Alcohol Poisoning: How to Recognise the Signs and What to Do (First Aid Guide)

Alcohol Poisoning Kills. Knowing the Signs Saves Lives.

Every year in the UK, hundreds of people die from alcohol poisoning. Many of these deaths are preventable. They happen not because nobody was around, but because the people present did not recognise the severity of what they were seeing, or did not know what to do. They assumed their friend was just "really drunk" and would sleep it off. In some cases, that assumption proved fatal.

This guide exists to make sure you know the difference between someone who is drunk and someone who is in a medical emergency. Whether you are a university student, a parent, a teenager heading to your first party, or someone who simply wants to be prepared, this information could save a life.

What Alcohol Poisoning Actually Is

How Alcohol Affects the Body

When you drink alcohol, your liver processes it at a rate of roughly one standard unit per hour. When alcohol is consumed faster than the liver can metabolise it, blood alcohol concentration (BAC) rises. At moderate levels, this produces the familiar effects of intoxication: relaxation, lowered inhibitions, impaired coordination. But alcohol is a depressant, and at high concentrations it begins to suppress the body's most vital functions.

When Drinking Becomes Poisoning

Alcohol poisoning occurs when BAC reaches levels that begin to shut down the areas of the brain controlling breathing, heart rate, body temperature and the gag reflex. This is not an extreme scenario that only happens to people with severe alcohol problems. It can happen to anyone who drinks too much, too quickly. Binge drinking, which the NHS defines as consuming more than six units in a single session for women or eight for men, is the most common cause.

Who Is Most at Risk

Young adults and university students are disproportionately at risk due to binge drinking culture, drinking games and social pressure. People who have not eaten before drinking, those with lower body weight, individuals who are not used to alcohol, and anyone mixing alcohol with other substances (including prescription medication) face higher risk. However, alcohol poisoning can affect anyone, regardless of age, experience or tolerance.

Recognising the Signs: Drunk vs. Dying

Signs of Severe Intoxication (Needs Monitoring)

Slurred speech, unsteady on their feet, loud or emotional behaviour, repeating themselves, difficulty focusing their eyes, and poor decision-making. At this stage, the person needs to stop drinking, drink water, eat something if possible, and be monitored by someone sober. They are intoxicated but not typically in immediate medical danger.

Signs of Alcohol Poisoning (Medical Emergency)

This is where it becomes critical. Call 999 immediately if someone shows any of the following signs: they are unconscious or semi-conscious and cannot be woken; their breathing is slow (fewer than eight breaths per minute), irregular, or has gaps of ten seconds or more between breaths; their skin is pale, cold, clammy or has a bluish tinge, particularly around the lips and fingertips; they are vomiting while unconscious or semi-conscious; they are having a seizure or fit; their body temperature has dropped noticeably (hypothermia).

The Critical Distinction

A person who is very drunk can usually be woken up, even if they are groggy and confused. A person with alcohol poisoning may be unresponsive to shouting, shaking or pain. If you cannot wake someone up, this is a medical emergency. Do not wait to see if they improve. Do not assume they will "sleep it off." Call 999.

First Aid for Alcohol Poisoning: Step by Step

Step One: Call 999

If you suspect alcohol poisoning, call emergency services immediately. Do not worry about getting into trouble. Do not worry about wasting their time. Paramedics would always rather attend a call that turns out to be less serious than expected than arrive too late for one that was not reported. When you call, tell the operator what the person has been drinking (if you know), how much and over what time period, whether they have taken any other substances, their age and approximate weight, and exactly what symptoms you are seeing.

Step Two: Put Them in the Recovery Position

If the person is unconscious or semi-conscious, place them in the recovery position immediately. This means lying them on their side with their top knee bent forward to stop them rolling onto their stomach or back. Tilt their head back slightly and ensure their mouth is pointing downward so that if they vomit, it drains out rather than being inhaled into their lungs. Choking on vomit is one of the most common causes of death in alcohol poisoning cases.

Step Three: Stay With Them

Do not leave them alone, even to go and get help if you can call from where you are. Monitor their breathing continuously. If their breathing stops or becomes very irregular, be prepared to begin CPR if you have been trained to do so. If you have not been trained, the 999 operator can talk you through it over the phone.

Step Four: Keep Them Warm

Alcohol causes blood vessels to dilate, which leads to rapid heat loss. A person with alcohol poisoning is at serious risk of hypothermia, particularly if they are outdoors or in a cold environment. Cover them with a coat, blanket or anything available. Do not put them in a hot bath or shower, as the rapid temperature change can cause cardiac arrest.

Step Five: Do Not Do These Things

Do not give them coffee. Caffeine does not sober someone up; it just creates a wide-awake drunk person whose body is still shutting down. Do not make them vomit. If they have a suppressed gag reflex, forcing vomiting can cause them to choke. Do not put them in a cold shower. The shock can cause unconsciousness and hypothermia. Do not let them "sleep it off" without monitoring. Blood alcohol levels can continue to rise even after someone stops drinking, as alcohol in the stomach is still being absorbed. Do not give them food or water if they are unconscious, as they could choke.

After the Emergency: What Happens Next

At the Hospital

If someone is taken to hospital with alcohol poisoning, they may receive intravenous fluids to prevent dehydration, oxygen therapy to support breathing, glucose to prevent blood sugar dropping dangerously low, and medication to prevent seizures. In severe cases, stomach pumping (gastric lavage) or dialysis may be used, though these are less common. Most people who receive timely treatment recover fully, which is why calling 999 early is so important.

The Conversation After

Once the immediate crisis has passed, there is an important conversation to have. This applies whether you are a friend, a parent, a partner or a flatmate. Approach it with care and concern rather than blame. The person may feel frightened, embarrassed or defensive. Say something like: "I was really scared last night. I am glad you are okay. Can we talk about what happened?" This opens the door without putting them on the defensive.

When One Incident Suggests a Bigger Problem

A single episode of alcohol poisoning does not necessarily indicate alcoholism or alcohol dependency. It may result from inexperience, misjudging tolerance, drinking games, or social pressure. However, if someone has experienced alcohol poisoning more than once, if they regularly drink to the point of losing control, or if they express difficulty cutting down despite wanting to, these are signs that professional support may be needed. Encourage them to speak to their GP or contact Drinkline on 0300 123 1110 for confidential advice.

Myths That Put Lives at Risk

"They Just Need to Sleep It Off"

This is the myth that kills people. Blood alcohol concentration can continue to rise for 30 to 40 minutes after the last drink. Someone who appears merely very drunk when they fall asleep can deteriorate into a medical emergency while unconscious. If you are unsure, err on the side of caution. Check on them regularly. If you cannot wake them, call 999.

"Eating Bread Will Soak Up the Alcohol"

Once alcohol is in the bloodstream, food cannot absorb it. Eating before drinking can slow the rate of alcohol absorption, but eating after heavy drinking does not reverse intoxication and will not prevent alcohol poisoning. If someone is showing signs of poisoning, they need medical help, not toast.

"Cold Air or a Cold Shower Will Sober Them Up"

Cold exposure does not reduce blood alcohol levels. It can, however, cause hypothermia, shock, falls and loss of consciousness. A person with alcohol poisoning needs warmth, monitoring and medical attention.

"You Cannot Die From Alcohol Alone"

You absolutely can. Alcohol alone, without any other substances involved, can cause death through respiratory arrest, choking on vomit, hypothermia, cardiac arrhythmia and severe dehydration. Mixing alcohol with other depressants such as benzodiazepines, opioids or even antihistamines increases the risk dramatically, but alcohol on its own is lethal in sufficient quantities.

Prevention: Reducing the Risk

Know Your Limits

The UK Chief Medical Officers' guideline is no more than 14 units per week, spread over three or more days. One unit is roughly half a pint of standard-strength beer, a single measure of spirits, or a small glass of wine. Many people significantly underestimate how much they are drinking, particularly when pouring at home or drinking cocktails with multiple measures.

Eat Before and During Drinking

Having food in your stomach slows alcohol absorption, giving your liver more time to process it. This does not prevent intoxication, but it reduces the speed at which BAC rises, lowering the risk of reaching dangerous levels quickly.

Alternate With Water

Drinking a glass of water between every alcoholic drink slows your overall consumption, keeps you hydrated and gives your liver more time to keep up. It is one of the simplest and most effective harm reduction strategies available.

Watch Out for Each Other

The most effective prevention comes from the people around you. If you are on a night out and you see someone drinking dangerously quickly, intervene. Suggest water. Suggest food. Suggest slowing down. If they are past the point of persuasion, keep an eye on them and be ready to act. Looking after your mates is not being boring. It is being responsible, and it could be the difference between a hangover and a hospital visit.

Helplines and Support

In an emergency, always call 999. For non-emergency medical advice, call NHS 111. For alcohol advice and support, contact Drinkline on 0300 123 1110 (weekdays 9am to 8pm, weekends 11am to 4pm). Alcoholics Anonymous offers 24-hour support on 0800 917 7650. For young people specifically, the FRANK helpline on 0300 123 6600 provides confidential advice on alcohol and drugs. If you are a university student, contact your university's student wellbeing service for on-campus support.