As a General Practitioner doctor, I have dealt with my fair share of patients battling addictions, most commonly alcohol addiction, but it is not unusual for me to be managing patients who have addictions to heroin, cocaine and marijuana – and sometimes a combination.
These people suffer from an illness and need support from a number of agencies. During a pandemic, while we are living in lockdown and are unable to mix freely with other people, getting this support can be a major challenge for those seeking help with an addiction.
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Under usual circumstances – when there is no pandemic – people battling an addiction can access doctors and support groups, either in crisis or as a result of illnesses or injuries secondary to their addictions.
Indeed, living in lockdown could well fuel an addiction, making it more severe. Self- isolation, unemployment, increased spare time, and family dynamics could all contribute to this. Loneliness, in particular, has been shown in studies to increase the risk of alcoholism.
However, lockdown also means that the supply of whatever you are addicted to may be restricted. If someone in active addiction cannot get adequate supplies, they may face having withdrawal symptoms at a time when services are least able to give them help and support.
As alcohol dependency is the most common addiction I treat, I will focus on this. People with alcohol dependency are a vulnerable group when it comes to a potential coronavirus infection due to the other illnesses they may have that are secondary to their alcoholism.
It is good to see that many organisations such as Alcoholics Anonymous (AA) have moved recovery support meetings online, but people who are suffering from addictions often need face-to-face support and human touch. This has meant that some people in early recovery – those who are in the early stages of trying to give up an addiction – find themselves going it alone, often to the detriment of their health.
Being weaned off alcohol and drugs can take weeks or months for those with a severe addiction – even when they have support in the community. These people need careful supervision from a professional; going it alone at home could be dangerous.
The severity of alcohol withdrawal symptoms can depend on the length of time the person has been drinking and the amount of alcohol regularly being consumed, and also on whether there have been any previous severe withdrawal episodes. The higher the number for each one of these, the worse the withdrawal is likely to be.
Alcohol withdrawal syndrome typically starts six to 24 hours after your last drink.
Alcohol works on the receptors of cells within the main body of the nervous system, upsetting the balance between the chemical transmitters that send messages to nerves and the nerves themselves.
In broad terms, it increases the activity of a chemical transmitter that slows down nerve impulses, producing the typical symptoms of feeling intoxicated – lack of coordination and drowsiness.
At the same time, it decreases the activity of another chemical transmitter that is responsible for a cell’s response to stimulation. Because this particular chemical transmitter binds to specific receptors on cell membranes to make them respond to stimulus, when alcohol decreases its activity, the cells think there is less of it around, so they compensate by making increased numbers of the receptors the chemical transmitter binds to in an effort to help what little amount is available bind to them.
Over time, your body ends up with too much “slowing down” chemical transmitter and not enough “stimulating” transmitter along with lots of empty receptors on cells waiting for the “stimulating” transmitter to appear. Nerve impulses slow down, and the body’s reactions overall become slower.
When alcohol is abruptly withdrawn, this process suddenly stops. You end up with lower levels of the “slowing down” chemical transmitter and higher levels of receptors for the “stimulating” transmitter to bind to. The result is a “hyper-excitable” state that causes the symptoms of alcohol withdrawal.
These symptoms include anxiety, headaches, nausea and high blood pressure in the initial stages. After 12 to 24 hours, more serious symptoms can set in, such as agitation and confusion.
One of the most serious complications of alcohol withdrawal is Delirium Tremens (DTs) which has a fatality rate of between 1 and 4 percent. DTs typically occur on day two or three of withdrawal and can last up to a week.
Because there is a sudden influx of the “stimulating” chemical transmitter and lots of empty receptors on cells for it to dock onto, nerve impulses suddenly speed up. There is also a sharp decrease in the “slowing down” chemical transmitter, leading to a massive imbalance in the opposite direction to what the person was used to. Things start to speed up but in an erratic way.
Symptoms of this new imbalance include shaking, shivering, irregular heart rate and sweating.
People suffering from DTs often have vivid and frightening hallucinations as the chemical transmitters and receptors in their nervous systems try to balance out.
If confusion, hallucinations, palpitations or altered consciousness develop alongside the shaking and shivering, urgent medical attention is needed. Sometimes, highly specialised care in an intensive care unit is needed. Drugs to relax and calm the body, such as benzodiazepines and high-dose vitamin B-complexes, are used while the chemical transmitters return to normal.
The symptoms can last between three and seven days. Death can occur, caused by the sudden imbalance of chemical transmitters which can trigger an irregular heartbeat and even a heart attack.
About 5 percent of those people who develop DTs go on to have a seizure or fit. This happens when the body loses consciousness and shakes violently. The person may bite their tongue or soil themselves during this episode.
Seizures occur due to the ongoing imbalance of chemical transmitters and the brain receiving jumbled messages from the nerves that have been affected by long-term alcohol abuse.
The vast majority of seizures resolve spontaneously within five minutes, but if they go on for longer, urgent medical attention is needed, as patients can stop breathing during a severe fit.
People who have gone on to develop DTs or seizures as part of their alcohol withdrawal syndrome can be left with long-term cognitive problems. Their memory, ability to learn and logical thinking is likely to be less effective than those who did not get DTs.
Without proper medical supervision, alcohol withdrawal is a dangerous thing – this is the problem if people decide to detox at home during the coronavirus pandemic.
Apart from the risk of heart attack, the severe overheating and very low blood sugars which arise from the dangerous imbalances in the nervous system can induce a potentially fatal coma.
After treatment in hospital, a period of medical supervision either in a specialised facility or at home will be required, along with medication to minimise the side effects of alcohol withdrawal.
A complete detox programme for someone who is dependent on alcohol can last between four and six months.
As counterproductive as this may seem, the pandemic may not be the best time for someone with an alcohol addiction to stop drinking.
It is hard to predict whether someone will suffer from DTs and seizures; only 4 percent of people dependent on alcohol do. But, if the person has been drinking large quantities of alcohol for a long time, they are more likely to do so. In this case, withdrawing alcohol suddenly can be a bad idea. These levels will vary from person to person.
Medical resources are stretched, and the appropriate facilities may not be open to support severe alcoholics to reduce their alcohol levels safely. It might be safer for those who do not have access to the right level of medical supervision to delay a decision to tackle the addiction until the pandemic is over, and support levels return to normal. Going “cold turkey” may cause more harm than good.
Many support groups have online forums and telephone support so people do not have to feel alone in this. Organisations such as AA are available in most countries in the world. Accessing them during the pandemic may help you to avoid some of the more serious side effects of withdrawal.
The pandemic may be a good time to reflect on the amount of alcohol you consume and reduce it, but for some, it may not be the right time to stop it completely.