Alcohol poisoning is a life-threatening emergency that happens when someone drinks enough alcohol to shut down basic body functions like breathing and temperature regulation. The key signs include slow or irregular breathing (fewer than 8 breaths per minute, or gaps of 10 seconds or more between breaths), inability to wake up, seizures, vomiting while unconscious, and skin that looks blue, gray, or pale.
The Critical Signs to Watch For
Alcohol poisoning looks different from being “really drunk.” A person who is dangerously intoxicated will show one or more of these signs:
- Mental confusion or stupor: not just slurred speech, but an inability to respond to questions or recognize where they are
- Difficulty staying conscious: passing out and being impossible to wake up, even with loud noises or shaking
- Vomiting: especially while unconscious or semi-conscious
- Seizures
- Slow breathing: fewer than 8 breaths per minute
- Irregular breathing: 10 seconds or more between breaths
- Slow heart rate
- Clammy skin
- Extremely low body temperature
- Skin that looks blue, gray, or pale
- No gag reflex: if you gently touch the back of their throat and they don’t react, this is a serious warning sign
You do not need to see all of these at once. Even one or two of these signs, particularly the breathing changes or inability to wake up, signals a medical emergency.
Why Alcohol Poisoning Is So Dangerous
At very high levels, alcohol suppresses the brain signals that control automatic survival responses. The gag reflex is one of the first to go. Normally, gagging prevents you from choking on anything that enters your throat, including vomit. Without it, a person who has passed out can vomit and choke to death. This is one of the most common ways alcohol poisoning kills.
Breathing is another automatic function that alcohol can shut down. The brain stem controls the rhythm and depth of each breath without you thinking about it. When alcohol reaches toxic concentrations, that signaling slows or becomes erratic. A blood alcohol concentration above 0.31% is considered potentially fatal, though people can die at lower levels depending on their size, tolerance, and overall health.
Body temperature drops because alcohol causes blood vessels near the skin to expand, releasing heat rapidly. Combined with impaired brain signaling, this can push core temperature dangerously low even indoors.
How to Tell It Apart From Being Drunk
The line between “very drunk” and “alcohol poisoning” can be hard to see in the moment, but a few distinctions matter. A very drunk person can still respond when you talk to them, even if their answers don’t make sense. Someone with alcohol poisoning may not respond at all, or may be completely limp. A very drunk person can usually be woken up. Someone experiencing alcohol poisoning cannot.
Another key difference is breathing. Count the person’s breaths for 30 seconds and double it. If the number is below 8 per minute, or if you notice long pauses between breaths, that’s not normal drunkenness. Skin color changes, particularly blue or gray tones around the lips or fingertips, also indicate the body is not getting enough oxygen.
It’s also important to know that blood alcohol levels can keep rising after someone stops drinking. Alcohol in the stomach continues to absorb into the bloodstream for up to 40 minutes or more after the last drink. Someone who seems okay when they stop drinking can deteriorate quickly.
What to Do While Waiting for Help
If someone is showing signs of alcohol poisoning, call emergency services immediately. While you wait, you can help keep them safe by placing them in a recovery position. Raise the arm closest to you above their head, then gently roll them toward you so they’re on their side. Tilt their head up slightly to keep the airway open, and tuck their nearest hand under their cheek to keep the face angled toward the floor. This position helps prevent choking if they vomit. Check on them frequently.
Do not move someone this way if you think they may have fallen and injured their spine.
What Does Not Help
Several common “remedies” for alcohol poisoning are not just useless but potentially harmful. Coffee does not sober someone up. Cold showers do not reverse alcohol’s effects on the brain, and the shock of cold water can cause further drops in body temperature or trigger cardiac problems. Ibuprofen and aspirin can irritate the stomach lining and increase the risk of internal bleeding, especially combined with alcohol.
Walking someone around does not speed up the metabolism of alcohol. Letting them “sleep it off” without monitoring is one of the most dangerous choices you can make if they’re showing any of the signs listed above. Only time allows the liver to process alcohol out of the body, and in the case of poisoning, the person may not have enough time without medical intervention.
Who Is Most at Risk
Binge drinking is the most common path to alcohol poisoning. This means roughly 4 or more drinks within two hours for women and 5 or more for men, though individual variation is significant. Smaller body size, lower tolerance, eating little food beforehand, and mixing alcohol with other substances all increase the risk. Young adults and college-age drinkers are disproportionately affected, partly because of drinking games and social pressure to consume large quantities quickly.
People taking sedative medications, opioids, or sleep aids face a compounded risk. These substances slow the same brain functions that alcohol suppresses, so the combination can become lethal at lower amounts of alcohol than it would take on its own.