BIG SUR, Calif. (WOWO) — The death of a 37-year-old hiker in California’s Ventana Wilderness is highlighting a potentially fatal complication of alcohol withdrawal that can occur when someone with chronic alcohol dependence suddenly stops drinking.

Joanna Ruth Shields was found unresponsive near Sykes Hot Springs in the Big Sur area. Initial concerns included the possibility of foul play, but an investigation and forensic examination concluded her death was most likely the result of alcohol withdrawal seizures associated with chronic alcohol use disorder, according to the Monterey County Sheriff’s Office and reporting by KSBW.

Andres Rosas, commander and primary public information officer for the Monterey County Sheriff’s Office, told KSBW that investigators found no evidence indicating criminal activity.

“This is a probable seizure that occurred as a result of chronic alcohol use disorder,” Rosas said.

Authorities said no further criminal investigation is planned.

The case is drawing attention to a danger that can be overlooked by people who have developed a physical dependence on alcohol: abruptly stopping heavy, prolonged drinking can trigger withdrawal that ranges from uncomfortable symptoms to seizures, delirium and potentially death.

The National Institute on Alcohol Abuse and Alcoholism warns that alcohol withdrawal can become life-threatening when someone who has been drinking heavily for an extended period suddenly stops. Symptoms can include nausea, rapid heart rate, seizures and other serious complications. (niaaa.nih.gov)

Alcohol changes the way the brain’s chemical signaling systems operate. With prolonged heavy drinking, the nervous system adapts to alcohol’s depressant effects. When alcohol is suddenly removed, that balance can shift sharply toward excessive nervous-system activity.

That can produce tremors, sweating, anxiety, elevated heart rate and blood pressure, nausea and insomnia. In more serious cases, a person can experience hallucinations, seizures or delirium tremens.

Alcohol withdrawal seizures generally occur within about eight to 48 hours after a person stops or substantially reduces alcohol consumption, with the greatest risk around the first day, according to the American Society of Addiction Medicine. Importantly, a seizure can occur even when other obvious withdrawal symptoms are not prominent. (asam.org)

That timing can make withdrawal particularly dangerous when someone is alone or far from medical care.

A person experiencing a seizure can lose consciousness without warning, fall or suffer another injury. In a remote environment, there may be no immediate access to emergency treatment.

The severity of withdrawal varies from person to person. A history of previous withdrawal seizures or delirium, numerous prior withdrawal episodes and a long history of heavy, regular alcohol consumption are among the factors associated with a greater risk of complicated withdrawal, according to ASAM guidelines. (asam.org)

Seizures are not necessarily preceded by a predictable progression of symptoms.

ASAM specifically notes that an alcohol withdrawal seizure can happen without other clinically prominent withdrawal signs. That’s one reason experts caution against assuming that someone is safe simply because they are not experiencing severe shaking, confusion or hallucinations.

More severe withdrawal can progress to delirium tremens, a medical emergency characterized by severe agitation, confusion and changes in vital signs. NIAAA says severe alcohol withdrawal can be life-threatening and may require medical monitoring and medication. (niaaa.nih.gov)

For people who are physically dependent on alcohol, the safest way to stop drinking may involve medical supervision rather than attempting to quit alone.

NIAAA advises people who have been drinking heavily for a prolonged period to seek medical help when planning to stop. Doctors can determine the appropriate level of care and may prescribe medication to make withdrawal safer. (niaaa.nih.gov)

Medical withdrawal management can range from closely monitored outpatient care for appropriate patients to residential or hospital-based treatment for people at higher risk.

Benzodiazepines are considered the first-line medication for preventing and treating serious alcohol withdrawal complications, including seizures, under medical supervision. ASAM recommends close monitoring following a withdrawal seizure because patients face an increased risk of another seizure and alcohol withdrawal delirium. (asam.org)

Stopping alcohol suddenly is different from simply deciding to skip a few drinks.

People who drink heavily but have not developed physical dependence may not experience dangerous withdrawal. But for someone with alcohol use disorder and physiological dependence, suddenly going without alcohol can trigger a rapid and potentially dangerous change in brain activity.

NIAAA says alcohol use disorder is a medical condition, and symptoms can include needing increasingly larger amounts of alcohol to achieve the desired effect and experiencing withdrawal symptoms when alcohol wears off. Those symptoms can include shakiness, restlessness, nausea, sweating, a racing heart and, in severe cases, seizures. (niaaa.nih.gov)

Treatment does not end with detoxification.

NIAAA emphasizes that withdrawal management is only the first step for someone seeking recovery from alcohol use disorder. Longer-term treatment can include counseling, medications and other forms of continuing support. (niaaa.nih.gov)

There are also medications approved by the Food and Drug Administration to help people reduce drinking or maintain abstinence, including naltrexone, acamprosate and disulfiram. The appropriate treatment depends on an individual’s medical history and circumstances. (niaaa.nih.gov)

The circumstances surrounding Shields’ death remain a reminder that alcohol withdrawal is not simply a matter of feeling sick after a night without a drink.

For people with chronic heavy alcohol use, withdrawal can become a medical emergency within hours. And in a remote setting — on a hiking trail, at a campsite or anywhere far from immediate medical care — a sudden seizure can have devastating consequences.

Anyone who believes they may be physically dependent on alcohol should talk with a health care professional before attempting to stop abruptly. NIAAA specifically recommends seeking medical help to plan a safe recovery when dangerous withdrawal is a concern. (niaaa.nih.gov)

The National Institute on Alcohol Abuse and Alcoholism also provides information about finding treatment for alcohol use disorder, including medically supervised withdrawal and longer-term recovery options.