If someone near you is extremely intoxicated, your first job is figuring out whether this is a “stay and monitor” situation or a “call 911 now” situation. The difference matters because alcohol poisoning kills, and blood alcohol levels can keep rising even after a person stops drinking. Here’s exactly what to do, step by step.
Know the Signs That Need 911
Not every drunk person needs an ambulance, but some absolutely do. Call 911 immediately if you see any of the following. You do not need to wait for multiple symptoms:
- Slow breathing: fewer than 8 breaths per minute
- Irregular breathing: gaps of 10 seconds or more between breaths
- Inability to wake up: you shake them, shout their name, and get no response
- Seizures
- Vomiting while unconscious or semi-conscious
- Skin changes: bluish, gray, or very pale skin, especially around the lips or fingertips
- Extremely low body temperature: skin that feels cold and clammy
A person who has passed out from alcohol can die. Alcohol is a central nervous system depressant, and at high enough levels it suppresses the brain’s ability to control basic functions like breathing, heart rate, and the gag reflex. Without that gag reflex, a person who vomits in their sleep can choke without ever waking up.
Many states have Good Samaritan laws that protect people who call for help during an overdose from certain legal consequences. If you’re at a party and worried about getting in trouble, know that calling 911 is almost always legally protected, and it could save someone’s life.
Put Them in the Recovery Position
Whether you’re waiting for paramedics or watching over someone who’s sleeping it off, positioning matters. Never leave a very drunk person on their back. If they vomit, the liquid can enter their airway and lungs, causing a dangerous infection called aspiration pneumonia or, worse, suffocation.
The recovery position (sometimes called the Bacchus maneuver) is simple:
- Raise the arm closest to you above their head.
- Gently roll them toward you onto their side, protecting their head from hitting the floor.
- Tilt their head slightly up so their airway stays open. Tuck their nearest hand under their cheek to keep the head tilted and the face off the ground.
Place a pillow or bundled jacket behind their back so they can’t roll onto their back while you’re not looking. This single step is one of the most important things you can do.
Stay With Them and Keep Checking
Do not leave a severely intoxicated person alone to “sleep it off.” Alcohol already in the stomach continues to absorb into the bloodstream, which means someone can seem okay and then get significantly worse 20 or 30 minutes later. What looks like deep sleep can quietly become unconsciousness.
Wake the person frequently. Every 10 to 15 minutes, try to rouse them. Say their name loudly, give their shoulder a firm shake. If they grumble, shift around, or open their eyes, that’s a good sign. If at any point you cannot wake them up at all, call 911. Count their breaths periodically. Fewer than 8 per minute, or long pauses between breaths, means their body is struggling to maintain basic functions.
What to Give Them (and What Not To)
If the person is awake enough to sit up and swallow safely, small sips of water can help. Dehydration is a real concern with heavy drinking, and staying hydrated supports the body’s recovery. But never try to give water, food, or anything else by mouth to someone who is vomiting repeatedly, lying down, or unable to sit up on their own. The choking risk is too high.
Skip the coffee. Research has shown that coffee actually slows down the enzymes your body uses to break down alcohol, potentially prolonging intoxication and making the hangover worse by allowing toxic byproducts to build up. It might make someone feel more alert, but it does nothing to lower the amount of alcohol in their blood. You end up with a person who is wide awake and just as impaired.
Cold showers are similarly useless and potentially dangerous. A very intoxicated person already has trouble regulating body temperature, and cold water can cause a sharp drop that pushes them toward hypothermia. Walking them around won’t speed up metabolism either. The liver processes alcohol at a fixed rate, roughly one standard drink per hour, and nothing you do from the outside changes that. Time is the only thing that actually sobers someone up.
Things That Can Make It Worse
Some well-meaning instincts are flat-out dangerous with a severely drunk person:
- Don’t try to make them vomit. Without a functioning gag reflex, inducing vomiting dramatically increases the risk of choking.
- Don’t give them more alcohol. “Hair of the dog” raises blood alcohol levels further.
- Don’t put them in a bath. Drowning risk goes up sharply when someone can’t coordinate their body, and water accelerates heat loss.
- Don’t leave them in a car. Temperature extremes, whether hot or cold, are especially dangerous for someone whose body can’t thermoregulate properly.
The Next Morning
Even after a person wakes up and seems coherent, recovery takes time. The body is still processing alcohol byproducts, and dehydration, low blood sugar, and stomach irritation are common. Offer water, simple foods like toast or crackers, and a calm environment. Nausea can persist for hours.
Watch for lingering warning signs in the hours after heavy intoxication. Continued confusion, persistent vomiting (especially if there’s blood in it), complaints of chest pain, or difficulty breathing all warrant medical attention. These can signal complications that developed overnight, including aspiration pneumonia, which sometimes doesn’t show symptoms until hours after the event that caused it.
If you’re unsure at any point whether the situation is serious enough to call for help, call. Emergency dispatchers are trained to walk you through exactly what to do over the phone, and they can help you assess whether an ambulance is needed. Overcautious is always better than the alternative.