How old is Ralph now? The critical phase usually starts mid-40's to early 50's, that's when the more serious health issues from heavy drinking usually start to manifest. Stuff like pancreatitis (turning chronic quickly in alcoholics), varices in the throat (i dimly remember some text message to Meigh where he said he's puking up black stuff, that's nothing but internal bleeding due to varices), all that fun stuff. Ethan will die like a dog from his lifestyle, i wager he's already at the point where a lot of the damage can't be undone by simply stopping drinking and popping pills. Probably long at the stage where going cold turkey (

) would kill him by way of seizure thanks to the alcohol + benzos combo.
He's also a fat cunt, that will exacerbate issues.