.
Remember that the most serious symptoms of alcohol withdrawal like seizures (and death can occur as a result) occur at days 3 to 5 typically so the treatment course needs to last a good week or so before the patient is physically in the clear, in general. One must consider variables as to how long and how heavily and how much the patient was drinking but this is general consensus.
Time for me to wrap up my blog for now as I have to give my 4 year old daughter breakfast but I wanted to add an important note on alcoholism. There is a lot of press about the opiod epidemic in recent years but let’s realize the current statistics: an estimated 88,000 American died in 2015 as a result of alcohol related deaths [Source: National Institute on Alcohol Abuse and Alcoholism https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics] while the 33,000 Americans died from opiod related deaths in 2015 [Source: Center for Disease Control and Prevention https://www.cdc.gov/drugoverdose/index.html]. I’m not trying to diminish the opiod epidemic as deaths are rising at an alarming rate and I will likely be writing about this in the future; however, I did want to emphasize the toll that alcohol continues to take and even though alcohol kills more Americans by a rate of nearly three to one, our treatment goals need not be focused nor eclipsed by the current opiod epidemic. Let’s keep a view of the big picture people.
Thanks for reading and comments welcome.