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Alcohol WithdrawalAlcohol Withdrawal is No Laughing Matter By Ned Wicker On so many occasions, Otis Campbell checked himself into the Mayberry jail, went into the first cell, locked the door behind him and began to sleep it off. Fans of the Andy Griffith Show howled at the absurdity of the situation made even sillier when Otis would wake up the next day, clean up and check himself out. Did I mention that he’d get up, begrudgingly, to answer phone calls and take messages? The Otis character, played by Hal Smith, would probably not be so beloved in real life, especially after his weekly visit to the secret location to rendezvous with friends for a little moonshine social. Over time, after massive amounts of alcohol, poor Otis would probably not just sleep it off. Alcohol withdrawal is serious and can, in some cases, be fatal. Otis rarely had a hangover, which is a mild form of withdrawal. Hours earlier, old Otis would have enjoyed the benefit of the alcohol’s numbing effect on his brain and all of the inhibitions that melted away. However, after he stopped drinking, and probably before he had eight hours of sleep, all of his slow brain activity would kick into high gear, and that’s just the beginning. Withdrawal symptoms show up between 6-48 hours after taking the last drink, so you can imagine that Otis might have had quite a different experience. Those symptoms peak between 24-35 hours. His central nervous system would have been in high gear, and stress hormones produced to counter the previous inhibition. Now Otis was an amiable drunk. Not so in withdrawal, when he would have been agitated, or irritable or even prone to aggression. Otis probably won’t have been able to sleep at all once the withdrawal kicked into high gear, so he probably would not have been inclined to take messages on the phone. The rapid heart rate he would have experienced or the raising or lowering of his blood pressure were certainly possible. But that’s just the good news. About 10 percent of adults experiencing withdrawal have seizures that accompany withdrawal. Of those 10 percent of people experiencing a seizure, 60 percent will experience multiple seizures, usually over a six-hour period. Another withdrawal symptoms that is comically portrayed are the DT’s (delirium tremens), which are pink elephants or some other hallucination. The character in the film may count the elephants or carry on conversations with them, or make some other funny reaction to the ordeal. But in real life, it isn’t funny at all. A small percentage of alcoholics, five or less, may experience DTs in two to four days after their last drink. The hallucinations, confusion and agitation accompany the seizures, making DT’s extremely dangerous and even fatal in some 20% of cases. Medical intervention is often needed to treat withdrawal, especially in severe cases. Medical professionals may do an assessment to determine the right approach. For the 95% of patients who do not develop DTs, an outpatient treatment plan is sufficient. Between 15-20 percent of patients in withdrawal may have brief seizures or hallucinations, but they don’t last long. Patients with mild or moderate symptoms may be given medication, sometimes an anti-anxiety medicine (benzodiazepines), and sent home. The brain, which was calmed initially by the alcohol, is now excited and the medication helps to calm again. Some doctors will not recommend the medication, mainly because the drugs are easily abused. Patients may have to return to the emergency department if the symptoms become worse, and this is entirely possible given the time frame for increasing withdrawal symptoms. The movies also have a cure for alcohol withdrawal, which is not recommended by experts. The old “hair of the dog” treatment is typical in Hollywood. Take a drink to get rid of the “shakes.” There is no research to support this approach. If a medicine is necessary, the benzodiazepines have been known to work well. If old Otis had the DTs, the jail cell bed would not have been the place for him. He probably would have needed fluids and he might have needed restraint. The medical team would watch closely, and a variety of medications could have been used to control the severity of the DTs and other accompanying conditions. The episode of Andy Griffith that we did not see is the one when Otis’ years of alcoholism finally caught up to him. Andy and Barney come into the office and find him dead. He had multiple seizures and a heart attack. The autopsy showed that advancing liver disease probably would have gotten him anyway. Alcohol abuse, alcohol dependence and alcoholism can all set the stage for a tragic ending act. There are millions of Otis Campbell’s out there. They aren’t as obvious, they certainly aren’t regarded as beloved comic figures, but they are at risk of severe alcohol withdrawal symptoms. The sad ending is avoidable. Treatment and recovery programs do work. Ned Wicker is the Addictions Chaplain at Waukesha Memorial Hospital Lawrence Center.
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