There have been many conflicting reports of what caused Amy Winehouse's death on Saturday. While initial autopsy results were inconclusive and the outcome of further toxicology tests will not be available for several more weeks, a report out of England is raising new questions about what might have killed the troubled singer.
Winehouse, who famously struggled with drugs and alcohol during her rocket ride to fame in 2006-2007, was drug-free for the past three years, according to statements from her father, Mitch Winehouse. But the 27-year-old star appeared to still be struggling with alcohol, and unnamed family sources told English tabloid The Sun that it might have been Amy's cold-turkey approach to quitting drinking that did her in.
The sources said Winehouse's decision to give up drinking entirely for three weeks might have given a lethal "shock" to her system. "Abstinence gave her body such a fright they thought it was eventually the cause of her death," the source said.
"[Amy's father, Mitch] said doctors had told Amy to gradually reduce her intake of alcohol and to avoid bingeing at all costs. Amy told him she couldn't do that. It was all or nothing, and she gave up completely ... Mitch said the shock of giving up, after everything she had been through over a bad few years, was just too much for her to take."
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The family has reportedly speculated that Winehouse died as a result of a seizure because her small frame could not withstand such a dramatic withdrawal. People magazine reported that it had confirmed the family's speculation about the cause of death.
On Sunday, the singer's U.K. representative, Chris Goodman, told TMZ that Winehouse was found alone in her bed by a bodyguard who had been hired to keep an eye on her. "She was in her bedroom after saying she wanted to sleep, and when he went to wake her he found she wasn't breathing," Goodman said. "He called the emergency services straight away. He was very shocked. At this stage no one knows how she died. She died alone in bed."
MTV News asked Dr. Sam Zakhari, director of the Division of Metabolism and Health Effects at the National Institute on Alcohol Abuse and Alcoholism, if it's possible for someone to have this kind of reaction to stopping alcohol intake. Dr. Zakhari, who did not treat Winehouse and has no firsthand knowledge of her case, spoke in general terms about the scenario described by the unnamed source.
"People who drink heavily or who are alcoholics and stop all of a sudden may have withdrawal symptoms that range from agitation to intense anxiety to tremors, seizures, convulsions and delusions," said Dr. Zakhari. "In rare cases, it can affect the heart and cause cardiac standstill (heart stoppage), but that's in very rare cases."
Dr. Zakhari said it's difficult to say with any certainty if quitting cold turkey could cause a collapse, because there are many factors that play into that scenario. "You have to look at their nutritional status, family history of heart problems, whether they are using other medications that can interact with alcohol, whether they abuse other substances," he said. "The accurate answer is that we don't know if something like this is due to stopping drinking alcohol because the result depends on such a multitude of factors."
Dr. Dan Hall-Slavin, a psychiatrist and a consultant in addiction at the Mayo Clinic in Rochester, Minnesota, agreed that it's possible, but not common for someone who quits drinking to have such drastic health effects. "There is a phenomenon called 'kindling,' where withdrawals from alcohol can get worse and worse over time," said Dr. Hall-Slavin, who also had no firsthand knowledge of the Winehouse case and was speaking in general terms.
"From a clinical standpoint, you never tell anyone who has been actively drinking to just stop until they get into a monitored setting because alcohol is a central nervous system depressant and while some can stop and not experience problems, others with a previous history of alcohol withdrawal can experience very serious symptoms like seizures and a severe withdrawal called Delirium Tremens, where your temperature goes up, you become dehydrated, and you can die in that state."
Sometimes, people who suffer a seizure in private can aspirate the contents of their stomach and die, but different factors can also play in, such as other health issues that result from daily drinking at high volumes and the short and longer-term consequences to the cardiovascular system from use of stimulants such as cocaine.
"The other factor is that alcohol is more toxic for women at lower doses over a shorter period of time than for men," Hall-Slavin noted. "It's partly how alcohol is distributed and metabolized in the body."