British singer-songwriter Amy Winehouse rocketed to fame singing about her refusal to go to rehab. So when she died recently at age 27, many people assumed her legendary addictions to drugs and alcohol were to blame.
How did Amy Winehouse die? The full autopsy report is still pending, but her family recently announced that no illegal drugs were found in her system. What’s more, they speculated that what killed Winehouse was her attempt to stop drinking on her own.
In fact, alcohol detox can be deadly, if it’s tried cold turkey.
Dr. Ryan Estevez, a University of South Florida addiction specialist and assistant professor in the department of psychiatry, has shepherded thousands of substance abuse patients through detox. He says there is no question that the experience, if mishandled, can be life threatening.
And alcohol, the most commonly abused substance, can be worse than drugs when it comes to withdrawal.
“Alcohol is the most dangerous one,” Estevez said. “Even withdrawal from heroin won’t kill you but alcohol withdrawal can, if you are a heavy drinker.”
Here’s more of our conversation with Estevez:
Q: What is the right way and the wrong way to do detox?
A: The right way is in a hospital or certified detox centre setting. The wrong way is to stop drinking cold turkey. A lot can go wrong quickly. It can also be real dangerous for a well-meaning family member to just take away alcohol from a heavy drinker.
Q: How do you know which category you’re in?
A: If you wake up and need a drink to start the day, an eye-opener, that’s a good first sign that you are dependent on alcohol. If you experience shaking or tremors after several hours without a drink, that’s a sign of dependence.
Q: What can happen during withdrawal that’s so dangerous?
A: Seizures, what we call delirium tremens and some people call the DTs. You have to be treated medically for that. The heavy, daily drinkers, the alcoholics, are at risk. We see it in the hospital all the time. People come in for some other reason and all of a sudden they go into acute withdrawal because they aren’t drinking. It can cause shaking, a spike in blood pressure, horrible anxiety, uncontrolled thrashing around. They can become violent, not purposely, but they aren’t aware of their surroundings. We have to treat that with medications.
Q: What happens in detox? What’s the role of medication?
A: We use medications like Xanax, Ativan, Valium and Klonopin (all sedatives known as benzodiazepines) in a carefully controlled protocol to stop or prevent seizures and minimize discomfort. Some patients may require anti-seizure medications, too, but 90 per cent of patients can be treated with benzodiazepines, which reduce anxiety and other symptoms.
A nurse will check on them every 15 minutes at first, take their vitals and monitor them for clinical signs of withdrawal.
That helps determine the dose and frequency of medications. Then you are slowly weaned off the medications that are helping you detox. Ideally, the detox program will also address some aspects of recovery and will offer group and individual therapy.
Q: What needs to happen after detox?
A: Detox is the easy part. It’s the sustained recovery that really challenges a person and whatever is going on psychologically that drives them to drink. Ideally the detox centre will set up a plan for recovery. Alcoholics Anonymous is a wonderful program that saves millions of lives. There are meetings at all hours of every day. If you can see a psychiatrist or psychologist once or twice a week at first and go to AA meetings every day, that’s the best of both worlds.
Irene Maher contributes to Scripps Howard News Service. imaher@sptimes.com.