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The Unreal World

‘Crazy Heart’s’ addictive hero

What are the odds of Bad Blake, Jeff Bridges’ alcoholic, chain-smoking country singer, overcoming and/or surviving his demons?

March 08, 2010
(Lorey Sebastian / Fox Searchlight )

"Crazy Heart"

Butcher's Run Films

Currently in theaters

The premise: Otis "Bad" Blake ( Jeff Bridges) is a 57-year-old country singer and songwriter who has fallen on hard times. He's an alcoholic and chain smoker. He's experiencing frequent blackouts and episodes of vomiting from the alcohol, and he has jitters when he goes more than a few hours without a glass of whiskey.

While playing in a small nightclub in Santa Fe, N.M., he becomes romantically involved with a newspaper reporter played by Maggie Gyllenhaal and befriends her 4-year-old son, Buddy (Jack Nation). But he continues to drink. He has a blackout while driving and crashes his car, breaking his ankle and suffering a concussion. In the hospital, Bad is told that his high cholesterol can be treated with a pill but that, if he doesn't stop drinking and smoking, he'll end up with emphysema, heart failure, cancer or a stroke. He doesn't stop, however, until, while drunk, he loses track of Buddy in a shopping center.

Shortly thereafter, he enters a detox rehabilitation program, where he admits to being an alcoholic and begins taking the alcohol-deterrent drug antabuse (which makes users sick if they then consume alcohol).

The medical questions: What is the recidivism rate among severe alcoholics who enter rehab? Is antabuse helpful? What is the likelihood that an alcoholic who drinks several glasses of whiskey a day over many months has permanently damaged his liver? Can it recover? How much do the risks of lung and heart damage diminish after a chain smoker quits? Are jitters, vomiting episodes and blackouts common among alcoholics?

The reality: Alcoholism has a five-year relapse rate of 30% to 50%. Ultimately, 94% of alcoholics who have stopped drinking will "fall off the wagon" only to go back on the wagon later. "Usually patients gain some insight and don't relapse all the way to their original behavior," says Dr. Judith Martin, immediate past president of the California Society of Addiction Medicine.

Antabuse (disulfiram) can help deter some alcoholics from drinking, Martin says. It causes vomiting, sweating and headaches that can progress to breathing problems, heart arrhythmias, convulsions and even death; the risks and effects increase proportionally with the amount of alcohol consumed.

The amount of liver damage due to alcoholism varies based on genetic susceptibility, overall health and the presence of other liver problems, such as viral hepatitis. Alcoholic hepatitis (inflammation of the liver due to the toxic effects of alcohol) occurs in 35% of heavy drinkers, and cirrhosis (scarring of the liver) in 10% to 20%. The liver has a great regenerative capacity and can recover almost completely over several years unless it is already cirrhotic, in which case liver transplant may be an option.

It's unlikely that a patient who is known to drink as much as Bad would ever be offered a cholesterol-lowering statin drug, Martin says, because of its potential to elevate liver enzymes, ultimately becoming toxic to the organ.

As for smoking, the elevated risks of lung cancer and heart damage can be largely reversed by quitting, though emphysema (lung tissue destruction, most commonly because of smoking) is not reversible.

Blackouts are common among heavy drinkers, occurring when alcohol blocks nerve transmission. And because alcohol irritates the stomach, chronic use can cause gastritis or ulcers, leading to frequent vomiting episodes.

The jitters and shakes are similarly common during alcohol withdrawal, Martin says. Alcohol depresses brain function, and stopping it causes agitation as the brain recovers from its physical addiction.

Bridges' rendering of the medical difficulties of a chronic alcoholic is mostly accurate, as is his protracted, uneven and courageous recovery.

Siegel is an associate professor at New York University's School of Medicine.

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