Getting a friend home, and knowing when to call 911

If a friend has had too much to drink, you might be the one who has to decide what happens next. This guide covers the signs of alcohol overdose, why you should never leave someone to sleep it off, and how to get a friend home safely. You don't have to handle it alone, and your own safety comes first.

What to know about alcohol overdose

What it is. An alcohol overdose happens when there's so much alcohol in someone's blood that the parts of the brain controlling breathing, heart rate and body temperature start to shut down [1].
It can be deadly. It can cause permanent brain damage or death [1].
It can keep getting worse after they stop. Alcohol already in the stomach and gut keeps moving into the blood, even after someone stops drinking or passes out [1].
Choking is a real risk. Very high alcohol levels can stop the gag reflex from working, so someone who is passed out can choke on their own vomit [1].
Mixing makes it more dangerous. Alcohol combined with opioids, sedatives, anxiety medicines, or even some over-the-counter allergy medicines raises the risk of overdose [1].
Young people are at particular risk. Drinking a lot in a short time can overwhelm the body faster than it can process alcohol [1].

Signs that mean you should call 911

Call 911 if you see any of these [1]:

Confusion, or being in a daze
Trouble staying awake, or you can't wake them up
Vomiting
Seizures
Slow breathing (fewer than 8 breaths a minute)
Irregular breathing (10 seconds or more between breaths)
Slow heart rate
Clammy skin
Dulled responses, like no gag reflex
Very low body temperature, bluish skin or paleness

They don't need to have every sign. Someone who has passed out can die [1].

Why you never let someone sleep it off

It isn't safe to assume someone who is passed out will be fine after sleeping [1]. Their blood alcohol can keep rising while they're out, and they could choke if they vomit [1]. Cold showers, coffee and walking it off don't reverse an overdose and can make things worse [1].

What to do while you wait for help

Call 911 [1].
Stay with them. Don't leave them alone, because they could get hurt or choke [1].
Keep them on the ground, sitting up or partly upright [1].
If they're throwing up, have them lean forward. If they're passed out, roll them onto their side so they don't choke [1].
Tell the responders what your friend drank, any other drugs they took, and any health conditions you know about [1].

Getting a friend home safely

If your friend has none of the overdose signs but still needs to get home:

Don't let them leave with a stranger [2].
Help them order a ride from their own phone [2].
Bring in other people. Find their friends or someone in charge, and say clearly what you need [2].
Don't assume a very drunk person can agree to anything. Someone who is intoxicated may not be able to consent [2].
Check in later to see how they're doing [2].

If at any point you see overdose signs, stop and call 911 instead [1].

Your safety, and worries about getting in trouble

Only do what feels safe for you [2]. If you're worried about someone, call 911, even if it's someone you don't know [2].

Fear of the police is a big reason people don't call for help in an overdose [3]. Some states have Good Samaritan or medical amnesty laws that protect people who call 911. In North Carolina, for example, someone who gets help for a person with alcohol poisoning is protected from certain underage drinking and drug possession charges. To be covered, they have to give their name and stay with the person until help arrives [3]. Laws vary by state, so look up the rules where you live. Whatever the rules, your friend's life matters more.

Where to get help

In an emergency, call 911.
Crisis Text Line: text HOME to 741741, 24/7.
RAINN National Sexual Assault Hotline, if you're worried someone was taken advantage of: 800.656.HOPE (4673), or text HOPE to 64673, 24/7.
See our Need help now page for more.