How Alcohol Kills You

How Alcohol Kills

Too much of anything, no matter how pleasurable it may be in the beginning, can lead to harmful effects. Anything that you might enjoy- eating chocolate, shopping, playing cards, even exercising- may cause harm if it is overindulged in. The negative effects or the consequences of overindulgence are well known- obesity, bankruptcy, harm to the body, etc. The same can certainly be said about alcohol. Ethyl alcohol is a highly toxic substance that can cause serious damage, both physically to the body and psychologically to the mind. An occasional drink is not the issue. But if drinking takes on a substantial role in one’s life, the effects can ultimately be devastating. You drive recklessly, you have poor coordination so you fall on your head, your inhibitions are down, so you get mouthy in a bar and get yourself stabbed or shot. 

Let’s talk numbers. Excessive drinking remains a leading cause of premature mortality nationwide. Alcoholism is a widespread problem in the US, with nearly 90,000 deaths attributed to alcohol each year, according to the Centers for Disease Control. They have established guidelines to help determine what constitutes excessive drinking.

First: A “drink” is defined as a 12-ounce beer, 8 ounces of malt liquor, 5 ounces or wine, or 1½ ounces of liquor. Remember that some cocktails contain multiple types of liquor, so they may have more than 

1½ ounces each.

Excessive drinking is considered 8 or more drinks in a week for women, and 15 or more drinks in a week for men.

Binge drinking is considered 4 or more drinks in a single occasion for women, and 5 or more drinks in a single occasion for men.

Binge drinking is the most common form of excessive alcohol consumption, and is responsible for more than 50% of the deaths from excessive drinking. Binge drinking is a major cause of alcohol poisoning, and is a pattern of heavy drinking: in males, binge drinking is the rapid consumption of five or more alcoholic drinks within two hours; in females, binge drinking is the rapid consumption of four or more alcoholic drinks within two hours. These numbers may be lower, depending on a person’s weight and body composition. An alcohol binge can occur over a period of hours or last up to several days.

Binge drinking can cause alcohol poisoning. Alcohol poisoning is a very serious- and sometimes deadly- consequence of drinking large amounts of alcohol in a short period of time. Drinking too much too quickly can affect your breathing, heart rate, body temperature, and gag reflex, and potentially lead to coma and death.

Most people can easily consume a fatal dose of alcohol before passing out. Even after losing consciousness, or after stopping drinking for the night, alcohol continues to be released from your stomach and intestines into your bloodstream, and the level of alcohol in your body continues to rise. Unlike food, which can take hours to digest, alcohol is absorbed quickly by your body- long before nutrients are. Most alcohol is processed or metabolized by your liver, and that’s why the liver is so damaged by alcohol. 

Captain Obvious says that the more you drink, especially in a short period of time, the greater your risk of alcohol poisoning. There are several ways thatbinge drinking and alcohol poisoning kill you: 

Choking: Alcohol may cause vomiting. And because it depresses your gag reflex, the risk of choking on vomit if you’ve passed out is very high. If you don’t die from that directly, you can also die from aspiration pneumonia. Aspiration pneumonia often results when you breathe in vomit, and you are not able to cough up this aspirated material, so bacteria grow in your lungs and cause an infection. Yucky! And deadly!

Stopping breathing: Accidentally inhaling vomit into your lungs can also lead to a dangerous, fatal interruption of breathing, called asphyxiation.

Severe dehydration: Vomiting can result in severe dehydration, leading to dangerously low blood pressure and fast heart rate.

Seizures: Heavy alcohol consumption can lead to seizure in multiple ways, including trauma to the head from falling or auto accident, a sudden drop in blood sugar, and even upon withdrawl from heavy drinking. 

Hypothermia: Your body temperature may drop so low that you become hypothermic, leading to cardiac arrest.

Irregular heartbeat: Alcohol poisoning can cause the heart to beat irregularly, called arrhythmia, or even stop, called cardiac arrest.

Brain damage: Heavy drinking may cause irreversible brain damage. This can happen intrinsically or as a result of head trauma from falling or car accident, etc. 

Death: Any of the issues above can lead to death.

If right now you’re thinking you’re safe because you don’t binge drink, think again. If you have “just a few” drinks every night, that is considered excessive consumption, so those few drinks each night are killing you, make no mistake. 

When you think about the ways alcohol kills, some obvious ways spring to mind: trauma from car accidents, trauma from falls from being drunk, and general stupidity from being drunk, such as things that happen when alcohol lowers inhibitions to the point that you pick a fight you can’t hope to win (and you don’t) or you get lost and walk drunkenly into a bad neighborhood and get yourself killed. For the lucky people that avoid a trauma-related death from alcohol, the negative effects of excessive alcohol consumption may not be apparent for some time, but at some point there will be obvious signs that alcohol is killing them.

Ways Alcohol is Kills

It is mind boggling just how destructive alcohol is to the brain and body. The signs alcohol is killing you may creep up slowly, with a symptom here or there, or hit you all at once with a liver that has stopped functioning, as happens in late stage alcoholism. 

Signs and ways alcohol kills:

Cardiac issues: Long-term heavy drinking takes a heavy toll on the heart. Signs of serious cardiac issues that could result in death include atrial fibrillation and ventricular tachycardia, two signs of heart arrhythmia, ie abnormal heart beat. Alcohol can also lead to a heart condition called alcoholic cardiomyopathy, which is when the heart muscle weakens and cannot pump enough blood to the organs. This can result in organ damage or heart failure.

Cognitive dysfunction: Alcohol use can lead to brain damage, which shows up first as a reduction in cognitive functioning and problems with memory. Alcohol use often leads to Thiamine (B1) deficiency, which leads to significant brain damage. Alcohol also destroys the   hippocampus, the part of your brain involving memory and reasoning.  You get confusion, memory loss, and muscle coordination problems. You also interfere with the body’s ability to repair and build new nerve cells, called neurogenesis; it is much less effective. So without a sober brain, without a clear memory, and without thinking clearly, you will put yourself in very dangerous situations that may end with you dying. Or maybe you have so much confusion and memory loss that you take the wrong dose of medication or the wrong medication completely? Or you have such impairment that you drive and cause an accident or drive and get lost. It happens every day. I had a long time patient named Rona. She was a severe alcoholic; I don’t even remember how many times she went to detox and/ or treatment. She tried to quit drinking so hard and so many times. Back then, my office was in West Palm. One day she had an appointment with me, and I could tell she had been drinking, but she didn’t seem wasted. I told her for the eighteenth million time that she had to quit drinking, and Rona dutifully replied that she knew. I made sure that she hadn’t driven to the office and she said she would be taking the bus home, so I let her go. The next day I got a visit from two sheriff’s detectives, and they told me that  Rona was dead, and did I think that she had been suicidal. I told them she had not been suicidal and explained my assessment and protocol for suicidal patients asked how she had died. They said that she was downtown and walked out into the street and right in front of a car. Her whole left side and head were destroyed by the hood of the car, and she was Trauma Hawk’d to the trauma center. Unfortunately, she had massive internal injuries and severe head trauma and she died about 3 hours later. Rona’s story is an example of the kind of trauma that happens when people drink. I had another patient, a 36 year old man named Jennings, that had very poor coordination from drinking, but he didn’t think so. Jennings had this false illusion that he was as capable as everyone else, if not more so, and when he drank he thought he was invincible. His wife had divorced him about a year earlier so he lived alone. He either did really well for himself or had family money. I always suspected a combination of the two. One Saturday afternoon, he was sitting on his porch, drinking of course, looking at his boat at the end of the dock. While continuing to drink, he apparently got the bright idea that he wanted to take the boat out. He went and got it down from the lift and into the water, and then stepped from the dock into the boat to crank the engine. Then he got out and walked inside to get a cooler together, and he stepped again from the dock to the boat to load it in. He then evidently got out of the boat to get something else, and once he got it, he was stepping from the dock into the boat for the third time. But then his run of luck ran out. That third time, he didn’t quite make that step from the dock into the boat, and he slipped, hit his head on the side of the boat, and slipped unconscious into the water, where he drowned. It was a sad end to his life. 

Gastrointestinal problems: Alcoholism can cause acid reflux and excess acid in the stomach, which can lead to gastritis. It also causes irritation and inflammation of the stomach lining, which can cause painful ulcers and internal bleeding. Alcohol hampers blood clotting, so the loss of blood from these can be extreme, leading to anemia and causing extreme fatigue, or worse. Excessive drinking can also lead to stomach pain that may indicate chronic cholecystitis, a very serious gallbladder condition. 

Liver disease: Alcohol is incredibly toxic to the liver. The problem with liver disease is that the signs of it may not be detected until later stages, such as when cirrhosis occurs. At that point, the eyes will appear yellow, along with other signs of jaundice. Also, one loses their appetite so there will be sudden weight loss, as well as intense itching, weakness, and fatigue, and easy bruising. Cirrhosis of the liver, which often begins as fatty liver disease, is ultimately fatal, unless a liver transplant is successful. But before you die of cirrhosis, you are prone to die of fun things like esophogeal varices. These varices are abnormally dilated veins that develop beneath the lining of the esophagus as a result of the pressure from cirrhosis. The more severe the liver disease, the more likely esophageal varices are to bleed, and alcohol further thins the lining of the esophagus, which contributes to variceal growth, but also makes the varices more likely to bleed. And to top it off, alcohol thins the blood by wrecking clotting factors. So what does that mean? Ruptured varices. Which means all of a sudden, with no warning, blood gushes deep in the throat from all directions, choking you as you breathe it in and cough it up and eventually, you die. It is a painful, bloody, and terrible death, I promise. I have had many patients with very sick livers over the years succumb to esophageal varices. 

Pancreatitis: Alcohol causes severe pancreas issues and pancreatitis. The pancreas controls blood sugar by producing natural insulin. Alcohol interrupts this process, so the pancreas doesn’t secrete the insulin. Without the pancreas secreting insulin, your blood sugar sky rockets and you get diabetic ketoacidosis. This means that you have sugar in your blood, but you cannot get it into your cells without the insulin, and that leads to a host of metabolic issues and could easily end in you dead. 

Cancer: Excessive alcohol causes inflammation of the tissues, and this inflammation predisposes you to cancer. Types of cancer associated with heavy alcohol consumption include oral, throat, esophageal and voice box cancers, colon cancer, rectal cancer, pancreatic cancer, liver cancer, and breast cancer. The symptoms that may indicate cancer vary depending on the type of cancer, but symptoms generally begin with weight loss, fatigue, and pain in some area in the body. 

Absorbtion Syndromes: Alcohol also causes absorption syndromes. A big one is B12. Alcohol prevents you from absorbing B12 in your small intestines, and that leads to all sorts of muscular, brain, and central nervous system issues, causing confusion, memory problems, and eventually death. Alcohol also prevents you from absorbing folate. Folate is a neuroprotectant, so lacking folate causes memory issues. There are also anemias associated with lacking folate. 

Poor/ Lacking Sleep: Alcohol causes sleep disturbances. It causes snoring and sleep apnea, so you don’t sleep well and have inadequate sleep. And guess what? People who do not sleep have a shortened life span and a much higher incidence of accidental death. I had a patient named Richard. I don’t know if I would label him as an alcoholic, but he did drink at night and was a heavier weekend drinker. He had a really good job driving heavy machinery on construction sites. One day, there was an accident on the site. Richard had actually fallen asleep and he somehow hit a guy working on site. The injured guy was actually a friend of Richard’s. He was injured with a compound tibial fracture and was going to be fine after surgery, but Richard was sick about it. As a matter of course, the company tested Richard and found no drugs or alcohol in his system. After he told me about it, he admitted that he had fallen asleep on the job and that’s how the accident had happened. I asked him how he slept and he said he thought okay, but je was always tired during the day. I explained how drinking can interrupt sleep and the consequences of that and that I had the cure. He was excited until I told him the cure was to quit drinking. I told him that this time, he’d “only” hurt a friend and co-worker, that next time it might be worse. He said he’d think about it and left. Three days later, he was back, asking me to detox him. Hallelujah! That was almost three years ago, and Richard is doing well. He managed to keep his job and his friendship, and he’s a much happier guy, proud to look in the mirror again. So not sleeping can kill you, or maime you…or someone you care about.

Infections: Alcohol suppresses your immune system, which predisposes you to infections. These may be viral or bacterial infections. Both can kill you, especially if you’re in a physically weakened state from excessive alcohol consumption.

In addition to physical effects and consequences of alcoholism, life-altering impairment can be caused in many other ways as well. There are psychosocial issues, and these include legal problems due to DUIs, loss of a job, divorce, custody battles, and financial problems. There are so many signs…physical, mental, and psychosocial…that alcohol is devastating a person’s life. Make no mistake- the most devastating way alcohol affects lives is to end lives. If you drink, be aware and beware…it happens in far more ways than you could ever imagine. 

For more information and stories about alcohol use and abuse, please check out my book, Tales from the Couch, available on Amazon.com.

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They call her Nicky.

Her real name is Nicole, but everyone calls her Nicky. I want to tell you her story. She comes from New Jersey, but the family also has a Palm Beach estate where they spend a fair amount of time. Her family brought her to my office, and in that first appointment I spoke with all of them together to gather as much background as possible. She was 24, the baby of the family, with a brother named Vinnie and sister named Sasha. Nicky and her sister Sasha took after their mother; they were all beautiful, with dark hair, light eyes, and tan skin, but Nicky had a more striking exotic appearance that was unique among the three of them. The family is Italian, very wealthy, with the father owning several large car dealerships and car washes all over the place in Jersey. Nicky’s siblings Vinnie and Sasha both work for their father. He runs dealerships while she manages human resources. And then, there is Nicky. Nicky had her share of issues, but not everything was her fault. She came from a home where her mother stayed home with the kids, doing everything for them, while her father worked a lot and wasn’t home much. When he was home, he was drinking wine. Her mom also drank wine. Nicky had few memories of either parent without a wine glass in hand. They were alcoholics, but wine was where it began and ended for them, and it didn’t seem to be an obvious source of family strife. Her brother Vinnie was a bit of a partier, drinking more than he should and smoking marijuana, but he showed up at work everyday and did a great job running his assigned dealerships and making big profits for the family business. Her sister Sasha was an exercise fanatic; she worked out every day, and was in great shape. And then, there was Nicky.  

Now, you’re reading a story written by a psychiatrist who works with a lot of patients with addiction, so you probably know where this is going, but I’d like you to go on the ride anyway. Based on information I gathered from speaking with her parents and siblings, and of course Nicky herself, I learned that Nicky was an extremely precocious kid, both physically and in mind set and attitude. The journey that brought her to where she was now seemed to begin when she was 10 years old. Nicky at 10 was already obsessed with herself. She was into internet porn and pay-for-play live camera peep shows. She was fascinated by those and the people in them, and even thought the live camera show was something she could set up and operate for herself. She never even considered the thought that her very young age should stand in the way of her doing something she wanted to do, so she didn’t let it. She was also very preoccupied with social media, always posting inappropriate pictures and cyber-courting older men with provocative messages. She would get tons of likes and messages and friend requests, and she revelled in the attention, needing it as the very oxygen she breathed. Her mother showed me pictures of Nicky circa age 10, and I was somewhat disturbed by what I saw. The 10 year old in the picture was striking. Nicky certainly didn’t look 10….she looked closer to 15 or 16. Her hair was the blackest black, her green eyes were impossibly bright, and her skin was tanned. She had the kind of looks that could cause unwanted attention for any female, much less one that was only 10 years old. But then again, I knew that the attention she got was not unwanted…it was by design. 

As Nicky got older, her behavior and habits only got more concerning. In a picture taken of her at age 12, she absolutely looked over 18. As a result, she was able to buy cigarettes, so at 12 she started smoking on a daily basis. She was also drinking on weekends, courtesy of the creepy dude that worked at the liquor store….he wanted her and she knew it, so she did whatever with him, and in return, he let her buy booze and beer. In doing so, he also reinforced her notion that she could use her looks to get things in life that she wanted, a tactic that would serve her purposes well and often in the coming years. 

By 13, she expanded her repertoire by picking up marijuana and drinking more frequently, almost on a daily basis. She had no use for her very expensive private Catholic school. There is no question in my mind that she had undiagnosed attention deficit disorder. When she went to classes, she could not sit still. She was always hyper. At 13, she had a habit of smoking in the school bathrooms because she said it helped her to calm down. She was always getting in trouble, always acting out in her classes. Her parents were constantly getting called to school because she was impulsive, talking out of turn, always causing trouble, disturbing her classmates, and acting sexually provocative. 

At ages 14 and 15, she was still skipping classes to hang out with the wrong crowd, drinking every day and smoking marijuana. She was honing the art of how to exploit her own sexuality for her benefit and became even more impulsive, especially with spending money. She was spoiled, and had several of her father’s credit cards. She put these to good use, ordering thousands of dollars of merchandise online, whatever her heart desired. As she maxed out all of the cards, her father would pay them down and she would be back in the saddle again. 

By 16, she graduated to having sex on a regular basis. I’m not certain, but I strongly suspect that she was turning tricks for money. I hate to say these things of a 16 year old, but she was dressing far too provocatively; a lot like a prostitute, and she was acted like a prostitute, hitching her hip, smiling and waving at men in cars. What came to mind was, ‘if it looks like a duck and walks like a duck….’ Anyway, at this point, she would easily pass for 21, so her weekends and many weeknights as well were spent smoking marijuana and getting drunk in a dark and nasty local bar. One night, another bar fly introduced her to cocaine, and taught her how to line it up and snort it. And suprise suprise, she liked it. 

Her 17th year looked a lot like the one before, just with more of everything. She was now smoking cigarettes and marijuana every day, drinking every day, and snorting cocaine on weekends. She wasn’t hiding things as well at this point, and was barely passing her classes at school. But private schools are in business to make money, and evidently they were fine with keeping her barely passing….as long as daddy wrote them a check each semester. 

Once again, Nicky’s 18th year was a lot like the one before, with regular abuse of alcohol, marijuana, and cocaine. The big news was that Nicky somehow managed to graduate from high school, despite almost never going to class in her senior year. It was a Catholic school, so I guess her graduating could’ve been considered a miracle. More likely her father made a substantial “donation” for Nicky to walk across that stage to get her diploma. After graduating, she decided she wanted a change, so she moved into her family’s Palm Beach house. She supposedly had decided that she was going to get her act together and take some college courses at a nearby university. At least that’s what she told her father. Apparently she was convincing, and he gave his blessing, along with one of his credit cards and his first support check for $4,000.00. They had made a deal that he would send her that check every month, as long as she was getting her crap together. It was a pretty sweet offer, especially since she’d also have his credit card. That meant that his monthly check for $4 grand was pretty much gravy. A lot of gravy. And when she arrived at the Palm Beach house, guess what awaited in the driveway. A brand new car! She was spoiled, but that wasn’t really her fault. It was just the way her folks rolled. And surprise suprise, she liked it. 

She had time and money on her hands and wasn’t really working to get her life together, though she gave her father glowing narratives on how well she was doing. In reality, she had found a source for cocaine and marijuana and was still drinking all the time. She started dating a guy of like mind and similar habits and he introduced her to his friends. At a party shortly thereafter, somebody gave her some 10mg oxycodone tablets, Percocet, aka percs and told her to take two, so she did. And surprise suprise, she liked it. 

In no time, she was taking 4 to 5 percs a day, then after a month, 8 to 10 a day. She was spending a lot of cash buying as many as she could from the original guy that gave them to her as well as other drug-using acquaintances. One day while driving high, she wrecked her new BMW and was taken by ambulance to the hospital. She wasn’t seriously injured, but she complained of pain and flirted with the ER doc and managed to get a scrip for 60 percs. That lasted her all of about 5 days. Now she had an opiate habit, she was totally addicted to the percs. But then it became impossible to get scrips because Florida shut down pill-peddling docs and adopted super strict opiate guidelines. Nicky was out of choices. She talked to her friends and various contacts and hooked up with another opiate addict that was in the same boat. Unfortunately, his solution to his inability to supply his opiate pill addiction was to do heroin. **Please see the comment on this subject at the end of this blog.** 

Now back to Nicky. She was then officially introduced to heroin….how to buy it, the amount it takes to get high, its price, how to snort it, how to cook it, how to load a syringe and shoot it, the whole nine yards. And suprise suprise, she liked it. 

Nicky had only been in Florida for about four months. Her father had replaced the car she had wrecked and had it delivered. She wasn’t working or going to school, but she was drinking, smoking cigarettes and marijuana like a chimney and doing coke everyday. She was also thoroughly hooked on heroin, buying and using at least 10 bags a day. And her appetite for heroin was only growing with each passing week. 

It wasn’t long before her father’s $4,000 a month wasn’t sufficient to cover the cost of her booze at the bars, her 2 packs of cigarettes a day, marijuana, cocaine, and the newest addition, heroin. After only two months of using the heroin, she was doing tricks on the street to get more money, because the cost of her various addictions exceeded the $4,000 check her father sent every month. But that didn’t stop her. She just used more. And the more she used, the more she wanted to use, then the more she needed to use. She was up to 15 to 20 bags a day now. So, she was having to prostitute on the side even more frequently to get the money to support her ever-growing habits. She had also had a drug using friend move in with her in exchange for $750 a month, which she always used promptly after getting it. Then one Friday night after finishing with her “clients,” Nicky pointed her car toward home. It was about 3am, and the roads were quiet; traffic was mostly drunks recently kicked out of the bars. And wouldn’t you know it? Boom! Crash! She wrecked the car. She gave a story centering on a drunk guy and it was all his fault, not hers, yada yada. Thankfully, she wasn’t injured. But the car was toast.

She took a cab home and joined her roommate in snorting some heroin. She felt kind of wired, so she may have used a little more than usual. That little more was evidently too much, and she overdosed for the first time. Thankfully, her roommate was there and called 911. At the hospital, she was treated terribly. It was basically like ‘hey, you’re an addict and you overdosed. It’s your fault, so get out of our ER’ and she was discharged very quickly. Unfortunately, the overdose didn’t stop her. She didn’t even consider stepping down on, or getting off of anything she was using.

Nicky said her life at that time was a drug induced blur, reduced to a cycle of drinking, hooking, snorting, smoking, repeat. Before long, she had overdosed twice more and totalled her second and third new cars sent by her father. For the life of me, I cannot understand his thought process, what he was thinking when he kept sending new vehicles to Nicky like lambs to the slaughter.   

So, now, we are into this odyssey for about 14 months or so, these episodes of using, prostituting, crashing her car, overdosing. She was losing weight and started looking a little haggard, worse for wear. Still, she brought guys home from her hangout bar and they paid $300 to $500 for the pleasure. There was one guy that hung out at the bar named Jimmy, and she’d forged just a friendship with him, no business involved. He really had a front row seat to Nicky’s decline and truly wanted to help her. He knew of my practice vis a vis his friend that was a patient, and he begged her to see me. He was pleased when after only a couple of days she agreed. 

He brought her into my office and he said “Doc, please, you’ve got to help get her off all this stuff.” After learning that “this stuff” was alcohol, marijuana, cocaine and heroin, I knew we were going to have an uphill battle, but Nicky was willing to try, and Jimmy was willing to help. I explained that we had to detox her, because she had a $300 a day heroin habit, which was most likely laced with fentanyl. I continued to explain that she had to be off of the heroin for 24 hours before we could start the detox drug, buprenorphine. I could see that both of them were about to freak out, but I assured them that I would give him several prescriptions to dose her with. My plan was to basically knock her out to get her to sleep for most or all of those 24 hours. I gave him scrips for clonidine 0.1mg to give every 3-4 hours, quetiapine 50mg every 4 hours, mirtazapine 30mg every 12 hours, phenergan 25mg every four hours so she doesn’t throw up all these meds, and lorazepam to throw in there every hour if she’s not sleeping and for withdrawl symptoms. I figured the whole combo would knock out a moose, so she should be okay. I gave him my cell number and asked him to call me every four hours and whenever with any questions. I told him to make sure she hydrates and eats, and that I want her zonked out so that she won’t run and use. That was my concern. I explained that the first 24 hours would be the hardest, but that once that’s over, you take the buprenorphine and everything starts to improve. But I also again explained and reiterated not to take the buprenorphine until after the 24 hours. That if it’s taken sooner, it will throw you into an immediate and horrifying withdrawl. Everybody seemed to understand so I sent them to her house to start the process with Jimmy taking care of her. 

Nicky made it through the 24 hours, and she got on the buprenorphine.  She took one, then a couple hours later, another; then three to four hours later, she took a third; then three hours later, a fourth. And tah-daaaaah! She was completely clean of heroin. She still wasn’t happy, but I think that also coming off of cocaine, marijuana and alcohol at the same time was giving her a hard time. She continued with the buprenorphine the next day and the day after. On that third day, I saw her in the office. She had just barely started to clear cognitively, and that chaotic thinking, erratic behavior, and impulsiveness, it was starting to simmer down a bit, and she was just beginning to get real. She said that she didn’t want to be addicted to the buprenorphine. I always worry when newly detoxed patients want to go off the buprenorphine, because it may be a sign that they want to use, and they don’t want the buprenorphine to block the opiate so they can’t get high. I explained that it is not like heroin at all in terms of addiction potential. And I said that her life had been so unsettled since the age of 10, but especially in the last few years or so, her life was total chaos, fueled by drugs, heroin, cocaine, heavy alcohol use and marijuana. I told her she should just stay on the buprenorphine for a little while to stabilize her behavior and get into a healthy, clean and sober daily routine. Her neurotransmitters needed a vacation off of dope, and she would need time to see what life looks like when she isn’t gorked out of her mind, going without sleep for days on end. I told her that once we got her into a ritualized life where her behavior was more routine, then I would consider getting her off the buprenorphine. I convinced her to stay on it. I don’t do this with everyone. For people who only relapse for say a month, I would give them a week detox and they’d be fine. Maybe, if they got regular cravings over the next 10 days, I’d have them take a little of it here and there if needed. But with someone who has lived a chaotic lifestyle for nearly their whole lives and had been living a very heavily drug-addicted and dependant lifestyle for the past few years, there is no way I’d take them off right after detox. So, I followed Nicky for the next two or three months, and Jimmy was her strength and support; I don’t know that she could’ve come that far without him. She came for one visit in a month, then a second visit, but just before her third visit, Jimmy told me she was out and using again. She was back to the whole enchilada- heroin and coke and weed and booze and prostitution to help pay for them. Four months later, Jimmy brought her back in, just out of the big blue sky. We went through the whole detox shebang all over again. Unfortunately, this is not unusual. I got her back on the buprenorphine,16mg twice a day.  Again, I told her she had to stay on it to block the cravings and stabilize her lifestyle after the detox. 

On this second run, she followed up for six months, but then relapsed again, went out drinking, and that lead her back to the marijuana, heroin, coke, and prostitution. She was snorting heroin and she ended up overdosing. She was in the hospital for like five days, on a respirator for three of them, because she had aspiration pneumonia, which happens when you’re so gorked out that you puke up stomach contents and then inhale them into your lungs. It’s an easy way to die. She came back to my office about three weeks after she was discharged. She grudgingly said that the hospital stay was sort of beneficial because she obviously wasn’t doing any drugs while in there, but she also added that the doctors had told her that she had major lung damage and needed to quit smoking if she wanted to live to reach normal life expectancy. 

I think that this was the first time where Nicky saw that her behavior, her extreme drug and alcohol abuse, had serious physical consequences and repercussions. I told her point blank that if she wanted a life, it would have to be a clean and sober one. To this she just nodded. She went back on the buprenorphine once again; this time she would stay on it for two years. She started to build a normal life, and she wound up taking a job at a local dealership here owned by a friend of her father’s. She was actually very intelligent, very capable, and she did a good job for him, though she complained about the pay. I told her to keep the job regardless, at least for a couple of years while she was still settling her clean and sober life. At this point, she did not smoke, drink, take any illicit drugs, or prostitute. She kept the dealership job for two years, almost to the day. I started tapering her off of the buprenorphine, and at that point, I put her on something called modafinil for her attention deficit disorder and as a pre-emptive strike against the fatigue she would likely experience when I stopped the buprenorphine. As it turned out, she got so fatigued that she could not drag herself out of bed. Once on 200mg of the modafinil each day, her focus and energy improved a great deal. She was much more alert and active on the modafinil. 

Nicky moved back to New Jersey a while back, but I still see her in Facetime visits every month. She takes the modafinil everyday. She followed her brother and sister’s cue and now she’s working in one of her father’s car dealerships, and she’s training to become a manager. All in all, she seems to be doing well. She’s not dating because she thinks it’s too risky to go to the bars and such. She says she spends time with her “crazy, loud, obnoxious Italian family” her words, not mine. She eats a healthy diet, and goes to spin classes with her sister Sasha. She learned that she enjoys yoga, and practices it often. This is the part where I’d like to say that Nicky lives happily ever after, but unfortunately, I can’t right now. For the past several months, Nicky has told me that she goes through the motions of life, but she cannot enjoy life anymore. She said that after doing so many drugs, and so much of them, that she can’t be happy. Nothing lifts her spirits. I’ve tried antidepressants, and nothing seems to work. She feels like her life while drinking and drugging was so crazy, so chaotic, that now her sober life is so boring, monotonous, and mundane. And I can imagine that that’s true. She wasn’t just addicted to the drugs and alcohol, she was also addicted to the life and lifestyle that came along with them. In addition to our monthly Facetime visits, she also has a therapist she sees in New Jersey, but so far there has been no resolution to her problem with her boring life. After watching her struggle so hard to get clean and sober, it’s such a bummer when she tells me how she doesn’t enjoy life now. It’s kind of like when you were a kid and you could hardly wait to finish the whole box of cereal so you could get the prize they promised on the front of the box, only to find that they didn’t put one in your box….you got gypped. That’s how I feel about Nicky. She got gypped, and that sucks. But, she takes care of herself and keeps to her routine, dull as it may be to her. I’ll keep following her, and I think that with time, she’ll find a new normal and new happiness. That’s what I hope for Nicky. 

For more patient stories, check out my book, Tales from the Couch. It’s available in the office and on Amazon.com. 

**Comment from above

As most people know, this country is in the grip of an opiate crisis. Staggering numbers of people are dying of opiate overdose every day. Very often it’s from heroin, often laced with fentanyl. People that were addicted to pills found they couldn’t get pills anymore, so they started doing heroin. Please, if you are addicted to opiate pills, do not turn to heroin to replace the pills. And if you’re hooked on heroin, stop. Go to detox and get off of opiates entirely. I detox people all the time, and I assure you that with the medications I utilize, it is far safer and easier to do than you think. 

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The Dangers Of Alcohol

As an addiction specialist, I see patients abusing substances of all kinds. Today I’d like to talk about alcohol. It is so ingrained and accepted in our society. Pop culture would have you believe that you can’t have any fun or lead a fulfilling life without alcohol. During nearly every commercial break on television, there is an advertisement for alcohol, full of smiling people having the time of their lives like they’re on a permanent vacation. As a matter of fact, as I write this, I have a television on in the background, and there was just a commercial for a Mexican beer. It was a fiesta, with women in bright costumes dancing around and people cheering and cheersing with cold cervezas. The message: you’re clearly missing out if your life doesn’t resemble the lives of these people, but if you drink their beer, your life can be as awesome as theirs.  

Fermented grain, fruit juice and honey have been used to make alcohol for thousands of years. Even early Greek writings warned of the perils of alcohol. In our modern world, the dangers of alcohol are well studied and well known. Despite this fact, alcohol is the most common drug used and abused by people. Here are some sobering facts and figures: an estimated 15 million Americans suffer from alcoholism, and nearly 90,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. 40% of all car accident deaths in the United States involve alcohol, claiming approximately 10,000 lives a year. According to the Institute of Alcohol Studies, consuming larger amounts of alcohol can cause more than 60 different health issues and hundreds of physical conditions.

Day in and day out, I witness the ravages of alcoholism, and it’s not pretty. Alcohol in any amount affects every part of a person, inside and out. It’s just a matter of degrees. 

What are these effects? Let’s start with the outward appearance. While drinking moderately may not have immediate disadvantages, over time you’ll start to notice them- especially when you look in the mirror. Drinking alcohol dehydrates you, which makes hair follicles dry and brittle and more likely to cause hair to fall out. What hair you have will look crispy with split ends. Heavy alcohol use can lead to permanent damage to the health of your hair. It can also cause hormonal issues like increased estrogen, which can cause problems with hair growth and loss, particularly in men.   

Drinking too much also dehydrates and deprives the skin of vital vitamins and nutrients. Instead of being soft and hydrated, your skin will begin to look cracked and wrinkled. This will leave others thinking you may be older than you actually are. Excess alcohol also alters blood flow to the skin, leaving an unhealthy appearance for days.Alcohol can also cause your face to look pale, bloated and puffy.Sometimes the blood vessels on your face burst and the capillaries break, causing a chapped look. Not only can your face become red, but the tiny blood vessels in your eyes become irritated and rupture, causing bloodshot eyes. Not cute. 

Over time, drinking heavily can have other, more permanent, detrimental effects on your skin. Rosacea, a skin disorder that starts with a tendency to blush and flush easily is linked to alcohol consumption. Continued alcohol consumption can eventually lead to a condition called rhinophyma, a facial disfigurment that is a subtype of rosacea, where large, red, pus-filled bumps develop on the face, commonly on the cheeks, chin, and especially the nose, where it can cause severe bulbous distortion. If you have rosacea, I strongly urge that you google rhinophyma and that you don’t drink. 

Let’s not forget that alcohol is fattening, high in empty calories. A couple of gin and tonics and a pint of beer equal about the same calories as a big fast food burger. You might be surprised to find out what the junk food calorie equivalents are for your favorite drinks. Alcohol also bloats your stomach. “Beer belly” is real people, but not only caused by beer. And then there’s cellulite; many believe the toxins in alcohol contribute to its build up. 

A less often discussed result of drinking heavily is B.O. Yes, the bad odor emanating from the body after a long night of drinking is directly related to the alcohol seeping from it. According to the Institute of Alcohol Studies, over 10 percent of alcohol consumed leaves the body unused through your sweat, breath, and urine. While pretty much everyone can smell it, non-drinkers are generally especially susceptible to the odor. And it is gross. Keep that in mind the next time you wake up after a bender. Your body odor could leave a lasting impression.

Let’s move from external effects of alcohol and go inside the body, starting with the brain. Obviously, when you’re drunk, your brain is impaired. There is loss of inhibitions, confused or abnormal thinking, and poor decision-making. But I want you to understand the chronic effects of alcohol on the brain and cognition, the long term effects. So, how does alcohol impact cognitive ability? Clearly, the impact is directly related to the frequency and quantity of alcohol consumed. 

Occasional and moderate drinkers:
– Memory impairment
– Blackout
– Recklessness
– Impaired decision-making

Heavy and/or chronic drinkers:
– Diminished gray matter in the brain
– Inability to think abstractly
– Loss of visuospatial abilities

-Memory loss

-Loss of attention span

In general, heavy alcohol use causes the brain to shrink. Any alcohol use causes clouded thinking, slow thought process or delays in cognition. If you drink at night – even two drinks – the next day, your thoughts aren’t as fluid, you’re not as clear, you’re not as creative. Alcohol use changes behavior. You may develop psychological issues,  personality issues. It is well established in the mental health field that alcohol consumption can exacerbate underlying mental health disorders. People become more irritable, anxious, and depressed when they drink. So why do it? People use it as a coping skill. It lowers inhibitions, gives “liquid courage” and allows us to do things we wouldn’t normally do. Some people use it to keep a job they hate, or to stay in a miserable marriage. It numbs pain, it’s an escape hatch for the psyche. It becomes a solution to a problem, or a way to mask the problem. Just as we are all different, the way alcohol affects us all differently. 

The following factors have been shown to influence how alcohol impacts a person’s brain functioning over time:
-The volume a person drinks
-How often a person drinks
-The age at which drinking began
-The number of years a person has been drinking
-The person’s sex, age, and genetic factors
-Whether the person’s family has a history of alcoholism
-Whether the person was exposed to alcohol as a fetus
-The person’s general health 

One of the biggest problems with alcohol that I see is trauma, people getting hurt. When you drink alcohol, your decision making is impaired. The brain that usually protects you is suddenly impaired, so you fall, you fight, you drive a car recklessly, and your coordination is off. You’re going to fall or make a bad decision and get hurt. So many accidents and deaths are attributed to alcohol. It’s especially disturbing because they’re preventable.

There is no bodily system that alcohol does not affect. What are other physical dangers of alcohol? Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, liver, and breast. The common thing that everyone understands is liver damage with alcohol. It causes fatty liver and cirrhosis of the liver which eventually kills you. There are a host of digestive problems with alcohol consumption: peptic ulcers, bleeding ulcers, diarrhea, pancreatic cysts/disease/failure. Alcohol can lead to diabetes, a compromised immune system, lung infections, stroke, and heart disease. It can be associated with memory issues, learning disorders, and neurological problems, where you have numbness in your arms and legs, lack of coordination, and slurred speech.   

Alcohol plays a role in other issues as well. Family problems, legal problems, and social problems. One of the biggest concerns with drinking frequently is (or should be) dependency, becoming an alcoholic. Right now, I’m sure almost 100% of you are thinking ‘I‘d never become an alcoholic.’ There’s a television show called Intervention that documents the trials, tribulations, lifestyles, and consequences of alcoholics and drug addicts. None of them planned on becoming alcoholics back when they drank socially or just had a few drinks at night. The great news is that if you never make alcohol a part of your life, guess what? You’ll NEVER have to be an alcoholic or deal with all of the issues that come with it. I can’t stress enough how strongly you should take this to heart. 

By now I’m certain that you understand the ravages and damages of alcohol use and abuse. But the dangers are minimized and we’re desensitized to it by pop culture; it’s so ubiquitous that we accept it as a part of life. If you tell someone that you don’t drink, they look at you like you have three heads. It is ingrained in every aspect of our society in terms of weddings, funerals, bars, restaurants, hotels, public events, private events, and clubs.  

Have you ever noticed how glorified alcohol is? They put it in these beautiful bottles. I admire alcohol bottles. The artistry and sculpture of the bottles…they’re just beautiful. They look like there must be something very good inside, so you want to find out. When you go to a restaurant, the first question is always, “Would you like a drink?”  Now, children’s birthday parties even serve drinks to the adults. If it’s so safe, why don’t we serve it to children? It’s because we know it’s poison, we know it’s dangerous, but it’s minimized. It’s socially acceptable. I’m not for prohibition; I think there is a place for alcohol in our society, but it shouldn’t be so glorified and so easily accessible. We need to acknowledge it’s dangers and be more restrictive with it. Take all-you-can drink mimosa or bloody mary brunches or happy hours for example, where drinks are two-for-one. These things encourage drunkenness, and then people leave with alcohol-induced poor decision skills and car keys in hand. These sorts of events need to be seriously restricted. There should be no event where we encourage people to get drunk. We should not condone its overuse or extoll its virtues. 

With all of that said, how does an individual stop drinking alcohol? It’s a simple theory. You make a decision to stop, and then you stop. There is no other way. If you’re not in control of stopping, then who is? I’ve spent more than thirty years medically detoxing and working with people with alcohol and drug addictions, and I assure you that there is no other way to stop other than the person making the decision to stop and living with it. I’m not saying it is easy, especially with alcohol all around us in grocery stores, restaurants, on television, on billboards…it is everywhere. But it can be done. I see it every day, people living fulfilling lives without alcohol. If you want to be one of those people living without alcohol, make an appointment. I can help you. I talk more about this in my books, A Chance to Change and Tales from the Couch, both available on Amazon.

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