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,

Taking care of your friends after they've had too much to drink is certainly a noble and critical thing to do. It can be a challenging and unpleasant job, though, and you've brought up a number of issues to consider.

Any friend who has had too much to drink needs to help and support. What you do for them might depend on factors 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 what your own level of intoxication is. 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 accurately and call for any needed help. Even one or two drinks can impair judgment, making it more difficult to figure out how urgent a situation really is.

It might help to start by understanding various signs that someone is intoxicated to the point of concern. A lot of people think that a person needs to be throwing up or passed out to need medical attention. However, there are many signs that can indicate a problem aside from vomiting. Some to look for are:

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  • Erratic, withdrawn, or aggressive behavior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

The first thing to do when someone has had a lot to drink is to make sure that they don't drink 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 is not the best idea. You also need to make certain that they're kept warm, since high blood alcohol levels can lower body temperature, even if the person actually feels warm.

If your friend is willing to drink water on their own, you can offer it to keep them hydrated. Dehydration is one of the side effects of drinking because alcohol is a diuretic, meaning that one expels more liquid than is actually taken in. 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. But remember, drinking water, or black coffee, or eating food will not speed up the process of getting sober. In fact, coffee can make things worse because it, too, causes dehydration, can be a stomach irritant, and will keep your intoxicated friend awake all night!

If your friend is sick, you might also be wary about encouraging your friend to eat something, as eating could actually make them feel more sick. Only offer food if your friend says they are hungry or think it will help them feel better. And remember, eating food after getting drunk isn't the same as eating food before or while drinking (a healthy drinking strategy you'll find elsewhere in the Alcohol and Other Drugs section of the Go Ask Alice! archive). By the time someone is drunk, the alcohol has left the stomach and is being absorbed through the walls of the lower intestine — it's already too late to slow that down. Another thing to remember — never force food or drink down anyone's throat. Their swallowing/gag reflex may be dulled and this could cause choking.

If your friend feels like lying down, make sure they are on their side, with something behind their back to prevent rolling over onto the back or stomach. If they vomit while on their back, they can choke. On their stomach, there is 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. It may sound silly, but bathrooms are cold, hard, and often wet — an unsafe environment for someone who is unsteady, has poor coordination, and is ill.

If your friend falls asleep, someone needs to stay with them and check continually to ensure that they are breathing normally. Many people don't realize the difference between someone who is sleeping and one who is at risk for (or already is) becoming unconscious. If someone is tired after drinking, that may be normal. Alcohol is a depressant. Therefore, it slows all of the body's functions down. If a person is sleeping, they can be woken up, and perhaps moved to a safe location or talked with. Someone who is unconscious will not respond to gentle shaking or being spoken to. You may notice that the person is breathing slowly or shallowly. They may feel cold to the touch or have blue-ish lips. An unconscious individual needs immediate medical attention. In large amounts, alcohol will dull the nerves that regulate one's 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, call an ambulance immediately. If you are unsure of what to do or how drunk they really are, err on the side of caution and call anyway.

Some people, especially 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 dangerous, and even life threatening. It's more critical, and in fact your responsibility, to see that your friends have the help they need. At many universities, there is 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. Sometimes, an individual will be encouraged to speak with someone — particularly if problems have been frequent or there has been other troubling behavior, such as fighting or damage to property. If you 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 personnel. There may be unwritten policies in place to encourage students to reach out for help without fear of discipline or even monetary implications.

You also have mentioned concerns about what to do if things are getting aggressive or out of control. This is another area where it's good to err on the side of caution. On the one hand, you can try to step in if you feel comfortable, and sober enough, to do so. On the other, your safety, and that of your friend, is the first priority. Sometimes the best thing to do is to get you and your friend out of the situation, or at least away from the "action," or call for help. You can ask a bartender, club manager or bouncer, or security/police personnel for assistance. If it is 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 are 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. Is that really the environment you want to spend time in with people you care about? Is cleaning up vomit, holding people's heads in the toilet, breaking up fights, or worrying about someone really a fun way to spend a weekend? In addition, always being willing to sort things out may enable your friend to keep making the same mistakes. 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 really affects you and find a way to tell them how you feel about it. The answer to Help for friends who drink too much in the Alcohol & Other Drugs archive offers some tips for having this type of conversation. Talking about it might help your friends to look at their own responsibility and learn to drink in a more healthy way.

Check out the Related Q&As for more information about how you and your friend can be healthier drinkers, avoid hangovers, and figure out when someone is having a problem with alcohol.


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