I think he has a medical scare, perhaps a heart attack or some such. However, it's not too bad and he makes it to hospital with the help of Meigh and heavy lifting equipment.
There the doctors tell him if he doesn't stop taking xannies and drinking, he's going to die. His body is starting to show the signs of the damage he's done to it for years.
So he does, he stops... For a week or two, but the withdrawal from the xannies is too much and he needs more. So he's back on the sauce and the pills, and he's worse than ever and then like clockwork one day he turns off his stream and it never comes back on.
Meigh is devastated, because she's got no house, no job, no prospects and her family hate her. On the upside, Ralph's dead.