If someone near you is drunk and throwing up, the most important thing you can do right now is keep them awake, sitting upright or on their side, and never leave them alone. Vomiting while intoxicated is dangerous because alcohol suppresses the body’s protective reflexes, including the gag reflex, which means a person can choke on their own vomit without waking up. Here’s exactly what to do, step by step.
Keep Them on Their Side
If the person is too drunk to sit up on their own, put them in the recovery position immediately. This is the single most important thing you can do to prevent choking. The goal is to let vomit drain out of the mouth instead of pooling in the back of the throat where it can be inhaled into the lungs.
To get someone into the recovery position, start with them flat on their back. Move the arm closest to you outward in an L-shape, roughly even with their head. Take their far hand and bring it across their body. Then gently roll them toward you onto their side so that their face tilts slightly downward, with their head positioned a little lower than their stomach. This lets any fluid run out of the mouth naturally.
Never put a drunk person on their back to sleep. Never prop them up with pillows in a way that could shift. If they’re vomiting actively, keep them leaning forward or on their side the entire time.
Know the Signs of Alcohol Poisoning
Throwing up after drinking too much is common, but it can also be one of several signs of alcohol poisoning, which is a medical emergency. Call 911 if you notice any of the following:
- Slow breathing: fewer than 8 breaths per minute
- Irregular breathing: gaps of 10 seconds or more between breaths
- Inability to wake up or difficulty staying conscious
- Seizures
- Bluish or very pale skin, or skin that feels cold and clammy
- Mental confusion beyond normal drunkenness, more like a stupor
A person’s blood alcohol level can keep rising even after they stop drinking, because the stomach and intestines are still absorbing alcohol. Someone who seems “just really drunk” can slide into unconsciousness within minutes. Don’t assume they’ll be fine once they fall asleep.
Stay With Them and Keep Checking
Do not leave a drunk, vomiting person alone to “sleep it off.” Even if they seem to fall asleep peacefully, wake them frequently. You’re checking that they’re actually asleep and not unconscious. If you can’t wake them, that’s an emergency.
Watch their breathing closely each time you check. Count their breaths for 30 seconds and double it. If the number is below 8 per minute, or if you notice long pauses between breaths, call for help. Also check that their skin still has normal color and temperature. Cold, clammy, or bluish skin is a red flag.
What to Give Them (and What Not To)
If the person is awake and alert enough to hold a cup, offer small sips of water. The goal isn’t to hydrate them fully right now. It’s just to prevent dehydration from getting worse while they’re vomiting. Don’t push large amounts of water, and don’t give anything to drink if they’re drowsy or having trouble staying awake. They could choke.
Don’t give them coffee. Caffeine doesn’t sober anyone up, and it can increase dehydration. Don’t offer food while they’re still actively vomiting. And don’t give them any medication while they’re intoxicated. Acetaminophen (Tylenol) is particularly risky because alcohol depletes the liver’s ability to process it safely, and the combination can cause serious liver damage. NSAIDs like ibuprofen are somewhat less dangerous but still harder on the stomach and kidneys, especially when the stomach lining is already irritated from alcohol and vomiting.
After the Vomiting Stops
Once the person has stopped throwing up and is more alert, continue offering small sips of water. Electrolyte drinks or broth are also good options because vomiting depletes sodium and potassium. Let their stomach settle before introducing any food. When they do feel ready to eat, stick with bland, easy-to-digest options: plain crackers, toast made with white bread, bananas, applesauce, plain rice, or broth-based soup.
Avoid anything greasy, spicy, acidic, or high in fiber for the first several hours. Raw vegetables, citrus fruits, fried foods, and whole grains are all harder on a stomach that’s already been through a lot. Popsicles and gelatin can also be gentle first foods if solid food feels like too much.
When Vomit Contains Blood
Forceful, repeated vomiting can tear the lining where the esophagus meets the stomach, a condition called a Mallory-Weiss tear. The most obvious sign is blood in the vomit, which appears in about 85% of these cases. The blood may look bright red or dark brown, resembling coffee grounds.
Other warning signs include dark, sticky, tar-like stools (which indicate bleeding further down in the digestive tract), dizziness, or fainting. If the bleeding is significant, the person may show signs of shock: pale and clammy skin, rapid heartbeat, and shallow breathing. Any blood in the vomit or dark sticky stools means a trip to the emergency room. Most of these tears heal on their own, but they need medical evaluation to rule out severe bleeding.
Why Choking Is the Biggest Risk
The reason all of this matters so much comes down to one thing: alcohol suppresses the body’s normal defense mechanisms. When a sober person vomits, their gag reflex and cough reflex work together to keep vomit out of the airway. In someone who is heavily intoxicated, those reflexes are dulled or completely absent. If vomit enters the lungs, it can cause aspiration pneumonia, a serious lung infection, or in the worst case, suffocation.
This is why the recovery position is not optional. It’s why you don’t leave them alone. And it’s why “letting them sleep it off” on their back is genuinely dangerous. The combination of suppressed reflexes, continued alcohol absorption, and vomiting is what makes alcohol poisoning one of the leading causes of preventable death in young adults. Keeping someone on their side, watching them closely, and calling for help when something looks wrong are simple actions that save lives.