As Pa. liquor stores close, advocates worry about risks of sudden alcohol withdrawal

As lines stretched out to the sidewalks in front of Pennsylvania’s liquor stores before they closed indefinitely on Tuesday night, advocates raised concerns about how the state plans amid the coronavirus outbreak to care for people who are addicted to alcohol — for whom quitting cold-turkey can be life-threatening.

State health officials said in a Tuesday afternoon news conference that they were working on help for people with alcohol dependencies, through Pennsylvania’s Department of Drug and Alcohol Programs. Though they acknowledged that the concern is an important one, they did not provide any further details on the plan.

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In Philadelphia, health officials noted that there are other places around town to get alcohol: The state, of course, isn’t suddenly entering a second Prohibition era. Pennsylvanians can still buy wine and beer at the grocery stores and convenience stores that are licensed to stock it, said Elizabeth Brassell, a spokesperson for the state Liquor Control Board. Bars and restaurants that have suspended dine-in services still sell beer and wine to go, if they’re licensed for it. Independent breweries, wineries, and distilleries can also sell alcohol to carry out.

But advocates for those with alcohol dependency say making alcohol less accessible can still pose a problem for people deep in addiction, with limited resources. People who can’t afford to buy enough wine or beer to satisfy their needs and rely on hard liquor may face alcohol withdrawal, said Bill Stauffer, the executive director of the Pennsylvania Recovery Organization Alliance, a nonprofit that advocates for people in addiction and recovery.

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“If you’re a middle- or upper-class person with heavy alcohol use, you’re going to find a way to get to those distilleries and get hard liquor," he said. “For poor members of the community who may not have access to those kinds of services, it’s going to continue to be a concern. Hopefully there are efforts to target support for them.”

Henry Kranzler, a professor of psychiatry at the University of Pennsylvania and the director of the school’s Center for Studies of Addiction, said that because alcohol is still available in other locations besides liquor stores, he didn’t believe closing the stores “is going to be a huge problem, particularly in the context of everything else."

He said closing PLCB stores was likely the right decision to limit the spread of coronavirus, part of a wider plan across the state to practice social distancing and isolation as cases of COVID-19 climb throughout the United States.

Still, he said, higher costs and lower access to alcohol could present a problem for some.

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Severe alcohol withdrawal can be dangerous, even life-threatening. Simple withdrawal — where someone feels shaky, has headaches, and is nauseated — isn’t serious and dissipates with time, Kranzler said. But severe withdrawal can bring on tremors, delirium, seizures, and autonomic instability — dysfunction in the nerves that regulate non-voluntary body functions. This can cause death.

“Those that are beginning to experience alcohol withdrawal, they need to get somewhere they feel safe and be treated. Trying to do that on their own can put them in a perilous situation,” said Joseph Garbely, chief medical officer at Caron Treatment Centers, which he said has been preparing for a potential influx of people in alcohol withdrawal.

Kranzler recommended that people worried about alcohol withdrawal during coronavirus-related shutdowns should try to taper down their drinking, rather than stop abruptly. If they need medical help, they should call a doctor or call ahead to an emergency room to avoid sharing space with people who may have the virus.

Stauffer said that the state should work to educate people about alcohol dependency and withdrawal so they can make decisions about how to seek care.

“I’ve worked with people who didn’t realize they were dependent, until something happened where they couldn’t get access to it, and they don’t realize why they’re going into withdrawal,” he said. “I think we’re going to focus on getting the public care and education — what does alcohol dependence look like, how common is it, and what to do in those circumstances.”