Twisted sicker than mad cattle,
Bovine spongiform encephalopathy (BSE) or mad cow disease, it is a fatal disease that can be transmitted to humans also. Cows infected can act ‘mad’ and therefore it’s called the mad cow disease
By “twisted” Earl means drunk and high at the same time(i.e. the following “six different liquors” line). The booze has him twisted sicker than mad cow disease, and that’s pretty sick.
Also, he refers to being “twisted” mentally (a sick mind)
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