hiraeth

Okay, real talk about a sensitive subject: Tony Stark is an extremely high functioning alcoholic.

High functioning alcoholics can function like normal people, for the most part, even when smashed. They don’t slur their words or stumble or show any real overt signs of drunkenness until they are WAY past the normal threshold. The tipoff is the smell. You can smell the liquor on them even if they haven’t spilled a drop. Sometimes, I think it comes through their pores.

Alcoholics usually have a higher tolerance for alcohol, built up like an immunity to poison…because that’s basically what it is. Often they will begin their day with alcohol, for a variety of reasons, not least of which is the ever present hangover. Some can’t function normally without it. But high functioning alcoholics will generally seem normal while intoxicated.

If you suddenly remove all alcohol, some of them experience delirium tremens (DTs), which you’ll need to look up if you want to use; they are rough and can be fatal if not experienced under the care of a medical facility.

Now, not all Tonys are alcoholic, I’m just taking about the ones who are. High functioning alcoholics are not silly drunks or cartoonish. They can walk a straight line, they can even operate vehicles (they are still impaired, they just hide it better).

He doesn’t slur or slide his consonants. He doesn’t fall down. Hell, drinking might actually calm normal mood swings for him. He could still be charming. He could be MORE charming while drunk.

Alcohol withdrawal is one of the worse withdrawals a person can go through. Even in hospitals with access to advanced medical care, it can still prove fatal.

Withdrawal can start as soon as 2 hours after the last drink, but usually starts somewhere between 6-24 hours. The initial symptoms include shakiness, nausea, vomiting, sweating, anxiety, headache and insomnia. While these symptoms can sometimes last for several weeks, at this point they are non-life-threatening. For some people, this is all the withdrawal symptoms they will experience.

If you feel like continuing your character’s torture, between 12 and 24 hours after their last drink, visual hallucinations may begin. These usually won’t last beyond 48 hours, and your character will typically know they are hallucinations and not real. The hallucinations typically take the form of spiders, snakes, or other creepy crawlies.

If that is still not enough for your whump goals, in some patients tonic-clonic (grand mal) seizures start 24-48 hours after the last drink. While the seizures are usually self-limiting, this is where the withdrawal starts to get potentially dangerous- about 3% of people who develop withdrawal-related seizures will develop status eplepticus, a condition in which a seizure may last for more than 30 minutes, deprives the body of oxygen, and may cause brain damage.

Now, if you’re really looking to put your character in danger, Delirium Tremens is the next step. This starts at about days 3-10 (peaks around day 5) and is hugely dangerous- untreated, 35% of people who develop DTs will die. Even with medical treatment, this number only goes down to about 10%. That’s one in about 10 people will still die even under medical supervision.

DTs symptoms include: High blood pressure, visual and/or tactile (touch) hallucinations which the person cannot distinguish from reality, tachycardia (high heart rate), fever, confusion, severe shaking, severe anxiety, profuse sweating, additional seizures, irregular heartbeat.

Treatment includes:

Benzodiazepines- the body uses these chemicals similarly to the way it uses alcohol- meaning they can help decrease or postpone withdrawal without exposing the person to actual alcohol. They can also decrease blood pressure, heart rate, anxiety and occurrence of seizures, making them ideal drugs for treating withdrawal.

Antipsychotic medications (often haloperidol) for treating hallucinations

IV Glucose (D5W), which decreases risk of DTs or worsening withdrawal.

IV Electrolytes

IV nutrient replacement- particularly thiamine, folate, magnesium and niacin. These are typically vitamins and minerals the body has a difficult time absorbing after long-term alcohol use, and replacing them reduces risk of complications.

If caught early and treated aggressively, the person has a higher chance of surviving. One problem is that the medications (particularly the benzodiazepines) must be given in very high doses to be effective. Medical professionals may not recognize this need and so may not prescribe or administer appropriate amounts of the drugs to counter the withdrawal symptoms. This is a very real problem and sometimes results in under medication, which can be extremely dangerous or uncomfortable to the person in their care.

Why would you want to save the galaxy? Because I’m one of the idiots who lives in it!