By: Jayne O’Donnell – usatoday.com – November 27, 2018
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On day three of Lowell Cauffiel’s final detox from alcohol, a giant rabbit in a tuxedo and top hat tapped on the window of his second-floor bedroom.
Cauffiel, a bestselling true crime author, Hollywood screenwriter and producer purposely didn’t go to rehab 34 years ago. When he abruptly stopped drinking two fifths of bourbon a day, he wanted to experience the full effect of withdrawal.
The week-long process started with the feeling that his “guts were being pulled out.” He shook. He sweat. He suffered some very vivid hallucinations.
“I knew it was going to be rough, but I wanted to use it as a motivation to stay sober,” Cauffiel says.
It was, and it worked. Cauffiel never took another drink.
But he could have killed himself.
Doctors say alcohol is often the most dangerous substance for the body to withdraw from – and still more so, when attempted without medical supervision.
About 16 million people in the United States have alcohol use disorder, which the National Institutes of Alcohol Abuse and Alcoholism define as “compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.”
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For those experiencing the most serious symptom of withdrawal – the shaking, shivering, sweating and confusion of delirium tremens, or the DTs – the death rate has been estimated as high as 4 percent, or 1 in 25.
Of patients admitted to one hospital in Spain with alcohol withdrawal syndrome from 1987 to 2003, a research team there found, 6.6 percent died. That’s roughly 1 in 15.
The Centers for Disease Control and Prevention counted 831 deaths in 2016 that could be characterized as related to alcohol withdrawal. The National Institutes of Alcohol Abuse and Alcoholism do not have an estimate of deaths from alcohol detox.
One recent casualty was the actor Nelsan Ellis, a star of the HBO series True Blood, who died last year from complications of alcohol withdrawal, according to his family. His father said he “was ashamed of his addiction and thus was reluctant to talk about it during his life.”
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Total alcohol deaths – through cancer, liver cirrhosis, pancreatitis, suicide and other causes – increased 35 percent from 2007 to 2017. The greatest increases were among people over 30 and women, who saw an 85 percent jump.
There was also a significant increase in emergency room visits related to binge drinking.
Along with patching up injuries and pumping fluid out of the stomachs of those addicted to alcohol, hospitals regularly have to deal with people going into abrupt withdrawal after they’re admitted.
The danger of withdrawal from alcohol, as from other drugs, “has to do with the body’s response to the extreme changes in the chemical processes going on in the brain and the rest of the body,” psychologist Adi Jaffe wrote in Psychology Today.
Compounding the risk is that few people are honest with their doctors about how much alcohol they drink.
Dr. Malissa Barbosa, area director at CleanSlate addiction treatment centers in Orlando, says she typically assumes twice the amount patients tell her, to be safe.
Barbosa, a former primary care doctor in rural Pennsylvania, recalls a typical case.
A patient wasn’t “very open about their alcohol abuse,” she says. The patient had hip surgery – and then the DTs set in. The patient ended up in intensive care.
Delirium tremens typically starts 48 to 72 hours after the last drink. Patients suffer confusion, a racing heart beat, high blood pressure, fever and heavy sweating. In extreme cases, delusion, violent shaking and visual, audio and tactile hallucinations – the sensation of bugs crawling on the skin – and even seizures.
When Susan Moore’s father was hospitalized in the mid-1970s for a minor surgery, she says, he was given a shot of whiskey each morning and evening. Doctors wanted to prevent a deadly detox.
The drinking ultimately killed him in 1996, the New Mexico woman says. The death certificate even said “alcoholism.”
Moore, now 72, quit drinking in 1988. Her husband refused to stop, she says, and they divorced.
Around 2004, she says, her ex-husband was undergoing an angioplasty surgery when he went into alcohol withdrawal. He was put in a medical coma.
Within two months, his family says, he was drinking again. He died in 2014 at 65 of “chronic alcoholism,” according to Lynda Moore, the couple’s daughter.
Lynda Moore, 48, sent her mother a bouquet in August with a balloon saying “I’m grateful” to mark the anniversary of her mother’s sobriety.
“She never forgets it and is very supportive and understands the struggle well,” Susan Moore says. “She has borne a lot.”
Even people who drink as little as two glasses of wine a night over many years can experience withdrawal symptoms when they stop, Barbosa says. People who drink four or more drinks a night should seek medical help when attempting to stop, she says.
Less extreme withdrawal symptoms include anxiety, shaky hands, headache, nausea, vomiting, insomnia and sweating. Those symptoms can be mistaken for a virus, Barbosa warns, which could lead people to miss the onset of withdrawal.
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