Why is alcohol withdrawal more deadly in comparison to “harder” drugs like heroin?
In: Biology
because alcohol acts to suppress the chemicals in your brain that send messages. when one stops consuming alcohol, the chemicals go into over drive- “excitotoxicity” which can product seizures and brain damage
ELI5 our brain uses chemicals to work. Alcohol creates an imbalance of those chemicals. If your brain gets used to this imbalance you’ve changed the way your brain works. Quickly taking away alcohol means your brain no longer knows how to work without this imbalance and it can stop working very suddenly. These chemicals are specific to alcohol, but not all drugs.
Non-ELI5 but straight forward. Alcohol works on many neurotransmitters in the brain, but as a sedative it primarily targets GABA. As use frequency, duration, and quantity increases over time
these GABA receptors have become over stimulated, depressing your central nervous system.
If all of sudden, alcohol is removed these GABA channels are now closed, and replaced by glutamate, an excititory neurotransmitter to attempt to rebalance. However this sudden imbalance presents in severe anxiety, and physical symptoms such as tremors, racing heart, vomiting, sweating, insomnia, auditory and visual hallucinations, and seizures that can result in death.
Alcohol and benzodiazapines withdrawal are the two that will kill you if they are severe enough.
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Alcohol IS a very hard drug. It’s just the easiest one to produce, so humans made and consumed it thousands of years before anything else was available. That long timeline allowed it to become very socially acceptable for a hard drug.
On top of all the very good answers explaining the biochemistry, the other reason is that the notion of alcohol not being as hard or the whole notion of “hard” drugs is fucking stupid.
Side question: how long do you have to be drinking (and what amount) in order to get to the point of getting withdrawals? 2 weeks? 3-4 beers per day?
Alcohol works through the GABA system. GABA modulates neuron activation. Alcohol basically turns down the volume on your neurons, sort of, making them less likely to activate. Your body gets used to this, and stops regulating the volume itself.
Then when you don’t drink alcohol, when the speakers kick on they’re maxed out and blow out. Or, more technically, your neurons get overexcited and start cascade-triggering until they burn out, which, from the outside, looks like a seizure followed by a coma/death.
Opiates work in a fundamentally different manner-they affect the opioid system, which is what makes you feel good after exercise (and turns off the pain of all the microtears in your muscle that will then regrow and make you stronger). When that is taken away, you just become very sensitive, especially to pain.
The only common drugs that really target the GABA system are alcohol and benzodiazepines like xanax/valium. They are also the only drugs where withdrawals are potentially deadly.
Because body.
A non ‘drug’ like a beta blocker for blood pressure can kill you if you suddenly stop taking it.
That’s because the body normally tries to compensate for whatever outside influences, to keep a steady state, and thus gets ‘used’ to a drug or medication to some degree (but rarely fully or most medications couldn’t be used long term).
That’s the reason for people abusing drug taking more and more as the time progresses: the body develops a tolerance thus they need more to get the same pleasant effects.
Now how deadly suddenly stopping the drug or medication is really doesn’t much care for whatever positive pleasant effects you get, but rather how sensitive the bodies subsystem is to sudden changes, and whether even small changes can cause permanent harm
In opioids like heroin, there’s not much that can go wrong as permanent harm in the body when the drug suddenly disappears. The opposite effects of opioids is just feeling extremely bad. Like a severe flu or Covid infection, including runny nose and whole body aches etc.
But there’s nothing of those symptoms that are an imminent threat to life.
Because the body itself can keep running with zero opioids existing in the first place.
Alcohol on the other hand, interferes with a much more basic system of brain regulation of agitation/relaxation.
Normally a neurotransmitter called GABA is used by parts of the brain to tell other nerve cells to keep calm and stop messaging too much.
This is very strictly regulated
Alcohol mimics this gaba. And once the nerve cells get used to being told to keep it down all the time, they reduce how much they keep it down to the same amount of gaba.
So when a person addicted to alcohol suddenly stops it, the brain will still continue producing the same amount of gaba. But now the nerve cells have stopped listening to that signal to calm down. So they will send more signals, and a beyond a threshold this excessive signalling leads to every cell signalling all at once, which is a seizure.
That’s also why benzodiazepines like Xanax have the exact same withdrawal effects as alcohol when quit cold turkey.
They work on the same gaba receptors, just more specifically and ‘clean’ so you don’t get all the side effects of alcohol when you use them.
But quit Xanax cold turkey, the same happens, all the nerve cells (neurons) start firing at random and rapidly because they have lost the ability to regulate when seeing normal levels of GABA
That’s also why amphetamines and meth have the most minor cold turkey symptoms: the body and mind used to constant stimulation just goes to the opposite and you feel extremely lethargic and tired, your blood pressure drops etc.
But the tolerance to the blood pressure increasing side effect of amphetamines specifically is rather minor, so withdrawal just causes your blood pressure drop to healthy low levels rather than dangerous low levels.
Basically the body tries to regulate itself to compensate for any drug or medication you take to some degree. The more your body can adapt the stronger the effects of withdrawal. But whether withdrawal is directly lethal or ‘just’ extreme suffering, depends on the exact sub system of the body the drug affects, and whether a sudden opposite effect could threaten your life.
Hence stopping beta blockers which do the opposite for blood pressure as amphetamines being dangerous, whereas suddenly stopping amphetamines being ‘healthy’.
It’s the same blood pressure regulation system they work on, but a sudden increase in blood pressure just happens to be much more risky than a sudden (moderate) decrease (especially because the body happens to have other ways to keep nlood pressure from going too low, but doesn’t have any when it artificially shoots up£
Eli5: it’s like driving a car and slowly pressing the brakes down and pressing the gas down more to make sure you go the same speed. A little more braking, a little more gas. Stopping drinking is like just letting go of the brakes without easing up off the gas. So the car starts going really fast. That’s your brain(and other parts of your body that have been trying to compensate for the slowing down) causing seizures and all kinds of other problems. Other drugs have this effect but it’s not nearly as much while they also do some serious damage to certain parts of your body, particularly your liver and kidneys but not so much your brain like alcohol
Hate to break it to you buddy, but alcohol, especially hard liquor is pretty freakin’ hard. Both in the physical effects on the body, physical and mental withdrawal effects, and absolutely extreme altered senses of consciousness and perception that it can easily cause .
It’s just promoted
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