Eventually, it catches up with you, and either austerity ensues or you go bankrupt. Happened to me a couple of times as a kid (via my parents, not my spending of course).
It doesn't have to mean being in debt, although I think for a lot it does. It can just be living paycheck to paycheck through most of their life and using credit to buy things they can't afford. The worst part beyond the stress it puts on a family is reality is forced on them around retirement, when it is really too late to change anything.
Really - how does this work? If you consistently live beyond your means, do you just die with a huge debt or do you repay it somewhere along the way?