ALCOHOL POISONING:
spot the signs of alcohol poisoning and learn what to do next

When does drinking become an emergency? What’s the journey from a few drinks to a hospital casualty department?

Buy the Alcohol Emergency booklet in the Substance shop

Consuming lots of alcohol quickly - known as binge drinking - will increase the chance of accidents, including falls, trips, violence and life-threatening alcohol poisoning (overdose).

The NHS estimates that as many as 70% of hospital emergency visits at peak times on weekends can be alcohol-related.

So when does drinking become an emergency? What’s the journey from a few drinks to a hospital casualty department?

This resource will help you in the following ways:

Understand how alcohol influences behaviour and increases the risk of injury
Recognise the signs of an alcohol overdose
Identify immediate action to take
Determine when medical help is needed
Learn how casualty departments handle alcohol-related admissions
Reducing alcohol-related harm

HOW ALCOHOL AFFECTS YOUR BRAIN

When you drink alcohol, it goes into your bloodstream and heads straight for your brain, altering how you feel and behave.
Alcohol influences neurotransmitters (brain chemicals) like dopamine and serotonin, which make you feel good and encourage you to drink more.

However, it also affects other neurotransmitters called glutamate and GABA. These regulate brain activity and keep you safe.

Quickly drinking alcohol causes alcohol levels to build up, leading to life-threatening conditions like alcohol overdose and landing you in the hospital - or worse.

There is no minimum amount a person has to drink to cause an overdose. It depends on many factors, such as age, sex (women ofteexperience the effects of alcohol more quickly and intensely than men), and weight. It also depends on how fast you've been drinking, how much you've eaten, your general health and if you have used legal or illegal drugs.

HOW ALCOHOL AFFECTS YOUR BEHAVIOUR

Alcohol affects chemicals in your brain and changes how you feel and act.

GETTING INVOLVED IN VIOLENCE

Alcohol doesn't directly cause violence, it affects the parts of your brain responsible for restraint and judgment. As a result, you may misinterpret social cues or act more aggressively after drinking.

SLURRING YOUR SPEECH

When you drink alcohol, it affects the signalling in your cerebellum and the basal ganglia, both of which play roles in motor functions. It has an impact on your reaction times and can impair muscle control, leading to symptoms like slurred speech.

TRIPS AND FALLS

Part of the cerebellum's role is coordinating your balance, movement and posture. Alcohol can slow down reaction times and disrupt the coordination of movements, leading to trips and falls.

SEX

Alcohol reduces inhibitions and impairs judgement, increasing the chances of engaging in risky sex. That's because alcohol affects the hypothalamus and pituitary gland, the parts of the brain related to sexual response and arousal.

Alcohol can increase libido but reduce performance, causing erection problems for men and reducing sensitivity and lubrication for women.

Impaired judgment can affect your ability to give or interpret consent. If there's any doubt over someone's ability to consent, it's safer and more ethical to avoid any sexual activity.

SLEEPINESS

You feel sleepy after drinking because alcohol acts as a central nervous system depressant, interacting with neurotransmitters to slow brain activity, leading to feelings of sleepiness. However, while it might help you doze off initially, it negatively impacts sleep quality by disrupting crucial REM sleep stages.

BLACKOUTS

You might have had nights out when you can't recall particular incidents or even the whole night. That's because alcohol affects your hippocampus, the part of your brain responsible for forming new memories. It prevents the hippocampus from making new connections between neurons, which are necessary for creating new memories.

WHEN TO GO TO THE EMERGENCY DEPARTMENT

Hospital emergency departments are only for critical injuries and life-threatening emergencies. Alcohol poisoning falls into the category of a medical emergency. If someone displays the symptoms of alcohol poisoning, don't hesitate — call 999 immediately, even if they don't exhibit every sign.

THE SIGNS AND SYMPTOMS OF ALCOHOL POISONING

Mental confusion
Difficulty remaining conscious or waking up
Vomiting
Seizures
Slow breathing (fewer than eight breaths per minute)
Irregular breathing (10 seconds or more between breaths)
Slow heart rate
Clammy skin
Extremely low body temperature
Bluish skin colour or paleness. On black or brown skin, this may be easier to see inside the lips, on the gums and under the fingernails

NOT SURE WHAT TO DO?
Call NHS 111 if you think you need medical help but are unsure what to do.

THINGS YOU CAN DO TO HELP SOMEONE WHO'S DRUNK TOO MUCH ALCOHOL

DO

Stay with them. There's a risk they could choke on their own sick or stop breathing
Sit them up if they're awake, preferably on the floor so they don't fall over
Lie them down if they are unconscious. Put them in the recovery position, roll them onto one side with an ear toward the ground to prevent choking
Check they're breathing
If they're conscious and can swallow, give them water to sip
Keep them warm with a jacket or blanket

DON'T

Let them drink more alcohol
Give them coffee or drinks containing caffeine because this can dehydrate someone with alcohol poisoning
Walk them around, it won't reverse an overdose and they could fall and hurt themselves
Put them in a cold shower or bath because there's a risk they could get too cold, fall, or lose consciousness in the water
Try to make them sick. They could choke on their vomit

WHAT TO EXPECT IN HOSPITAL

If you arrive at the emergency department after drinking alcohol, medical staff will follow a particular procedure. Practices may vary between hospitals, but below is a general overview of what you can expect.

TRIAGE ASSESSMENT

Triage involves a nurse or healthcare professional evaluating the urgency of your condition. Medical staff will prioritise you for immediate care if your condition is serious or life-threatening.

MEDICAL ASSESSMENT

Once your triage is complete and depending on the severity of your condition, a doctor or healthcare provider will see you. They assess your medical needs, perform necessary tests, and determine the appropriate course of treatment.

MONITORING

If you've been drinking alcohol and are showing signs of being drunk, you'll be closely monitored to ensure your vital signs (such as heart rate, blood pressure, and breathing) are stable.

TREATMENT

If alcohol has contributed to your visit to A&E, it will be addressed as part of your overall care. That might involve giving you fluids or medication or intervening in other ways to address the effects of alcohol and possible alcohol withdrawal if you're alcohol-dependent.

SUPPORT AND ADVICE

You will be offered guidance and advice on responsible drinking, potential risks of excessive drinking and resources for seeking help if you have alcohol-related concerns.

REFERRAL OR DISCHARGE

Depending on your medical condition, you may stay in the hospital for further observation and treatment or be discharged with instructions for follow-up care. If necessary, arrangements will be made for additional support or referrals to specialised services.

Give honest and accurate information about drug or alcohol use. This information will help medical staff make better care decisions.

ALCOHOL AND DRUGS DON'T MIX

Mixing drugs and alcohol is dangerous. Both go through the liver, making it work too hard and increasing the harmful effects. Some drugs also mix badly with alcohol, creating toxic substances.

STIMULANTS

COCAINE/SPEED/ECSTASY/MEPHEDRONE

As a depressant, alcohol slows down your breathing and heart rate, while cocaine, speed and ecstasy are stimulants, speeding them up and putting your brain and heart under a lot of pressure.

COCAETHYLENE

Using alcohol and cocaine together produces a toxic chemical called cocaethylene, which increases the chances of heart attack and stroke.

Most deaths from stimulant drugs are related to overheating and dehydration, so mixing them with the dehydrating effects of alcohol increases the risk.

DEPRESSANTS

GHB AND GBL

GHB and GBL have a sedative effect, dulling inhibitions and making you sleepy. By themselves, they can cause unconsciousness, coma or death, so mixing them with alcohol is particularly dangerous.

HEROIN

Heroin and opioids like fentanyl and methadone are powerful sedatives and painkillers, so there's a much higher risk of overdosing when you mix them with alcohol.
Even a small amount mixed with alcohol can lead to a fatal overdose.

SPICE/SYNTHETIC CANNABINOIDS (known as spice or K2)

These are depressants, like alcohol. Their effects increase if you mix them with alcohol. They're usually potent and unpredictable, so combining them with alcohol increases the risk of overdose, resulting in seizures, coma and death.

PRESCRIPTION MEDICINES

Always check the instructions on the pack and consult your doctor about the risks of drinking alcohol with prescribed medication.

ANTIDEPRESSANTS

Alcohol can make you feel more depressed and can increase the effects of antidepressants.

It can also make the side effects of the medicine worse.

Using alcohol with MAOI-type antidepressants, such as Nardil, Parnate, and Manerix, can make your blood pressure go up a lot, which can lead to a stroke.

TRANQUILISERS

Valium (diazepam), Librium, Temazepam, Nitrazepam, Lorazepam
Mixing tranquilisers with alcohol can be deadly because they slow your heart rate, and breathing and lower your blood pressure.

SAFER DRINKING

These simple tips should help you reduce the chances of your drinking leading to a trip to casualty.

IF YOU'RE GOING OUT

Avoid drinking before you go out. But if you drink, try to set a limit on how much and try to eat something. Alternate alcohol with soft drinks. This will help you stay hydrated and means you drink less alcohol.

EAT BEFORE YOU DRINK

The food in your stomach will help absorb alcohol and release it steadily so your liver can cope better. Drinking on an empty stomach can also irritate the lining, causing you to vomit.

DRINK LATER

Go to the pub an hour later than normal or, if you drink at home, find something else to occupy you so you put off when you start to drink. Or drink soft or low-alcohol drinks instead.

NO AND LOWER ALCOHOL DRINKS

Check the label on the bottle or look for the ABV number on the pump or packaging and go for one with less alcohol content.

ONE MINUTE, YOU WERE OKAY . . .

If you play drinking games, your liver is unlikely to be able to keep up. Your alcohol level will rapidly build up, delivering a massive dose of alcohol to your brain.

MISS A ROUND

You can alternate with a soft drink or go for a kitty instead of a round.

KNOW THE STRENGTH OF YOUR DRINK

You can tell how strong your drink is by the number of units it contains. This list of drinks and units will help you understand the strength of some popular drinks:

Gin, rum, vodka, whisky, tequila and sambuca:
Large (35ml) single measures 1.4 units

Can of lager/beer/cider:
(440ml, ABV 5.5%) 2.4 units

Pint of lower-strength lager/beer/cider:
(ABV 3.6%) 2 units

Standard glass of red/white/rosé wine:
(175ml, ABV 12%) 2.1 units
SIZE MATTERS
Always check the standard measure in a pub/bar or club
and go for the smallest.

Your body can only process about a unit an hour.
The quicker you drink, the faster alcohol will build up to dangerous levels.

FURTHER HELP AND SUPPORT

We hope you find the information in this booklet useful. Below are some organisations that can also help you:

NHS ALCOHOL SUPPORT

Alcohol support · You often feel the need to have a drink · You get into trouble because of your drinking · Other people warn you about how much you're drinking
www.nhs.uk › Live Well › Alcohol advice

DRINKLINE - The National Alcohol Helpline

Drinkline runs a free, confidential helpline for people concerned about their drinking or someone else's. The purpose of the Drinkline service is to offer free, personal, accurate and consistent information and advice to callers concerned about their own or someone else's drinking regardless of the caller's age, gender, sexuality, ethnicity or spirituality.

Free, confidential helpline: 0300 123 1110 (weekdays 9am–8pm, weekends 11am–4pm)

www.drinkaware.co.uk/alcohol-support-services

TALK TO FRANK

National drugs awareness site for young people and parents/carers. 24 hrs a day, seven days a week.
Call 0800 77 66 00 (calls are free and confidential)
www.talktofrank.com

NHS 111

NHS 111 can help if you think you need medical help right now. You can get help from NHS 111: by using 111 online, in the NHS App, or by calling 111.

www.111.nhs.uk