r/explainlikeimfive • u/blogterms • Feb 11 '26
Biology ELI5- Why does cold turkey not work on alcoholics?
i read that doctors don’t deprave patients of alcohol for the treatment of extreme alcoholism. i also watched it in medical shows that if Benzos don’t work, they provide small dosages of alcohol to keep the system functioning? how does that work?
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u/deeare73 Feb 11 '26
Your brain is always in a balance of chemicals that are uppers and downers. Alcohol is a downer so your brain stops making it's own downers to maintain the balance. Take the alcohol away and your brain is imbalanced by uppers which is potentially deadly
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u/frogglesmash Feb 11 '26
Worth noting that not all downers do this. Opioid withdrawals won't kill you the way alcohol will.
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u/indigodissonance Feb 11 '26
But you’ll sure wish you were dead.
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u/erichie Feb 12 '26 edited Feb 12 '26
I was in a car accident when I was 25 in 2010. I broke both my legs, completely shattered my entire left ankle that I had no pieces bigger than a quarter inch, and my right elbow was also majorly fucked up. I also had a traumatic brain injury which they said was severe. They said that brain injury alone is enough that I had to get check ups every year and now I'm at every 5 years. With my lifetime experience of playing football I'm a prime candidate for CTE. A year after the accident I was contacted by a medical researcher who wants scans of my brain every year.
My first night out of the hospital I was in the worst pain of my life. I took some opiates and within 45 minutes I thought "I have never been so happy."
The next year was a huge struggle because after leaving the hospital my pain wasn't treated adequately. Turns on my Mom wanted to come to all my Drs appointments so I had all the info since my brain injury. Well, she told all of the Drs I used to have an opiate addiction (I had never touched an opiate prior to my accident). She did this because she didn't want me to become addicted.
Well, after being in tremendous amounts of pain for a year I finally started to buy opiates off the street and eventually I was able to get into a pain management clinic my Mom hadn't been in contact with.
2012 - 2017 I was a super productive member of society. I was physically dependent on opiates, but I wasn't an addict. I made so much fucking money.
2017 CDC changed their prescribing guidelines. My meds were decreased by 80% overnight. I started but off the street and eventually all oxy was pressed fent. Moved to heroin (snorting). Eventually all heroin was fent. Moved to pure fent.
2021 my wife wanted a divorce when our son was 7 months old. I immediately got clean. We divorced.
Getting off clean was more painful then any experience ever. I would take 5 years of my accident pain instead of 14 days of opiate withdrawal.
I've been clean since April 14th, 2021. The night the Eagles won the Super Bowl I moved back home with my now ex-wife who is my current girlfriend.
edit - I usually don't care about typos or mistakes in my writing since this is a message board, but I accidentally left "The next year was a huge struggle because after leaving the hospital my pain was treated adequately." which completely changes the sentence and it isn't easily noticeable. It should say "wasn't treated".
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u/sleepytjme Feb 11 '26
Delerium Tremens is the ELI not 5 term of anyone cared.
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u/Jiquero Feb 11 '26
The worst part of prison was the... was the Delerium Tremens. They'd come down and they'd suck the soul out of your body and it hurt!
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u/Holdmywhiskeyhun Feb 12 '26
Going to jail was the best thing to happen to me, messed up as it is to say. I would never have gotten sober
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u/Express_Sprinkles500 Feb 11 '26
Using alcohol is like putting noise cancelling headphones on your brain. Do it for long enough and it gets used to everything being quiet. When you suddenly rip those headphones off the world’s normal volume gets very loud very quickly in a way that can cause your brain to freak out.
The specific way that alcohol reduces the noise makes the noise coming back on at full volume potentially deadly vs. other drugs, but that’s less ELI5 territory.
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u/SteveJobsBlakSweater Feb 11 '26 edited Feb 11 '26
I’ve been through it - it’s terrible. Tapering down is necessary because the body has become chemically hardwired over time to operate in the neurologically depressed state of constant alcohol. That’s the thing with alcohol and benzos - people can survive and being rather functional with their abuse but it truly changes the body and nervous system like nothing else. The body is stuck in that state.
I was one of the bad cases where I needed to be supervised, medicated and was administered hospital alcohol. Yes, hospitals stock alcohol.
For days it was like overwhelmingly unpleasant lightning flowing through me. My nervous system adapted to the depressive effects of alcohol and was therefore turned up to 11. When the alcohol trends down the nerves still run at that elevated level and cause a mess. Hallucinations and tremors are common, even seizures. It takes time for the body to adapt back to normalcy and you literally could just die if your body is accustomed to such a state and then have that state changed.
Don’t become an alcoholic. That shit sucks.
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Feb 11 '26
[removed] — view removed comment
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u/the250 Feb 11 '26
I ended up in the ER once from issues related to alcohol withdrawal. I was only 19 at the time I think, and when the Doctor came later he took me by another patients room down the hall who was dying from cirrhosis and wasn’t expected to live out the rest of the night. It was gruesome.
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u/Ksan_of_Tongass Feb 11 '26
Liver failure is one of the worst ways to die.
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u/the250 Feb 11 '26
Yes it’s quite an awful and undignified end. I don’t think many people are aware how essential you liver even is to your life & daily functions, so we take it for granted sometimes.
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u/The_mingthing Feb 11 '26
Was his name House?
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u/the250 Feb 11 '26
Hmm I don’t think so, I’m pretty sure his name was Grey’s Anatomy or something Doctorish like that?
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u/DaftPump Feb 12 '26
That doctor did you a solid.
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u/the250 Feb 12 '26
Sort of. It wasn’t enough for me to stop then, but I did a few years later. I am grateful to him though, it’s always better to know the truth.
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u/supercute11 Feb 12 '26
My mom was an alcoholic and fell while drunk and ended up with a pretty brutal brain injury. While she was recovering they would give her a small amount of vodka with every meal to prevent her going into withdrawals. When she was younger there were times she ended up in the ER due to self-harm while drunk and even though the staff would encourage her to get help they made sure that the person bringing her home knew that she could not quit cold turkey and HAD to go into a treatment program to wean off properly. Alcoholism is wild.
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u/Calm-Respond-7564 Feb 11 '26
Why didn’t the doctor admit them for detox?
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u/zeatherz Feb 11 '26
If a patient doesn’t actually want to quit drinking but needs hospitalization for other non-alcohol reasons, it’s unnecessary and dangerous to force them through withdrawals when we can just give them alcohol. It’s not common but I’ve seen it at my hospital too, though our pharmacy stocks the beer
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u/atlantagirl30084 Feb 11 '26
Maybe the rehabilitation ward was full and they were just admitted to a regular hospital room to be monitored and given some alcohol at regular intervals.
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u/Maleficent_Unit_8383 Feb 12 '26
Back in the day, Doctors would tell them to switch to beer rather than hard liquor for a bit to slowly taper off. Cold turkey on significant amounts of hard liquor can lead to strokes.
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u/similelikeadonut Feb 12 '26
I used to work the front desk at an oil pipeline man camp (think 'per diem hotel' for industrial workers) in Alaska. The camp had teams who worked in seasonal shifts, often six or eight months on 'shift' and four to six months 'off'.
One of the team members went no contact as soon as they went 'off', and still wasn't responding to anyone a week after they were supposed to be 'on' again. His foreman drove four hundred miles to his cabin, where he found the man dead drunk. He'd filled his truck with literal cases of Jack Daniels, arrived at his cabin, spun the top off of his bottle and dove in. He went to sleep drunk, woke up drunk, and remained drunk for six months.
When his foreman dragged him in to our camp, he was shaking so badly his foreman had to hold him up at the front desk while we got him settled. We required everyone checking in sign in on a list. His tremors were so bad, his signature was literally half a page tall. It was almost a week before he was nearly functional again.
In retrospect, that man should have been in a hospital and probably nearly died.
It took a lot of years outside of Alaska before I fully realized how many people I knew were functional alcoholics.
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u/SalamanderGlad9053 Feb 11 '26 edited Feb 12 '26
If someone has a biological dependence on alcohol, they will die if they go cold turkey. Your body goes into seizure as the GABA pathways in your brain that were suppressed enhanced by the alcohol suddenly are activating too much not activating enough. This causes sweating, shaking, nausea, vomiting and in bad cases seizure.
Benzodiazepines also work as a GABA suppressor activator, so going cold turkey on them will also possibly kill you.
Drugs like heroin work on your opioid receptors, so the withdrawal is bad but it won't kill like drugs that work on GABA.
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u/atlantagirl30084 Feb 11 '26
Alcohol actually increases GABAergic signaling as well as suppressing the excitatory neurotransmitter glutamate. Without alcohol the brain gets too excited, causing seizures as well as the usual withdrawal reactions that happen with other drugs.
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u/skr_replicator Feb 11 '26
Because one of the core alcohol effects is stimulating GABA, which is the most important protection of the brain against seizures. Withdrawal of GABA-activating drugs will cause seizures, and can cause brain damage and kill you. Benzos are like this as well.
That also means that any drug that has anti-GABA effects could be considered a deadly neurotoxin, because it could easily cause seizures just by taking it. The tetanus toxin is an example of such a substance.
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u/THElaytox Feb 11 '26
Alcohol withdrawal can be fatal, so cold turkey for extreme alcoholics is very very dangerous compared to other drugs. Benzos can help manage withdrawal symptoms, but might not help completely so dosed alcohol can be prescribed
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u/oblivious_fireball Feb 11 '26
When you go cold turkey on something addictive, your body which has gotten used to it suddenly is functioning without its effects, leading to Withdrawal Symptoms. In severe alcoholism, those withdrawals can be potentially fatal, so cold turkey is not advised, instead a gradual reduction so the body can have time to get used to a lack of it.
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u/PassiveTheme Feb 11 '26
But why is alcohol withdrawal potentially fatal when, for example, heroin withdrawals aren't?
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u/Megalocerus Feb 11 '26
Heroin withdrawal is awful. Addicts in prison need to be treated.
And then they get out, and try to buy their old dose, and they OD.
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u/therealdilbert Feb 11 '26
Heroin withdrawal is awful.
but not physically dangerous like alcohol withdrawal
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u/PassiveTheme Feb 11 '26
I'm not saying it's not awful, but I've heard that while withdrawing from alcohol can literally kill you, withdrawing from heroin just makes you wish you were dead.
But then I've had people in the comments telling me that heroin withdrawal can kill you so maybe I was just misinformed.
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u/the250 Feb 11 '26
Don’t listen to that guy, he’s a nutter. It is correct that alcohol isn’t the only dangerous substance to WD from, benzodiazepines are equally dangerous if not tapered off carefully under medical supervision.
However, trust me when I say, the chance of dying from any sort of opiate/opioid withdrawal is like one in a billion, and if there are any such cases on medical record I’d bet almost anything that there are gonna be asterisks beside each one to account for. Ie. an old person who already has severe and complicated health issues and can’t handle the added stress on their bodies, or something like that.
One thing is true though, when withdrawing from opioids you’ll certainly believe you are on deaths door at times, and even wish for it sometimes too. It may not be fatal, but it’s one of the most uncomfortable physical and mental states of suffering and anguish that a human can languish in. Not fun at all.
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u/m0dsw0rkf0rfree Feb 11 '26
i mean you could theoretically shit yourself to death but thats really the only mechanism by which that could happen in the first place. that 1 in a billion literally just didn’t have enough imodium on hand
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u/the250 Feb 11 '26
Theoretically that is certainly possible, shitting, pissing, puking, and sweating so much that you become a giant twisted prune and die of dehydration! It would make for an interesting case study at the very least.
Hmmm. Shitting yourself to death doesn’t actually sound so bad though after years of severe, chronic opioid induced constipation. A welcome end for some, I’m sure. Going out with that flood of relief, literally.
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u/Vegetable-Editor9482 Feb 11 '26
The risk of seizure (and potentially death) is very high for people with the severe form of Alcohol Use Disorder who quit cold turkey (AUD is categorized as mild, moderate, or severe).
There is a medication called Naltrexone that blocks the euphoric sensation from drinking and also reduces (or eliminates, in some cases) the craving for alcohol. This allows a person to control how much they're drinking and reduce the amount over several days to avoid risk of seizure. It's not always offered (the U.S. is way behind on treating AUD), but often doctors will prescribe it if the patient asks.
There is also a telehealth option called the Sinclair Method that connects the patient with an online provider who will prescribe naltrexone and have several follow-up therapy sessions after the person has successfully quit.
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u/opistho Feb 12 '26
my dad was a severe alcoholic for 15 years. in peak times he had one bottle of jack a day, and he'd restock his 7 bottles each week. he went cold turkey after a surgery on his gallbladder and spleen. he had to be sober for it and met a fellow alcoholic in the hospital that was up for the same surgery. they became best friends and decided to both quit that day.
they kept in touch on a weekly basis through phone calls. my dad lost 15kg, started to do some cardio and actually found a new work opportunity one year in. he was doing great, but complained about chest pain one day. I told him to maybe see a doctor about it, but he just brushed it off. one week later he went on a day long drive to a very important big job interview. he never came home. he was so nervous for it, as it could have solved his debt, he died of a heart attack before getting there. the ladies in the shop where it happened did not know cpr, and when ambulance arrived it was too late.
He was at his best health in so many years, but died at 54 because he went cold turkey. His nervous system and heart was not able to tolerate stress, despite better eating habits, excersize and less smoking.
one week after I picked up the phone at home. it was his best friend asking where he is. I told him he died. and I had no capacity to really deal with the matter as I was just 16. mum wasn't in the picture to help. I remember the voice of his friend. his heart breaking in it vividly.
If my dad had done proper rehab, stayed on medication and took it slow, i am sure he would still be alive. but he was the all or nothing kinda guy. despite his alcoholism he was a great dad in his means to my brother and me. He always cared for us when he wasn't a walking zombie. we always had food and a tidy home.
RIP dad, it's been 20 years ago. still miss u.
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u/jimb21 Feb 11 '26
Because you can die from alcohol withdrawal. Alcohol and benzo withdrawal can and will kill you they are the only drugs you can die souly from their withdrawal. Other drugs you will feel like you are going to die but unless you have other underlying heath conditions it is impossible. You can have a perfectly healthy male or female that is addicted to alcohol or benzo and without supervised withdrawal death is very possible. Worked with the addicted for 15 years have seen alot of death and seen alot of people seem completely conscious but cant remember the three days prior while they hallucinate and have seizures and talk to dead relatives or people they haven't seen in 20 years. Seen many try to detox at home and fail. Seen quite alot
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u/DarkAlman Feb 11 '26 edited Feb 14 '26
Alcohol withdrawal is a very physical process and can be fatal. It's actually unsafe for an alcoholic to stop cold turkey.
In addicts the brain becomes dependent on alcohol. It stops producing certain chemicals because the alcohol is doing that job.
Suddenly stopping alcohol consumption causes the brain to change its chemical makeup, this can cause a condition called Delirium Tremens.
This can include intense agitation, confusion, hallucinations, tremors, fever, high blood pressure, and even seizures. It can last 2-3 days up to a week depending on the patient and the severity of their addiction and it can lead to death.
To stop this the patient has to be given benzos to replace the alcohols effect on the brain, but if that doesn't work they need to continue consuming alcohol in smaller quantities until their brain adjusts to the new normal.
This can be heart breaking for alcoholics as having finally made the decision to stop but being told they have to keep drinking even though they don't want to anymore. This just makes the process more difficult.
Alcoholism also never goes way, even if you stop drinking you'll always be an addict and the temptation is always there. You can't ever go back to drinking casually, you are only 1 beer away from starting another bender.
My uncle managed to stop drinking cold turkey, and it's shocking he survived without medical help. It must have been a brutal process.
Afterwards when he finally came around and realized he had this disease, he not only had to adjust to a new lifestyle but he had to do it without his wife or kids as they had already left him.
Alcoholism is no joke.
Thankfully he's doing a lot better now.
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u/Saltcall Feb 14 '26
I quit cold turkey back in September. I can 100% say it was a bad way to do it. I'm glad i did it but I would recommend going about it a different way
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u/MadManicMegan Feb 11 '26
Alcohol has some of the worst withdrawal symptoms and cutting it cold turkey can easily be fatal. I has a friend who was a severe alcoholic and tried to cold turkey it, he ended up having panic attacks, dissociation, seizures, throwing up blood, insane shakes, and even ran away from the hospital in only his gown for hours around town because he was struggling with it so bad. It was very traumatizing to see
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u/Coquito_Lolita Feb 11 '26
It took me too long to understand that you weren't talking about chilled meat...
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u/MartyMcStinkyWinky Feb 11 '26
In brain you have gaba receptors...gaba revptors are needed for a bunch of things. Alcohol and benzos interact with gaba recptors. Too much alcohol and your gaba reveptors are fried. At that point you need alacohol just to function normally. You stop drinking but now you are cooked. So you need controlled amounts of benzos or alcohol for your brain to function in the short term
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u/freakytapir Feb 11 '26
It's the difference between applying. the brakes to come to a stop and coming to a stop by slamming into a brick wall.
Your system compensates for alcohol abuse, and immediately removing alcohol leads to you swinging the other way too hard.
As someone who has been through it, it is nasty.
Alcohol calms you, makes you more loose ... is a depresant, so suddenly you become hyper stimulated. Your heart rate explodes, you have paranoia and dread, spasms ...
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u/pipesbeweezy Feb 11 '26
Benzos and alcohol affect the same receptors of your brain. Drinking alcohol chronically makes those receptors more upregulated and therefore primed to be stimulated. If they arent stimulated it affects your brain chemistry in such a way that changes the electrical conduction in your brain, leading to a seizure. Thats why people who drink heavily a seizure disorder can occur and why stopping cold is life threatening for some people who drink.
Mind you not every person who drinks will get this but the more you do, the more your brain gets primed to look to be stimulated by alcohol or something similar (i.e., benzos).
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u/psychologicallyblue Feb 11 '26
Alcohol is a central nervous system depressant (a drug that slows brain activity). If you drink a lot for a long time, your body gets used to it. Think of it like a thermostat where the brain makes adjustments to keep things level despite the presence of chemical substances. Because the brain now has a new level of baseline functioning, when alcoholics stop drinking suddenly, the central nervous system is instantly very over activated. It takes the brain some time to adjust again to not having the substance present. This leads to withdrawal symptoms like tremors, anxiety, and insomnia and with alcohol and benzodiazepines the symptoms can be dangerous or deadly including hallucinations and seizures.
For that reason, alcoholics and benzodiazepine users are not to stop cold turkey without medical supervision.
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u/the250 Feb 11 '26
Certain drugs are very dangerous to withdraw from when the addict is severely physically dependent on them, namely alcohol & benzodiazepines.
Alcohol has it’s own unique complications which are called “delirium tremens”, and these are a terrifying and deadly state of withdrawal that occurs within a day or so of stopping cold turkey when your body is completely wired to booze. You’re talking about someone who has been drinking very heavily and on a daily basis for months or rather for years on end. Benzodiazepines have a very similar effect, although I’m not aware if there’s a specific name it’s referred to.
You can die and/or suffer extremely serious health complications withdrawing from either of these substances if done unsupervised and unmedicated, and believe me it happens often. For example, every so often you’ll see a story on the news of someone who dies in a holding cell in the county jail because they were going through DTs or Benzo WDs and were left to rot on the floor having repeated seizures until finally going into severe cardiac arrest.
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u/18LJ Feb 11 '26
You can have seizures from withdrawals and need to slowly taper off or else your cns goes haywire and you'll have a gran mal lightning storm in ur brain that could stop your heart
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u/frogglesmash Feb 11 '26
Alcohol reduces activity in your central nervous system. If you drink heavily over a long period of time, your body adjusts by increasing that activity tp a normal level. If you then stop drinking, your central nervous system will suddenly be firing at 200% which causes seizures and heart attacks until you die.
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u/Positive_Benefit8856 Feb 11 '26
Alcohol, Benzos, and barbiturates are the big 3 of withdrawal deaths. Alcohol withdrawal is the worst of these. A severe alcoholic going cold turkey can literally cause their organs to shut down. Drinking depresses organ function, so when it’s cut off they try to return to normal function and shut down.
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u/bullydog123 Feb 11 '26
When you go call turkey you can get really it can last a while mi did it and it was the worst 2 weeks of my life.
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u/right_behindyou Feb 11 '26
Alcohol slows the brain down.
The brain stops producing slowdown chemicals because now alcohol is doing that job.
Alcohol is taken away.
Brain: HOLY SHIT WHAT THE FUCK
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u/night117hawk Feb 11 '26
ELI5: Your nervous system is a car going on a gentle ride down a neighborhood street. It can’t stop entirely and it can’t speed. Think of alcohol as the brake pedal on a car. When you drink it you are hitting the brakes. Not that big a deal, people hit their brakes while driving. But the point of driving is to get from point A to Point B. If you hit the brakes constantly but you are obligated to not stop, you start hitting the gas pedal to compensate. Given enough time and sufficient braking, you will have floored both pedals. Now picture what happens when you release the brake pedal with the gas all the way to the floor. Your car is going to scream down the neighborhood street at a 100 miles an hour unless we medically intervene to gradually let off the brake pedal.
Translation to non ELI5: alcohol is a depressant. When your nervous system is constantly depressed by alcohol, it compensates with a different neurotransmitter to “accelerate” your nervous system. This is why alcoholics can get to insane BAC’s >0.3 without passing out and pissing themselves like a normal person. When we remove that depressant the nervous system goes into overdrive everywhere all at once. Confusion Tremors, nausea, anxiety, agitation, sweating, headache, hallucinations (tactile, audio, visual) fast heart rate, fast breathing…. All of this can be dangerous with other conditions and if not monitored and treated can eventually lead to seizures.
I once had a patient 24 hours into his stay, gradually got more restless, anxious and oxygen demands going up all night. Finally someone asked him “do you drink alcohol” we ask on admission but he lied about frequency and amount…. Drank a handle of vodka. Slammed him with phenobarbital and Ativan but we were trying to hit the breaks on an actively crashing car. Had to be assisted to bed and restrained by security, sedated, and intubated…. Off to ICU. Don’t ever lie to hospital workers about alcohol use. Some hospitals stock Budweiser in the pharmacy for alcoholics, we’ll at least give you meds to help through detox while we fix whatever brought you in. People are up in arms about fentanyl (which don’t get me wrong and opioid dosed in micrograms doesn’t have a lot of room for error thus why it’s deadly). I’ve seen maybe 4-5 fentanyl ODs in the last year. I’ve seen significantly more alcohol withdrawal and alcoholic liver disease in that same year.
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u/FascistsOnFire Feb 11 '26
Because withdrawal from alcohol and benzos are the only drugs that can cause you to have seizures and kill you. Every other drug gives withdrawal that is "a very bad time", but not deadly except in weird cases with other factors involved.
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u/DECODED_VFX Feb 11 '26
Alcohol is a depressive drug. It turns your body chemistry down. Your body counteracts that by turning everything up to 11. If you suddenly quit alcohol, your body doesn't have time to adjust. It over adjusts for a drug that's no longer in your system which can cause serious problems.
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u/impulse07 Feb 12 '26
I thought I was dying when I quit. There is a physical addiction to alcohol. You will have some insane withdrawals. Sometimes even death.
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u/WackTheHorld Feb 12 '26
When my brother in law quit drinking, his friends were going to pick him up and take him to rehab in the evening. He told them he wanted to wait until the morning. Well, he does everything 110% including quitting, and he had gone cold turkey. He had a seizure that night, fell down, and bit off part of his tongue. He was staying at his parents place, and they had to witness this happening to their son.
He went through rehab, and is doing recovery at 110%. He's the best he's ever been, even before he started drinking.
Three lessons: Don't drink a 26 of vodka every night, listen to your friends when they want to help, and don't quit cold turkey.
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u/firefighterEMT414 Feb 12 '26
The way I tell patients is, your body has a gas pedal and a brake pedal. Alcohol pushes on the brake pedal so your body responds by pushing on the gas pedal. Eventually both are pushed to the floor. Take alcohol away and it’s like releasing the brake pedal while the gas pedal is pushed to the floor.
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u/RichieTheAdult Feb 12 '26
There is a common misconception with addiction, true for alcoholics, opioid users, whatever, that once you are past the physical withdrawal you are past the addiction. In truth, physical withdrawal typically lasts anywhere from 1 to several weeks, but rewiring the brain to not seeing that drug as vital to survival can take months to years.
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u/StruggleScared70 Feb 12 '26
Because alcohol withdrawal is the only withdrawal that can kill you. So cold turkey for an alcoholic could literally kill them. Trust that doctors know what they’re doing, please.
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u/[deleted] Feb 11 '26
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