End-stage definition...

Most alcoholics never reach end-stage. They drink and they fall victim to an alcohol related death such as a car accident, a fall down the stairs, foul play, accidental drug/alcohol combination overdose, undiagnosed conditions, or many other situations. An end-stage alcoholic is one that has the advantage of avoiding the previous mentioned downfalls either by luck or a very astute caretaker.

An end-stage alcoholic is an alcoholic whose body and mind have degenerated to the point where the detox process is just as dangerous as continuing to drink. That’s a quick and simple answer to a complicated question that is asked frequently. If a medical professional tells you to continue to give the alcoholic booze because to be without it, outside a hospital environment, would mean certain death – that’s end-stage. Here are other factors in making the determination.

Most end-stage alcoholics have already been through the detox and rehab process several times. The end result is often a return to the bottle within a short time – sometimes just days after discharge. On the good side, sometimes the alcoholic will wait months before getting drunk. That is good – the longer the time between detox and drinking the more of a chance the body has had to recover. But even then, a return to an end-stage condition, after post-detox drinking, will happen at a more rapid rate than it did previously.

I want to stress here that some end-stage alcoholics never get into detox or rehab. They are so adamant about drinking that they never entertain the thought of a possible better life. They like things the way they are and refuse to change. Riley, even after numerous rehab and detox, has stated that if he has to choose between sober or dead – he chooses dead.  

I’ve written before about the Child/Pugh and MELD score which is determined by using information from a blood test. The two tests are designed for ranking the status of people who are waiting a liver transplant. (See my post Information please... in March 2011) A Child-Pugh score of Class C and/or a MELD score higher than 30 would make the alcoholic at end-stage.

There are a host of alcohol related diseases that also contribute to the determination. How far advanced these diseases are can give you an idea of how much time an alcoholic has left. But, in true end-stage, that really doesn’t matter because the only way to recover from any of the diseases is to quit drinking. That is not likely with end-stage alcoholics.

An end-stage alcoholic will drink anything containing alcohol if traditional sources are not available. This can include, Listerine, vanilla extract, cough syrup or even perfume. Anything else that contains the word alcohol in the list of ingredients is a potential beverage for the end-stage alcoholic.

Because of the amount of alcohol saturating the frontal lobe of the brain, the end-stage alcoholic personality, most often, is not the same as the personality of the same person without the alcohol. Some traits may include: easily angered; unrealistic demands; lack of determining appropriateness of actions; loss of short-term memory; highly emotional; easily confused, and; inability to determine night from day. Alcoholics are subjective – what’s important to them revolves around drinking. At end-stage this is magnified and the end-stage truly wants everyone to “mind their own business” and let him/her do whatever they want – even if it impacts on other people’s lives.

Stomach issues are very common at end-stage. The end-stage alcoholic may demand dinner at a certain time, but will probably not eat much, if any. Often, whatever is eaten will be vomited. Because of that the alcoholic becomes malnourished and will often become very thin. But, this isn’t always true because sometimes the alcoholic will appear to gain weight. Unfortunately the weight gain is usually a result of advancing cirrhosis.

At end-stage the alcoholic has worn away large amounts of the mucus membrane lining the esophagus as well as the entire digestive system. The esophagus will split and bleeding will occur. Sometimes the esophagus will actually “blow out” and can cause almost immediate death. The force of vomiting alone is enough to cause a bleed in the esophagus or stomach. Alcohol is a natural blood-thinner. At end-stage the blood doesn’t coagulate. I’ve seen a bleeding cut or sore on Riley’s last for hours and even a whole day before the bleeding stops. Anything bleeding becomes a potential life-threatening occurrence.

The stomach may develop bleeding ulcers – a painful hole in the tummy. Imagine having a cut finger and pouring isopropyl alcohol directly onto it. It would be the same thing for an alcoholic to drink when he has a bleeding ulcer. And that condition, added to the lack of food and proper nutrients, as well as the inability to coagulate, can be fatal. Diarrhea occurs almost daily and the further along the alcoholic the more explosive the pooping.

Some physical traits of the alcoholic are the yellowing of the eyes and spider-like veins in the fact. At end-stage the skin may turn a fluorescent yellow/green, the nose becomes something like Rudolph’s, the scalp is itchy and flaky, and fingernails have a tendency to split.

If you are afraid to leave the alcoholic in your house alone because you don’t know what he will do – you’re probably in end-stage. The loss of memory can mean leaving a stove burner on under an empty pot. The lack of judgment could mean lighting a candle and placing it next to the curtain. The loss of balance can mean a fall and combined with a hit on the head – the results can be fatal.

Determining whether or not an alcoholic is end-stage is often easier for the caretaker than it is for the medical professional. That’s because the determination is based on what happens in daily activities and bodily functions. The caretaker can TELL the doctor, but to see it and live it gives a better perspective on reality.