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.Learn More
Ivan’s Addictions: Alcohol Detox
I want to discuss what people can expect when detoxing off of alcohol, inspired by my patient Ivan. He was a long-time patient, though I hadn’t seen him in a while. He was big time addicted to opioids years ago, and he had dragged his sorry butt into my office, barely coherent, begging for help. That’s how we met. I managed to get him clean off of the oxy’s he so dearly loved, but I would learn that Ivan had a very addictive personality…this guy could get addicted to oxygen. Anyway, that’s where it started with Ivan, and over the subsequent years I saw him in the office here and there. Now fast forward twenty years and in walks Ivan. It looked like the years had not exactly been kind to him. He looked like an alcoholic. Red swollen nose, check. Ruddy grey skin, check. Blood shot eyes, check. Balance just slightly off kilter, check. Gaunt frame with distended belly, check. I could go on, but suffice it to say that after so many years of doing what I do, I can spot an alcoholic from 50 yards. He said he was still clean, off opiates, but admitted to drinking in excess for many years. I burst his bubble with a sharp prick of cold harsh truth: he was an alcoholic. When I said it, he might’ve flinched, but he didn’t argue.
I asked him what he was doing for work. He said he was rehabing properties. He had inherited some money, bought a bunch of properties, fixed them up and rented them out. He collected the rent paychecks every month from his “magic money mailbox.” That sounded great, but the down side of this equation was that he wasn’t expected to be anywhere at any given time. And that left a lot of time for drinking. When I asked how much he was drinking, he admitted to drinking at least ten of those 2 ounce airline mini bottles a day. He had found some place where they only cost a buck a bottle. I was floored. That is an incredible deal. But I digress. I told him that we would have to do a medical detox, and he was on board. What follows are all of the things I told him.
To start, I explained that he needed to hydrate. Even though alcohol is liquid, it is very dehydrating, so there must be copious amounts of water during detox. As I told Ivan, drink water until you think you’ll burst. Next, start eating healthy foods. This is critical, getting food in your system, because alcohol causes irritation of the walls of the stomach and intestines. Also, you have to kick start the digestive tract, because alcoholics don’t eat well, if they eat at all. Next, start taking an over the counter stomach proton pump inhibitor like Prilosec or Prevacid. This will help to decrease the acid in the stomach as well as heal the stomach wall and the esophagus. Next, start taking B complex vitamin and multivitamin to replenish the system. He said he understood as he dutifully wrote all of this down.
Next, I explained the important warnings about detox, the reasons why it’s important to medically detox. We have to use a type of drug called a benzodiazepine to prevent severe alcohol withdrawal. Without it, you will start shaking, you can become delirious and confused and have grand mal, full body seizures. There is a possibility of death: up to 25% of people actually die from severe alcohol withdrawl when they don’t use the benzodiazepines. I use medications liberally to prevent the withdrawl and safely detox. My goal is to keep patients comfortable with meds, but never nodding out. I wrote a scrip for 2mg alprazolam and told him to take one 2 or 3 times a day. I also gave him one to take immediately in the office because it had been 16 hours since his last drink and he was really starting to feel it. He had all of his instructions, so I told him I’d call him at 8pm that night as well as every six hours thereafter, and that he could call my cell phone anytime with questions or problems. With that, he left.
That night when I called, he said he was feeling not so great, but that he had eaten, was drinking lots of water, and taking the vitamins. When I called him the next morning, he said he woke up feeling very uneasy, very tense, and with some slight tremor. I told him to take the alprazolam right then and to take another in the afternoon around 2 or sooner if he felt tremulous. He repeated the alprazolam schedule on day 2 and also took it that night. When day 3 came, I explained that this is the most dangerous time. While seizures and delirium can happen at any time, they are most likely to happen on day 3. It’s also the worst day. It was really tough for Ivan. He was sweating. He had tremors. He was a little confused. His girlfriend came over and made him chicken soup, served with some TLC, and checking to be sure he was hydrating and taking the vitamins. He took the alprazolam three times that day, but didn’t sleep much. I gave him a drug called mirtazapine for sleep, and this helped. The fourth day dawned and Ivan saw the light at the end of the tunnel. Day 4 was better than day 3, but he was still feeling tremor, still sweating, and still needed 2 alprazolam that day. On day 5, he had no tremor. The sweating had lessened, but he still felt restless. He took just 1 alprazolam that day. As of the 6th day, he didn’t need the alprazolam at all. The detox was done. I told him to continue the vitamins and the Prilosec stomach meds for 2 months, keep up the improved diet, and keep hydrating.
Ivan followed all of my instructions and he came out the other side and did pretty darn well. He got in great shape by walking his dog Malcom for a minimum of 3 hours a day, and he felt better every day. In fact, Ivan had dodged some serious bullets in that he had no major organ damage from the alcohol. There are several very common things that go bad with alcoholism. Most didn’t happen to Ivan, but let me caution you what can happen with alcohol abuse. Pancreatic issues are common. The pancreas is the most important organ for blood glucose regulation and digestion. You become a diabetic if your pancreas shuts down. Gastritis quickly becomes a potentially lethal problem. Gastritis is extremely dangerous, it is irritation or bleeding of the stomach, leading to bleeding ulcers. Aspiration pneumonia is a concern: where you are so drunk that you throw up or cough up stomach contents and you breathe the stomach contents into your lungs, causing a serious and life threatening infection. A very common issue with alcoholics is that they get drunk, fall, and break a bone or hit their head, causing subdural hematomas of their brain. And you can’t forget liver disease. One of the key features of chronic alcohol abuse is liver failure and liver cirrhosis. The liver shuts down and so the body diverts the blood flow around the liver because the liver is so scarred and gnarly that it no longer accepts blood. As a result, you get big vessels forming in the esophagus and rectum, and they explode, causing hemorrhage and death. Ivan was lucky… he didn’t have any of those things. But he didn’t get off scott free. The most common thing I see with alcohol- that no one escapes- is cognitive damage. The brain slows down. It is permanently damaged. As a result, you cannot think straight. You are not as coordinated as you were. You become less active so there can be muscle wasting. These had happened to Ivan. As I said, no one escapes this. So Ivan was little bit slower, a little less coordinated, legs a little weaker. But he’s not drinking, and that’s a major accomplishment. I’ll continue to follow him in his clean and sober life. If you are abusing alcohol, Ivan would advise you to medically detox, as would I. If you would like to read more about alcohol withdrawl, medical detox or more patient stories, check out my book, Tales from the Couch, available on Amazon.com.Learn More