Issue 11

By 

Andrew John Tucker, LCSW, CASAC 

“Bad habits are like a comfortable bed, easy to get into, but hard to get out of.” ~ Unknown

Introduction 

I worked with Opioid Treatment clients for years, and one of the primary reasons people came into the clinic was to avoid opioid detox sickness. Quitting cold turkey is painful – usually taking 3-6 days, but with post-acute withdrawal syndrome (PAWS), the detox can last a month or more. My heart goes out to them every time. Like all substances, opioids are cruel – if you try to leave them, they punish you for it. They are a dysfunctional relationship – a Syd and Nancy experience enmeshed in a toxic sludge of over-dependence, death, and pain. It’s no wonder people do much better with medication-assisted treatment like methadone and Suboxone. The support, comfort, and opportunity for more help overwhelmingly have far better outcomes. But amidst all that suffering opioids have produced from overdosing on Heroin, Fentanyl, and now Xylenzene, contrary to popular belief, a cold turkey detox off opioids won’t kill you. You’ll feel like you’re dying – but your not. Nausea, vomiting, diarrhea, dehydration, restless legs, lack of sleep, irritability, anxiety, and a really crappy attitude – sure. And, of course, that may be enough to exacerbate pre-existing conditions, so we don’t recommend going cold turkey, but – death from opioid detox – doesn’t top the charts. Those slots belong to far more acceptable medications – not the ones with a dark ally, needles, and criminal elements – but the one’s the “functioning” people use all the time—mothers’ little (deadly) helpers. The two detoxes that are far most likely to kill you if you quit cold turkey are Alcohol and Benzos. That soft bed just got a little harder to get out of.  

What is Dependence?

We’ve heard the story before. Someone drinks for years, but they hold a job, make money, and show up for family functions. They are what we call a “functioning” alcoholic. Never mind the emotional vacancy or feeling that something is “off” about this person. They drink every day, but they work, so they’re ok, right? Sure….but their system doesn’t know that, and maybe one day they get pneumonia, and because no one considers them an alcoholic, they don’t consider the danger of not drinking for a couple of days. That’s when it happens. Almost out of nowhere, they stop making sense, start hallucinating, push mom down the stairs, and run into the neighborhood in their underwear. The neighbors call the police, an ambulance comes, and the education on dependence and alcoholism begins. The cat comes flying out of the bag. 

According to the National Survey on Drug Use and Health (NSDUH), which is conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 14.5 million adults aged 18 and older had alcohol use disorder (AUD) in 2019 in the United States. The Journal of Addiction Medicine tells us the mortality rate associated with alcohol withdrawal is estimated to be between 3 and 5%, but it’s probably higher. That means many people die each year from alcohol withdrawal simply because they either didn’t know or didn’t consider the potential consequences.  

The Four Horsemen

It starts with a few shakes of the hand and can blossom into full-blown Delirium Tremons or “DTs.” which is a severe form of alcohol withdrawal that can occur in individuals who have been drinking heavily for a prolonged period and suddenly stop or significantly reduce their alcohol consumption. DTs usually occurs within 2-3 days after stopping alcohol and can last up to 5 days. DTs are serious medical emergencies and can be life-threatening. 

In severe cases, DTs can lead to death due to various complications, such as:

1. Respiratory failure: During delirium tremens, the brain becomes hyper-excitable and can cause the respiratory center in the brainstem to malfunction. This can lead to abnormal breathing patterns, including shallow breathing or periods of apnea (cessation of breathing). In severe cases of delirium tremens, respiratory failure can result in a lack of oxygen to the body’s tissues and organs, which can be life-threatening. 
2. Cardiovascular complications: DTs can cause an abnormal heart rhythm, such as ventricular tachycardia or fibrillation, which can be life-threatening. These arrhythmias can cause the heart to beat too fast or irregularly, preventing the heart from pumping blood effectively. DTs can also cause a heart attack by blocking the blood supply to the heart. This can cause severe chest pain and shortness of breath and can be fatal if not promptly treated.
3. Dehydration and electrolyte imbalances: Individuals experiencing DTs can become dehydrated and develop imbalances in their electrolytes, such as potassium and sodium. This can lead to complications like Hypokalemia: a condition where the potassium levels in the blood become too low. Prolonged alcohol use can lead to decreased potassium levels, which can cause muscle weakness and cardiac arrhythmias and can be fatal if left untreated. Among others, there is also Hyponatremia: a condition where the sodium levels in the blood become too low. Hyponatremia can cause confusion, seizures, and in severe cases, cerebral edema, which can be fatal.
4. Seizures: DTs can cause seizures resulting in death from respiratory failure, rapid blood pressure changes, aspiration, cardiac arrhythmia, and blunt force trauma from falling.  

It’s essential to seek immediate medical attention immediately if you or someone you know is experiencing DT symptoms. Call 911 immediately. Treatment typically involves hospitalization, medications to control symptoms, and supportive care to manage vitals, dehydration, and other complications. It’s important to note that individuals who have experienced DTs are at increased risk of future episodes. They should seek help from healthcare professionals or addiction specialists to manage their condition. 

A Little Pill – A lot of Pain

The number two spot for the most deadly detoxes is Benzodiazepine. Alprazolam (Xanax), Diazepam (Valium), and Lorazepam (Ativan), to name a few. Their death rate from cold turkey detox comes in second at just under 1%.

According to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 5.3 million adults aged 18 or older misused benzodiazepines in the United States in 2019. That means thousands will die each year because they tried to stop on their own, ran out of drugs, or never thought it would happen to them. 

Medical complications from unsupervised benzo detox can include:

1. Seizures: Benzodiazepine withdrawal can cause seizures, particularly in people taking high doses of the drug or using it for an extended period. Seizures can be life-threatening in dangerous settings, such as near water or while driving.
2. Respiratory failure: Benzodiazepine withdrawal can cause respiratory depression, leading to respiratory failure and death.
3. Suicide: Some people may experience severe anxiety, agitation, or other mental health symptoms during benzodiazepine withdrawal. This can lead to suicidal thoughts or behavior.
4. Cardiovascular events: Benzodiazepine withdrawal can cause changes in heart rate and blood pressure, increasing the risk of cardiovascular events such as heart attack or stroke.
5. Complications from other conditions: Benzodiazepine withdrawal can be hazardous for people with pre-existing medical conditions, such as epilepsy or liver disease, who may be more susceptible to withdrawal-related complications.

Recommendations

The big message here? Seek help! Don’t try and detox yourself; strongly advise your loved ones or anyone you know dependent on these substances to go to the Emergency Room or gain admittance into a detox facility immediately so they can be safely and medically supervised. If they don’t want to do that, call a specialist in Addiction who can help navigate how to move forward safely. Also, substance use disorder is a shame-based disease, so we understand when there is hesitance to accept or seek help from fear of stigma. However, we would also remind you that substance use is a common experience and that many people struggle every year. It is not a personal or moral failing but rather a complex health issue that requires support and resources. Connecting with supportive communities and medical professionals who choose to specialize in substance use disorder can help people feel less alone and more understood. You are not alone. Seek help now – even if it’s just a call to vent and explore.  

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If you or a loved one would like guidance in practicing these techniques or is experiencing substance misuse, depression, or anxiety – call or text for a free 15-minute consultation. 646-504-6212.