Dear Science,

My roommate drinks. A lot. A scary amount. I've argued with him to cut back and pull his shit together. One of the excuses he fights back with is the danger of quitting drinking. He claims that when he quits for a bit, he gets the shakes, becomes sweaty, and starts seeing things. I get it: Quitting any drug you're addicted to sucks. It's painful and unpleasant—but beyond that, can it really kill you? I mean, people quit heroin, people quit smoking, people quit cocaine—is alcohol really that special? Can stopping drinking really kill you?

Teetotaler Roommate

Yes. Quitting drinking abruptly—for heavy drinkers at least—can result in life-ending withdrawal. To understand why, we must delve into how brain cells talk to each other.

Brain cells pass messages to one another via little molecules. The sender releases molecules that either excite (glutamate) or calm (GABA) the recipient. A given recipient can receive these message molecules from a multitude of senders; the ultimate response is based on the overall balance between the amount of excitement signals and calming signals. Alcohol works, in part, by mimicking a crucial calming signal molecule in the brain and body—GABA. When you drink, alcohol first floods into the blood and then into the brain. In the brain, it starts tipping the balance toward calming in all of these little conversations between brain cells.

Keep drinking alcohol regularly, in large quantities on a daily basis, and the brain begins to adapt. To counteract all of the (fake) GABA signals from the alcohol, the recipient cells start making more receptors (NMDA receptors, to be exact) that respond to the activating molecules (glutamate). This adaptation allows the brain to function (somewhat) despite all of the alcohol sloshing around.

The problem arises when all that alcohol suddenly disappears (after months or years of persistently being around). It takes days for the brain cells to ditch all those extra activating NMDA receptors. The balance tips overwhelmingly to massive activation of the recipient brain cells. At first, this shows up as the shakes—progressing on to headaches, sweating, massive anxiety, insomnia, and a feeling like your heart is beating funny. As more and more brain cells become overexcited, basic regulatory mechanisms start to fail: body temperature rises (like a fever from hell), blood pressure creeps up, and the mind becomes more confused. Illusions start at about half a day after abruptly stopping drinking, progressing into full hallucinations. Finally, the brain starts to seize. One in 20 who reach this point die, despite medical care.

Still, this is a bullshit excuse on your roommate's part. If you're drinking enough to get the shakes when you stop, that's too much drinking. With medical care, alcohol withdrawal is safe (stopping one from getting to the point of seizures). He needs to go to a detox clinic.

Signalingly Yours,

Science