Alcohol Poisoning: Never "Sleep It Off"
In 10 minutes you'll know the signs of alcohol poisoning, why you should never let someone sleep it off, and what to do while you wait for help.
Print this course — or save it as a PDF from the print dialog. Good for a fridge, a glovebox, or a waiting room.
Why this matters
Alcohol poisoning can kill by slowing breathing until it stops, or by letting someone choke on their own vomit while unconscious. It happens more often than people think, and it is entirely preventable once you know the signs and refuse to let someone "sleep it off" alone. This course teaches exactly when to call 911 and what to do while you wait.
Know the signs
The fatal mistake: sleeping it off alone
Someone who has passed out from drinking too much can die, and the most common way it happens is entirely preventable: a friend puts them to bed alone to "sleep it off," and checks on them too late.
Alcohol poisoning happens when someone drinks enough to slow down the parts of the brain that control breathing and the gag reflex (the reflex that keeps vomit out of the lungs). Once someone is that impaired, leaving them alone removes the one thing that could save them: a person watching, ready to notice when something goes wrong.
When to call 911
Call 911 if a person who has been drinking can't be woken up, even by shouting or shaking them. Also call if their breathing is slow — fewer than about 8 breaths a minute — or has long gaps between breaths, their skin is cold, clammy, pale, or bluish, they have a seizure, or they vomit while unresponsive.
You do not need to know how much they drank, and you do not need to be sure it's "bad enough." Most colleges have medical-amnesty policies that protect the student who calls for help, precisely so that fear of getting in trouble never stops that call.
The recovery position, and why it matters
While you wait for paramedics, roll the person onto their side with the top knee bent forward for balance. This is the recovery position, and it keeps the airway clear if they vomit.
Choking on vomit, not the alcohol itself, is what kills many people who pass out drunk. Someone lying on their back can't clear their own airway. Stay with them, and keep checking that they are still breathing normally until help arrives.
Blood alcohol keeps rising after the last drink
Alcohol already in the stomach and intestines keeps entering the bloodstream for a while after the last drink, so blood alcohol level can keep climbing even after someone stops drinking or passes out.
That means a person can look okay when they fall asleep and get measurably worse an hour later, with no more alcohol involved. "He only had a few" or "she stopped drinking a while ago" is not a reason to assume the danger has passed. If the 911 signs are there, the timing of the last drink doesn't change what you do.
Myths that waste time
Coffee, a cold shower, and walking someone around do not sober a person up or make alcohol poisoning safer. None of them speed up how fast the body processes alcohol, and a cold shower can actually be dangerous if someone is too impaired to keep their balance or stay conscious.
The only things that help are the recovery position, calling 911, and staying with the person. If you find yourself reaching for coffee or a shower instead of the phone, that instinct is the one to override.
How it really looks
Letting him sleep it off
At a dorm party, Rowan's friend stops responding to anything, and someone suggests just putting him to bed so he can sleep it off. Rowan shouts his name and shakes him. Nothing. His breathing looks slow, with long pauses between breaths. She calls 911 right away, worried about the school finding out, until a resident assistant reminds her the college's medical-amnesty policy protects students who call for help. While they wait, Rowan rolls him onto his side so he won't choke if he vomits. Paramedics arrive within minutes. He spends the night in the hospital and is back on campus two days later, glad someone stayed instead of leaving him to sleep it off alone.
Cold, clammy, and written off as "too much champagne"
At a wedding reception, Imelda notices an older guest slumped in a chair, his skin cold, clammy, and pale. She tries talking to him and shaking his shoulder; he barely stirs and mumbles something that doesn't make sense. Other guests laugh it off as too much champagne, but Imelda checks his breathing and counts long gaps between breaths. She calls 911, then rolls him onto his side on a nearby bench while she waits, in case he vomits. The paramedics tell her afterward that his blood alcohol was still climbing when they arrived, hours after his last drink. Imelda's quick call, not the champagne joke, is why he wakes up in a hospital bed instead of not waking up at all.
What to do until help arrives
- Try to wake them with a loud voice or a firm shake.
- Call 911 if they can't be woken, breathing is slow or gapped, skin is cold or bluish, they have a seizure, or they vomit while unresponsive.
- Roll them into the recovery position, on their side with the top knee bent, so they won't choke if they vomit.
- Stay with them the entire time. Never leave someone this impaired alone, even for a few minutes.
- Do not give coffee, put them in a cold shower, or walk them around. None of it sobers a person up.
- Keep checking that they are still breathing normally until paramedics arrive.
- Tell paramedics roughly how much and how recently they drank, if you know.
Myths & mistakes
People often think you should let someone sleep it off if they've passed out from drinking.Actually that is the mistake that kills. A person that impaired can stop breathing or choke on vomit with no one there to notice.
People often think coffee, a cold shower, or walking someone around will sober them up.Actually none of it speeds up how the body processes alcohol, and a cold shower can be dangerous if someone can't keep their balance or stay conscious.
People often think someone is out of danger once they stop drinking or fall asleep.Actually blood alcohol keeps rising for a while after the last drink, so a person can get worse, not better, over the next hour.
What you learned
- Sleeping it off alone is the mistake that kills. Stay with anyone who has passed out from drinking.
- Call 911 if they can't be woken, breathing is slow or gapped, skin is cold or bluish, they seizure, or they vomit while unresponsive.
- The recovery position, on their side with the top knee bent, keeps their airway clear if they vomit.
- Blood alcohol keeps rising after the last drink, so someone can get worse even after they stop drinking.
- Coffee, cold showers, and walking it off are myths. Most colleges also protect the student who calls for help.
Sources
- National Institute on Alcohol Abuse and Alcoholism (NIAAA) — Understanding alcohol poisoning and how to respond
- Centers for Disease Control and Prevention — Alcohol poisoning deaths and warning signs
Spot an error? Tell us — accuracy matters more to us than being fast.
Common questions
How do I know if it's just drunk or actually alcohol poisoning?
You don't have to be certain. If the person can't be woken, their breathing is slow or has long pauses, their skin is cold, clammy, pale, or bluish, they have a seizure, or they vomit while unresponsive, call 911. You never need to know exactly how much they drank before you call.
Won't we get in trouble if we call 911 at a party?
Most colleges have medical-amnesty policies that protect the student who calls for help from discipline over underage drinking. Policies vary by school, so this isn't a guarantee everywhere, but the bigger risk by far is not calling. A friend in a hospital bed is far better than a friend who never wakes up.
He stopped drinking two hours ago and seems calmer now. Do we still need to worry?
Yes. Alcohol already in the stomach keeps entering the bloodstream for a while, so blood alcohol level can keep rising even after someone stops drinking or falls asleep. Looking calmer isn't the same as improving. Watch for the 911 signs regardless of when the last drink was.
Check what you know
Five questions. Four correct to pass. Retake as many times as you like — this is practice, not a test.
Keep going
This course belongs to Mental Health & Crisis. Courses that pair well with it:
From other readers
Comments are read by a person before they appear. Please do not post medical advice or anything about a specific person's health — this is not the place for it, and it will not be published.
If this is an emergency, do not comment. Call 911.