Dear Alice,

Two questions on alcohol:

A friend has had a lot to drink, and they are on the verge of collapsing or throwing up, etc. I'm good at the emotional consolation stuff when people get upset, but what about what I should do physically?

Should they lie down, sit upon the floor, sit in a chair? Should they drink water? Should I get them to eat something? Should I take their wrists and make them wave their arms to keep blood rushing? Should I get them to walk? Should they be outside in the fresh air, or in the warmth? Where should I be, sitting side by side with them, sitting on the floor with my chest to their back?

Secondly, if I'm also drunk and I think that the atmosphere around me is getting aggressive, how can I accelerate sobering up to retain the role of a coordinator and get people sorted out?

Thanks if you can help.

Dear Reader,

It's great that you're asking these questions, as any friend who has had too much to drink needs help and support. What you do for them might depend on criteria such as how much they've had to drink, where you are, what other factors are involved (such as other substances, including illicit drugs, prescription or over-the-counter medications), and your own level of intoxication. One of the key risk reduction strategies to remember is that if at least one person in your group is completely sober, they'll probably be best suited to assess the situation and call for any needed help. Even one or two drinks can impair judgment, making it more difficult to figure out the urgency of a situation. In terms of your role when people get aggressive, it's key to maintain your own safety in that situation (whether you leave, call for help, or both), as only time can help increase your sobriety.

It might help to start by understanding various signs that someone is intoxicated to the point of concern. There are many signs that can indicate a problem, such as:

  • Slurred speech
  • Stumbling or having difficulty maintaining balance and walking independently
  • Trouble making eye contact
  • Feeling excessively cold or warm (to themselves or to the touch)
  • Shortness of breath
  • Erratic, withdrawn, or aggressive behavior
  • Queasiness, vomiting, or dry heaving
  • A tired stupor
  • Unconsciousness

One of the first ways to help when someone has had a lot to drink is to try to make sure that they don't consume any more alcohol. It may help for the person to sit in a quiet place where they can relax comfortably. An individual's reflexes and coordination can be severely impaired when intoxicated, so walking around may not be the best idea. It's also wise to make certain that they're kept warm, since high blood alcohol levels can lower body temperature, even if the person actually feels warm. Depending on how your friend is feeling or behaving, you may choose to take different actions. Some situations you may encounter include your friend:

  • Wanting to drink water. You can offer it to keep them hydrated. Dehydration is one of the side effects of drinking because alcohol is a diuretic, meaning that they expel more liquid than is actually consumed. Keeping hydrated won't make someone sober — only time will allow the alcohol to work its way through the system and eventually out of the body — but it may help them feel better the next day. It can be good to remember that coffee may result in feeling worse because it, too, causes dehydration, can be a stomach irritant, and will keep your intoxicated friend awake all night!
  • Being sick. You might also be wary about encouraging your friend to eat something, as eating could actually make them feel more sick. You may only want to offer food if your friend says they're hungry or think it will help them feel better. Eating food after getting drunk isn't the same as eating food before or while drinking. While eating before or while drinking may slow the absorption of alcohol in the body, having eaten after becoming intoxicated doesn't slow down the absorption rate. Another idea to keep in mind — never force food or drink down anyone's throat. Intoxication may dull the swallowing/gag reflex and doing this may cause them to choke.
  • Wanting to lie down. It's good to make sure they're on their side, with a support behind their back to prevent rolling over onto the back or stomach. If they vomit while on their back, they can choke. If they're on their stomach, there's a risk of drowning by breathing in the vomit. If your friend feels ill and wants to go to the bathroom, it's best that someone accompany them. Bathrooms are cold, hard, and often wet, which can be an unsafe environment for someone who is unsteady, has poor coordination, and is ill.
  • Falling asleep. It's highly recommended that someone stay with them and check continually to ensure that they're breathing normally. If someone is tired after drinking, that may be normal, as alcohol is a depressant. Therefore, it slows all of the body's functions down. But there’s a difference between sleeping and being unconscious — a sleeping person can be woken up, but someone who is unconscious may be unresponsive and unable to wake up. You may notice that the person is breathing slowly or shallowly, they may feel cold to the touch, or have blue-ish lips. In large amounts, alcohol will dull the nerves that regulate breathing, heartbeat, and gag reflex. This could lead to injury, or even death. If there are any signs that your friend is having trouble breathing, is severely ill, or is already unconscious, it's critical to call emergency help immediately. If you're unsure of what to do or how drunk they really are, erring on the side of caution and calling anyway may be a life-saving decision.

Some people, including college students, are afraid of getting into trouble if they need to call for help. Some decide to leave their drunk friends to fend for themselves because of this concern. This is unsafe and can even be life-threatening. It's more critical, and in fact your responsibility, to see that your friends have the help they need. If you're a student and have questions or concerns about your school's policies about helping intoxicated students (whether due to alcohol or other drugs), you can speak with your deans, residential life staff, security office, or health care professionals. At many universities, there's a strong commitment on the part of the administration to handle all calls for an intoxicated student as the medical emergency that it is, following up only to be sure that the student and their friends are safe.

You also have mentioned concerns about what to do if the atmosphere is getting aggressive or out of control. This is another area where it's good to err on the side of caution. Your safety, and that of your friend, is the first priority. Sometimes the best approach is to get you and your friend out of the situation, or at least away from the "action," or call for help. Acting as a "coordinator" as you mentioned may not be the safest role for you to play. Ultimately, if you're already drunk, only time will help to sober you up, and you may not be well-positioned to help coordinate others. You can ask a bartender, club manager or bouncer, or security/safety officer personnel for assistance. If it's your friend who is behaving in an unsafe way, intervening can be awkward. But again, your safety, and ultimately theirs, is at stake. You always have a right to speak up if you feel that someone is acting in an inappropriate way.

In fact, this brings up one other point. If you find that your friend is repeatedly drinking to the point where they're unable to care for themselves, are making decisions with poor judgment, or are acting aggressively, it may be time to think about your own boundaries and limits. How do you feel about spending your time in this way with these friends? If you find yourself taking care of your friends who’ve had too much often, are you able to enjoy yourself, too? What would it be like for you if you were with people who consumed alcohol in a way that didn’t make you worry? Relatedly, while it may seem being there to help friends who often have too much to drink is helping, there may be more going on that is related to their substance use that goes unresolved or unchecked. In the end, this could lead to resentment on your part, or some pretty destructive patterns in their own lives. You might want to think about how their behavior affects you and find a way to tell them how you feel about it. Talking about it might help your friends to hear your concerns and may encourage them to revisit their relationship with substance use. Check out the related Q&As for more information about how you and your friend can drink in a low-risk way if you choose to drink, avoid hangovers, and figure out when someone is struggling with alcohol.

Alice!

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