Hopefully you’re never in the position of being scared for a friend who’s passed out drunk. Many drunken nights end with nothing worse than an impending hangover. But our society’s generally casual approach to alcohol can make it easy to underplay the potential dangers of drinking too much, like losing consciousness.
You may already know that passing out from drinking too much alcohol is a symptom of alcohol overdose, also known as alcohol poisoning. As the National Institute on Alcohol Abuse and Alcoholism (NIAAA) explains, alcohol overdose doesn’t just mean someone is too drunk. This health hazard happens when a person’s level of intoxication is interfering with the basic physiological functions that keep them alive. On average, six people a day die from alcohol poisoning in the United States, per the most recent available numbers from the Centers for Disease Control and Prevention (CDC).
No matter how aware you are of alcohol’s potential dangers, a friend passing out from alcohol can turn a theoretical risk into a very real and frightening one. We get why you might be hesitant to spring into action. You might not be sure if your friend is truly passed out or if they will sleep off the booze and be completely fine. You might also worry that making a big deal over it will brand you as a buzzkill. But if someone is passed out from alcohol, there’s a very real chance they’re in life-threatening trouble. It might be up to you to save them. This is how to tell if a friend’s life is in danger after drinking too much and what to do next.
Why does alcohol make people pass out in the first place?
“Alcohol’s main effect on the brain is sedation,” Darria Long-Gillespie, M.D., an emergency room doctor and clinical assistant professor at the University of Tennessee School of Medicine, tells SELF. As the CDC explains, alcohol is a depressant that impacts your central nervous system, which is comprised of your brain and spinal cord. With that in mind, it’s no surprise that alcohol’s sweeping effects can impact mental functions like decision-making along with physical ones like your ability to stay alert.
“When alcohol is first being absorbed and our blood alcohol concentration (BAC) is on the way up, we may feel stimulated,” Susan Stoner, Ph.D., a research consultant at the University of Washington Alcohol & Drug Abuse Institute, tells SELF. This is because alcohol acts on your brain’s “reward” system by prompting the release of dopamine, a neurotransmitter that can induce good feelings. But the more alcohol you drink, the more your body builds up adenosine, a chemical that makes you tired—hence why you might feel gently relaxed after half a glass of wine but fall asleep after two.
Alcohol also affects neurotransmitters such as glutamate, which governs brain function. If you drink enough alcohol, its depressant effects can reduce your breathing and heart rate, which is when alcohol intoxication can become life-threatening. Alcohol intoxication can also kill someone more indirectly, Dr. Long-Gillespie says. A drunk person can fall and hit their head, think they’re fine to drive and crash, pass out and choke on their vomit, or get into other life-threatening situations.
“Everyone who drinks four or more drinks in one setting—or spends time with someone who does—should become familiar with a blood alcohol chart that shows how many ‘standard drinks’ result in a dangerous BAC,” Stoner says. A standard drink is around 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of an 80-proof spirit like rum or tequila. Here’s a blood alcohol chart for women and one for men, though keep in mind that things like how much you’ve eaten and how your body metabolizes alcohol in general may influence how true this kind of chart is for you. As Stoner notes, a BAC of around 0.3 percent or higher is considered to be possibly fatal.
If you can’t wake your friend, you need to call 911 immediately.
“A person who is ‘sleeping off’ their alcohol should be fairly easy to wake up,” Stoner says. “Someone who is unconscious from alcohol would be very difficult to rouse.”
If calling your friend’s name and shaking their shoulders doesn’t work, Stoner suggests rubbing their sternum (breastbone) with your knuckles or pinching their earlobe. “In either case, it needs to be hard enough to cause pain,” she says. “If the friend doesn’t respond, they’re likely unconscious and could be at risk of death.”
Keep in mind that your friend doesn’t actually need to be passed out in order to be in danger. According to the NIAAA, other signs that your friend has overdosed on alcohol and that you should call 911 include:
- Clammy skin
- Blue-tinged or pale skin
- Low body temperature
- Breathing fewer than eight times a minute
- Pausing for 10 or more seconds in between breaths
- Reduced physical responses, like a lack of the normal gag reflex that prevents choking
Don’t take long to evaluate your friend for these signs. “If you have to look for more than a few seconds to tell if someone is breathing or not, and they do not wake up when you shake or shout at them, call 911,” nationally registered paramedic Heather Davis, associate director of the UCLA Center for Prehospital Care and program director for the UCLA Paramedic Education Program, tells SELF.
If your friend is vomiting while unconscious, Davis recommends placing them on their side to lower their likelihood of choking. “Ideally, another friend will call 911 [while you do this] and get paramedics en route,” she says. You can also lean them forward, the NIAAA says. Either way, it’s best if they’re on the ground so they’re not at risk of falling and hurting themselves.
When the emergency responders arrive, tell them as much information as you can, the NIAAA says. That includes how many drinks your friend had, what kind of alcohol, any other drugs they took, and any relevant information you may know, like that your friend has a certain health condition.
Monitor your friend even if they’re asleep and not passed out.
A person’s BAC can continue to rise even if they’ve stopped drinking because alcohol will keep leaching from their stomach and small intestine into their bloodstream.
“As your blood alcohol concentration goes up, the risk of most severe problems from a medical perspective [gets] higher as well,” Lorenzo Leggio, M.D., senior clinical investigator of the joint section of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), tells SELF.
That means a friend who is “only” very drunk could still deteriorate into alcohol poisoning.
“One of the biggest mistakes is thinking that your friend will ‘sleep it off’ and then leaving them alone without being observed,” Dr. Long-Gillespie says. “Friends often return hours later, only to find that their friend stopped breathing or choked on their own vomit.”
According to the NIAAA, symptoms of severe alcohol intoxication that could lead to alcohol poisoning include:
- Markedly impaired speech, memory, reaction time, balance, coordination, and attention
- An inability to drive due to dangerously impaired motor skills
- Risky decision-making and poor judgment
- Blacking out
- Loss of consciousness
If your friend is exhibiting these symptoms, they could be well on their way toward a life-threatening alcohol overdose. Be prepared to call 911 immediately. Go ahead and do it if they’re losing consciousness or vomiting, Dr. Long-Gillespie says.
Don’t leave your friend alone.
Even if your friend is sleeping and doesn’t have alcohol poisoning, leaving them alone could make them more vulnerable to sexual assault depending on your surroundings. “There is safety in numbers, so stick together,” Davis says.
The onus should never be on a potential victim (or their friends) to avoid an assault. The only person at fault for an assault is the one committing the crime. But the unfortunate reality is that until we as a society can trust people not to perpetrate assaults, sometimes safety measures such as staying together in this kind of situation are necessary.
Don’t be afraid to remove yourself and your friend from the situation as safely as possible, like if you’re at a house party, your friend is drunk and asleep, you’re also inebriated, and your ride home already left. For safety’s sake, Davis recommends always knowing your exact location and keeping your phone charged if you ever need to call for help, order a ride, or otherwise get home safely.
Some states have laws to protect people who call 911 in these instances.
You may be hesitant to call 911 because you worry you’ll get your friend (and possibly yourself) into trouble, especially if you’re too young to drink legally or if illegal drugs are involved. SELF doesn’t condone underage drinking or illegal drug use, but it’s always important to be able to get help in a potentially deadly situation without fear of repercussion. To encourage this, more than 30 states and the District of Columbia have introduced medical amnesty laws.
“[These laws] can provide immunity from criminal prosecution or, depending on the law, be offered as a defense at trial,” a representative at the Substance Abuse and Mental Health Services Administration (SAMHSA) tells SELF in an email. “Laws differ [by state] as to whether they apply to the victim, the caller, or those bystanders who offer assistance. A common element is that the person acted in ‘good faith’ in seeking help.” Another variable is whether or not the laws apply to drugs, alcohol, or both.
You can see if your state has a medical amnesty law and read it here. Some colleges and universities have also created their own medical amnesty policies in an effort to keep students safe. If your school has one, it may be on the website or in the student handbook. Here is Northwestern University’s medical amnesty policy as an example.
No matter the medical amnesty laws and policies in your location, Davis says that emergency responders tend to be most concerned with saving lives, not busting underage drinkers or people using drugs. “We often tell people that we are not the cops. We do not care what drugs you have done or how drunk you are. We are here to help,” Davis says. “In most states, there are not mandatory reporting laws for drugs or alcohol, so we do not have to call the police or file any sort of report if you have overindulged or were experimenting with drugs.”
When in doubt, always get medical help for a passed out friend immediately.
Even if there aren’t medical amnesty laws in effect where you are, getting help for a friend who’s dangerously drunk is worth it. It could save your friend’s life. Also (and less importantly), consider the outcome if you didn’t do anything and, in the worst-case scenario, your friend died. Not only would you be dealing with that loss, but you’d also be facing more serious consequences than you would be for something like underage drinking.
“You can't take back not calling in time if your friend dies,” Davis says. “[Emergency responders] can always just return to service if we are not needed.”
Know your limits to avoid passing out from alcohol yourself.
According to the United States Department of Agriculture’s Dietary Guidelines, adults who drink should do so in moderation, which means having no more than one standard drink a day for women and two for men. If you’re going to go beyond that, follow these rules to stay as safe as possible:
- Alternate one alcoholic beverage with one glass of water.
- Eat before and while you drink so you don’t absorb alcohol as quickly.
- Have a maximum of one drink an hour.
- Decide beforehand how many drinks you can have without compromising your safety, then don’t keep nudging that number higher when you’re actually imbibing. Once you know what your body can handle, don’t push it.