The death of actor Nelsan Ellis this month is a reminder of the serious, and potentially fatal effects of alcohol withdrawal on the body.
In fact, experts say that any program for becoming sober should not be entered into lightly.
But making the decision to become sober is a step worth taking.
“Quitting can be done safely and is safer than continuing to drink heavily,” Dr. Richard Saitz, chair of the Department of Community Health Sciences at the Boston University School of Public Health, told Healthline.
In addition to the psychological aspects of alcohol addiction, the ailment also has significant short-term and long-term physiological impacts on the body.
During alcohol withdrawal, symptoms will likely manifest, although to what extent depends on the severity of the addiction.
What can happen during withdrawal
Alcohol is a depressant, meaning it slows or lowers the functioning of the central nervous system.
Through chronic usage, the body eventually becomes conditioned to the presence of alcohol and is able to adapt to it.
During withdrawal, the functioning of the central nervous system attempts to readjust to the lack of alcohol.
“When you remove the alcohol, the system becomes overactive or hyperactive, out of balance again,” said Saitz. “Before it adapts to not having alcohol around, there is a hypersympathetic state ... which means rapid heart rate, higher temperature, and sweating, among other things.”
Anyone who has had a hangover has experienced these symptoms to some degree.
“We shouldn’t overstate the risks,” said Saitz. “Most people with physical dependence on alcohol actually cut down or quit with no medical attention, medications, or supervision, and they do so without complications.”
However, there are exceptions that may require medical assistance.
The most serious effects
More serious symptoms of withdrawal, known as alcohol withdrawal syndrome (AWS), can include delirium tremens (DT) in people with a severe alcohol addiction.
The effects of AWS can appear within hours of stopping drinking, or several days later.
Symptoms of AWS often include shaking, headache, high blood pressure, anxiety, and tachycardia (increased heart rate).
DT is also a serious type of alcohol withdrawal that can be fatal.
It is common among people with a history of alcohol withdrawal, those who drink heavily, and those who have had an addiction to alcohol for more than 10 years.
The most serious symptoms of DT are seizures, hallucinations, and confusion. However, many other symptoms, including sensitivity to light, confusion, and nausea, may also be present.
More serious symptoms of AWS and DT can lead to physical trauma due to seizures, as well as metabolic issues.
Low electrolyte levels can lead to cardiac complications during withdrawal, including arrhythmias and sudden death resulting from heart attack.
Hypophosphatemia (low levels of phosphate) can lead to muscle weakness, coma, and the stoppage of normal breathing functions.
Metabolic abnormalities can typically be corrected through an adequate intake of vitamins, fluids, and sugar. Regular over-the-counter medications can help with more benign elements of AWS, such as headache and nausea.
“The consequence of metabolic derangements also can affect heart and lung function — as in both can stop — if the blood becomes too acid, which can happen after a seizure or as a consequence of heavy alcohol use,” said Saitz.
A condition known as alcoholic ketoacidosis, is similar to that experienced by some individuals with type 1 diabetes mellitus. It is caused by alcohol’s effect on the pancreas’ ability to produce insulin.
Alcoholic ketoacidosis is a potentially fatal condition, but it can be treated with proper medical attention.
As far as drugs are concerned, only benzodiazepines, such as diazepam (Valium) and lorazepam (Ativan), have been proven to reduce the risk of the fatal complications cause by seizures and DT.
“The goal is to achieve a calm but awake state to keep someone safe. In general, a quiet room with personal reassurance and reorientation, and less bright light is also helpful,” said Saitz.
However, some clinicians choose to avoid benzodiazepines because of their addictive nature.
For those interested in stopping drinking, it is important to seek medical attention (even if it is just a checkup), especially for people who drink heavily, when there has been long-term alcohol abuse, and for those who have previously experienced DT or seizures caused by alcohol abuse.
For severe alcohol addiction, medical intervention may be needed to oversee the potentially dangerous effects of AWS and DT.
But, for those seeking long-term sobriety, withdrawals are just the beginning.
“The most important thing is to get help for the long run to stop drinking,” said Saitz. “Getting help with withdrawal has little to do with how to stay abstinent.”
“The most important thing is the next step — getting counseling and medication to treat the underlying condition [as well as] a social network that is supportive of that goal,” he added.