eli5 why can you not just go into a medically-induced coma to avoid the symptoms of withdrawal?
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ICU doctor here. The drugs we use to put people in ‘medically included comas’ also have potential for withdrawal once they’re stopped to wake the patient back up. It also becomes difficult to differentiate between withdrawal symptoms and medication induced delirium.
Additionally, the procedure would also require having a breathing tube placed into the airway, a method of feeding/hydrating, risk of skin breakdown from pressure ulcers, and 24/7 monitoring, among many other potential problems.
Not only would all this put the patient at more risk than benefit, it’s hugely inefficient and not at all cost effective.
I’ve done some time in ICU. Firstly, the cost, unless you’re paying privately. ICU beds can run 4-5000 dollars a day. Secondly, being sedated into unconscious is not risk-free. The list of things that have been taken care of run all the way down to having your teeth brushed by a nurse, to avoid dental infections. Which has to be done without dislodging the breathing tube. This is probably the least banal risk. They go up from there.
Basically, everything in life is risk/reward, right? Well the reward of avoiding the physical and psychological discomfort of withdrawal doesn’t balanced against the risk and cost of a fortnight of ICU.
A medically induced comma is a very risky procedure used as a last resort. There’s no guarantee a patient will be able to wake up again from it and all sorts of complications can occur that can lead to death.
Management of alcohol withdrawal is to use medications to slow the withdrawal process. If someone is so deeply sedated that withdrawal does not take place, they can withdraw when the sedation is removed. This happens often in surgical patients who spend a few days on a ventilator and sedated because of their surgery.
There are medication substitutes that can be given to reduce withdrawal symptoms as part of drug or alcohol related cessation programmes. On the whole don’t even need people in a coma (which implies so unconscious they need tubes to support breathing and other risky associated treatments). In very bad withdrawals such as seizures happening, the benzodiazapene levels used to control the withdrawal can definitely cause drowsiness bit rarely bad enough to need breathing support.
The reason they’re given as part of a programme is that quitting is only partially about physical addiction, psychological addiction (cooling mechanism alternatives and social triggers etc) need to be addressed.
You can do this. Jordan Peterson did it. Stoically, one assumes.
This article talks about that, and also has a bit about why you may or may not go down that route.
https://nationalpost.com/health/jordan-peterson-benzodiazepines
Not sure if anyone mentioned the massive health issues that come from bed rest even in short term situations (bone density loss, muscle atrophy, cardiovascular complications, pressure wounds etc). There’s a reason they try and mobilize people in the ICU because being totally immobile in bed is TERRIBLE for you
The hardest part of addiction is not the physical dependency it’s the psychological/emotional dependencies that keep us coming back.
To overcome the phychological/emotional aspects is to overcome baggage and to consciously choose to not partake in all the little rituals we create around our addictions. These rituals keep us in comfort bubble and become subconsciously programmed into our daily lives.
You have to choose to be aware of the issue and choose to replace these reinforcing rituals with something else.
This takes time, and consciousness;
awareness, discipline, growth.
A coma would not absolve you and your body from the symptoms/effects of withdrawal, you just would not be able to “experience” them consciously. That brings with it it’s own dangers that would require a greater level of medical intervention than simply enduring those effects while conscious.
You can. It’s just not sensible to.
Of the commonly abused substances likely to lead to dependence/addiction, very few lead actual potentially fatal withdrawals: alcohol, benzodiazepines, barbiturates. The last of the three has widely been superseded by benzos since it has a much worse safety profile without much benefits.
All the other substances likely to foster dependence — and even those highly unlikely or virtually impossible to, such as the classical psychedelics (LSD, psilocybin, mescaline, DMT) — aren’t going to kill you even if you quit cold turkey from however massive a habit. Sure, heroin withdrawals after a decade of daily IV use will make you wish you were dead so the pain would stop; but benzo withdrawals will actually just make you dead.
General anaesthesia of any kind is by design just an extremely risky thing. It doesn’t take much at all to result in the patient never regaining consciousness. Sometimes they just never do anyway, even if nothing went wrong. It’s trying to bring you as close to death as possible, and then trying to maintain that precarious balance for however long as is necessary, and then trying to make you come back alive. It’s an exceedingly delicate thing, and plain irresponsible of a thing in terms of a medical procedure for an ailment so trivial and survivable without any medical intervention (except in a very small minority of cases).
Interestingly, one drug that’s utilised to “reverse” the dependence on benzos in some exotic treatment regime not dissimilar to what you’re asking, is flumazenil. Flumazenil acts as an antidote for benzodiazepine overdose, the same way naloxone is for opioids, or ethanol for methanol poisoning. It can potentially “reset” a benzodiazepine dependency when administered. But it can also just as often result in inducing a massive seizure leading to death when administered to an individual with a heavy benzo (or plain GABA-ergic) tolerance.
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