By IRENE MAHER
Times Staff Writer
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."
Of course, heavy drinking can kill you too. The key is to get the right help to kick a serious alcohol dependency. Here's more of our conversation with Estevez:
What's the right way and the wrong way to do detox?
The right way is in a hospital or certified detox center 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. With someone who is not dependent, but is clearly abusing alcohol, you may be able to just take it away safely. But heavy, daily drinkers need medical help.
How do you know which category you're in?
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. Ask yourself: Are you able to go 12 to 24 hours without drinking? It's always best to err on the side of safety. If you're a daily drinker and trying to stop, talk to your doctor first. The real worry is for heavy drinkers who have to keep up the alcohol level in their blood at all times. They start withdrawing as soon as it drops, so they start drinking again to feel comfortable.
What can happen during withdrawal that's so dangerous?
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.
What do you tell patients who think they can detox on their own at home?
I ask them, do you want to stop drinking and feel just awful for three to seven days, or do you want to come off alcohol comfortably in a way where you won't feel like you're going to die? A lot of them think, "I can't get into treatment because I know how I feel when I stop drinking," and they're afraid to stop. In medically supervised detox it's going to be safe and comfortable while you do it.
What happens in detox? What's the role of medication?
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 antiseizure medications, too, but 90 percent 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.
(Note: These medications are legal and common, but have a high abuse potential, and are particularly dangerous if combined with alcohol, so never use them to detox on your own.)
What needs to happen after detox?
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 center 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. But without followup treatment, the person will probably relapse. A long-term plan is important. Medical detox is just the first step.
Irene Maher can be reached at firstname.lastname@example.org.
Searching for a solution
An in-patient, medically supervised substance abuse detox program with 24-hour skilled nursing care is ideal — but not if you can't afford it. If you don't have health insurance you may have to wait for an open bed in a community-sponsored detox center. "The average length of stay is three to five days," said Christine Pickens, director of nursing for Operation PAR, a nonprofit substance abuse treatment program based in Pinellas Park. "Once the person is medically stable they can be discharged and begin the next phase of treatment." For most people that means going to group and individual counseling sessions and frequent support group meetings. Others will need the more structured environment of a 30-, 60- or 90-day residential treatment program after detox, said Pickens.
The Florida Alcohol & Drug Abuse Association keeps a directory of most substance abuse treatment programs and facilities in the state. To find one near you, call (850) 878-2196 or visit fadaa.org/directory/search.cfm. To find centers nationally, go to dasis3.samhsa.gov/.