• Dr. Bob@lemmy.caEnglish
    50·
    3 days ago

    My first job in healthcare was in a veterans hospital. There were so many alcohol dependent residents that there was a pub in the basement to dispense the “medicine” and not stigmatize the residents. There was beer on the med carts for those with limited mobility.

    • Keilik@lemmy.world
      23·
      3 days ago

      My business partner from a past business was a former marine who had been through AA and was/is a sponsor. Every time one of his buddies would come in I’d ask if he knew him from the marines or from AA and the answer was always both.

      • Dr. Bob@lemmy.caEnglish
        5·
        3 days ago

        It was residential so they were never leaving. There was joy there as well. It was not the most tragic wing of that facility. Health can be hard because you are witness to the worst day of someone’s life. Every day.

  • dylanTheDeveloper@lemmy.world
    131·
    3 days ago

    Wait you can die from alcohol withdrawals? At this rate the only addiction that lacks withdrawals is eating bicycle parts and jacking off

    • Talcosis@lemmy.zip
      22·
      3 days ago

      Alcohol and benzodiazepines.

      Every other drug withdrawal might make you wish you’re dead, but only alcohol and benzos will straight up kill you.

        • AnarchistArtificer@lemmy.worldEnglish
          15·
          2 days ago

          Okay, so there’s two main reasons why alcohol withdrawal is so brutal (much of what I’m about to say also applies for benzos too)

          1.) Alcohol primarily increases the actions of a neurotransmitter called GABA, which is sometimes referred to as “the off switch of the brain” because of its role as the key inhibitory neurotransmitter. If you’ve ever heard people say that alcohol is a depressant, this is what this means (although people often use that to mean it will make you emotionally depressed, but that’s not what the phrase means — it means that it’s a central nervous system depressant. Certainly alcohol (and alcohol withdrawal) can affect mental health, but as a biochemist, that’s far out of my wheelhouse; I do know that the effect is not a simple one of “alcohol makes you sad”).

          Chronic alcohol dependence means that the brain has to upregulate a bunch of systems, in order to compensate for the neuronal inhibition caused by extra GABA activity. It’s basically the same phenomenon as how if you regularly drink caffeine, it will stop being effective due to compensatory upregulation of the system involved — except when you stop drinking caffeinated drinks, you’re mainly feeling the impact of that one upregulated system. It feels awful, but it won’t kill you. However, GABA has such a far reaching impact across the entire central nervous system that when you stop drinking, your entire brain is running at an increased level of excitation — which is what can lead to things like anxiety, tremors and seizures.

          2.) Another reason why alcohol withdrawal has such a big impact is because alcohol doesn’t just affect GABA, but many other neurotransmitters. It’s what my neuroscientist friend referred to as “a dirty drug” (n.b. there’s no value judgement in this statement, it’s just just referring to it being less specific than other drugs). Dopamine, serotonin, glutamate and norepinephrine (and others) are also affected by alcohol consumption, and as with GABA, chronic alcohol dependence causes these systems to adjust their level of activity to compensate for the alcohol. When a person stops drinking alcohol, it’s basically all of these compensatory mechanisms being suddenly revealed.

          Below is a diagram that shows how chronic alcohol dependence affects neurotransmitters (an up arrow to the left of a neurotransmitter means that it is upregulated due to alcohol (i.e. systems involved become more active), and the symptoms on the left are the result of the changes to those systems, only revealed during alcohol withdrawal. I don’t expect you to be able to follow the specifics of this image, given that even in the textbook I got this from[1], the main point of this image seems to be to go “There’s a heckton going on and everything is so interconnected that it’s super difficult to figure out exactly how alcohol withdrawal causes these symptoms”

          [1]: citation for the image: Howard C. Becker, Patrick J. Mulholland, Chapter 9 - Neurochemical mechanisms of alcohol withdrawal, Editor(s): Edith V. Sullivan, Adolf Pfefferbaum, Handbook of Clinical Neurology, Elsevier, Volume 125, 2014, https://doi.org/10.1016/B978-0-444-62619-6.00009-4. (https://www.sciencedirect.com/science/article/pii/B9780444626196000094)

          1. 1 ↩︎

        • Talcosis@lemmy.zip
          14·
          2 days ago

          Like the other guy said. Both primarily affect GABA, which chills out your brain. When you withdraw, you aren’t getting enough natural chill. Your neurons fire too much, then they burn out.

          External symptoms look like excitability, confusion, seizures, coma, and death. In that order.

          Edit: this is why liquor stores were considered essential businesses during the COVID shutdowns.

    • BurnedDonutHole@ani.social
      4·
      2 days ago

      Yes. I lost my uncle that way. His genius children decided forcing him without any precautions would be a good idea. He was a long time alcoholic. Had many problems but the doctor said withdrawal was the last straw that killed him.

    • Kairos@lemmy.today
      21·
      2 days ago

      Yes and alcohol is the only drug that can do this (benzoes are effectively the same as alcohol). The war on drugs brought a lot of misinformation and bad tropes about withdrawl being lethal in movies.

      • da_cow (she/her)@feddit.org
        2·
        2 days ago

        Benzodiazepine withdrawl can kill you too. Opioid withdrawal itself will not kill you, but the withdrawal symptoms can become dangerous if not managed properly (especially if the person has other health problems)

    • cRazi_man
      6·
      3 days ago

      I know a doctor who told me alcoholic patients in hospital will absolutely drink alcohol containing hand sanitiser and that it all needs to be locked away. I don’t think taste matters to this population as much as the chemical ingredient.

      • St.Elsewhere@threads.net@sh.itjust.works
        51·
        2 days ago

        willing to consume hand sanitizer

        • hardy
        • strong of will
        • microbe resistant
        • gluten free

        willing to drink Budweiser

        • fornicates with first cousins
        • no taste in alcohol
        • owns a pit where they keep their victims
        • supports Michael Bay

        Really, it feels like you’re missing the trees for the forest

  • jedibob5@lemmy.worldEnglish
    163·
    3 days ago

    I suppose prescribing alcohol makes sense in these situations for tracking and controlling the dosage and frequency of use. Feels odd to just… use cans of commercial beer, though. In a hospital setting (which this pic looks like), wouldn’t it be cheaper and more effective to use small amounts of neutral grain spirits or something? Could be watered down to mitigate the dehydrating effect (and prevent OD if someone sneaks into the supply). It’s not like the taste matters, right?

    • terranoid@lemmy.cafeEnglish
      261·
      3 days ago

      Probably cheaper to use budweiser. It’s already food safe and the economy at scale makes it easy to get.

      Then they can go and charge your insurance $5000 for a 12 oz

    • baldingpudenda@lemmy.world
      17·
      3 days ago

      There’s probably a contract and they got the cheapest alcohol that is still single use. a 70 year old RN once told me when she was about 28 there was a pt with cirrhosis,pancreatitis, and going through withdrawals. There was only so much medications they could give because the liver was damaged so much. They called the 65yr old MD, he looked at the chart, asked him on avg. what his daily alcohol intake was(4L of vodka) ,and asked the nurse what and when meds were given. He takes out some money from his bill fold asked the nurse assistant to go buy a 6pack of beer and to give him one beer as needed. The nurse stares at him. He winks and says to chart it as intervention for withdrawals and to just use the name of the beer.

        • baldingpudenda@lemmy.world
          3·
          2 days ago

          You always think you have a pretty good idea of what the top looks like. Then you see real pros in action and it wasn’t even close.

    • Dr. Bob@lemmy.caEnglish
      13·
      3 days ago

      Why go to the trouble of using something nasty. It’s convenient and non-stigmatizing for the residents. So why not?

      • Viceversa@lemmy.world
        2·
        3 days ago

        Why go to the trouble of using something nasty.

        If I had to choose between watered-down pure alcohol (grain spirits) and Budweiser, I think we both know which one is nasty.

      • Deebster@infosec.pub
        8·
        3 days ago

        No, 4% beer will cause vasopressin suppression, and you’ll urinate more water than the volume of the beer. More beers will worsen the effect.

        The breakeven ABV point for most people of around 2.8%, but some people find that even a 0.5% “nonalcoholic” beer has a diuretic effect.

  • cynar@lemmy.worldEnglish
    11·
    3 days ago

    A friend of mine (sadly now passed) was a chronic alcoholic. It got to the point where the doctors told him to stop trying to quit. Each time he did, he would have liver issues and turn Simpson yellow.

    • Dr. Bob@lemmy.caEnglish
      12·
      3 days ago

      Detoxing someone from end stage alcoholism is incredibly dangerous. In comparison detoxing from heroin is not great for the user, but there’s no risk of death. It feels like a really bad flu for 72 hours and a mild flu for another 72.

      • da_cow (she/her)@feddit.org
        1·
        2 days ago

        In comparison detoxing from heroin is not great for the user, but there’s no risk of death.

        That is not completely correct. While the abscence of opioids in an addicts system can not cause life threatening conditions, the withdrawal symptoms absolutely can.

        The most direct pathway to fatality during opioid withdrawal is through severe fluid and electrolyte imbalances. Persistent, forceful vomiting and diarrhea are hallmark symptoms of acute withdrawal. This loss of bodily fluids, compounded by excessive sweating, can quickly lead to severe dehydration.

        Dehydration can cause a dangerous concentration of electrolytes, particularly sodium, a condition known as hypernatremia. This electrolyte imbalance severely stresses the cardiovascular system. In extreme cases, hypernatremia can lead to seizures, brain damage, or cardiac arrhythmia and subsequent heart failure.

        Another potential risk is aspiration pneumonia, which occurs when a person inhales their own vomit into their lungs. This is a particular concern if the individual is weakened or unable to protect their airway. This serious complication requires immediate medical intervention to prevent lung infection and respiratory failure.

        Source: https://biologyinsights.com/can-you-die-from-opioid-withdrawal/