Alcohol abuse and alcoholism have existed probably as long as alcohol itself has. In fiction, TheAlcoholic is an often-used angst trope, as are other depictions of alcohol abuse and alcoholism. But what is alcohol abuse and alcoholism? What is the difference between the two, and how do you know if you are at risk for or are an alcoholic?
This article exists to give a short overview of alcohol abuse and alcoholism, and include ways you can find help for yourself and/or someone else if you or someone you know is an alcohol abuser or alcoholic.
''Alcohol abuse'' is simply the regular use of alcohol to a dangerous or unhealthy degree, the regular overuse of alcohol and/or the use of alcohol to a degree that it creates dangerous or problematic behavior on a regular basis. Almost all alcoholics are alcohol abusers, but not everyone who abuses alcohol is or will become a true alcoholic.
* Nobody can really agree on safe, moderate, healthy or whatever guidelines for drinking. The only consistency between sources, even the same ones over time, seems to be that the new guidelines keep contradicting earlier guidelines. The only ironclad advice is that safe drinking and drinking habits become known by self-observation. In the same vein, nobody agrees which percentage of the population has an alcohol problem. (Especially, as cynics may say, they don't have the problem, their neighborhood has the problem.) [[http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf?ua=1 WHO Report 2014]]
* Safe drinking advice:
** Figure out what your limits are.
** If you are an inexperienced drinker, do not try to keep up with veterans.
** Try to avoid drinking on an empty stomach. Drink with food.
** If you feel that dizzy drunk feeling, refrain from imbibing more until it subsides.
** Track your drinking and how much you drink.
** If drinking rapidly, only do this initially and settle to a sustainable pace later.
** 1hr/drink is the fastest truly sustainable rate.
** Do not drink to improve your mood -- it may work initially, but you'll soon feel miserable.
** Never try to regain a buzz -- those neurotransmitters are spent and you'll feel like crap.
** Avoid "one last drink", especially if you are already drunk, especially if it's a lot of alcohol.
** Beer is the weakest alcohol. Wine is twice as strong. Cocktails are stronger. Spirits are mightiest.
** The 8floz (330ml) 5% ABV (10 proof) beer has as much alcohol as 5floz (180ml) glass of 12.5% ABV (25 proof) wine, which has as much alcohol as a 1.5floz (45ml) shot of 40% ABV (80 proof) spirit.
** Limit yourself to an average of 100ml of spirits a day.
** If you find yourself thinking you'll have to buy more sooner than you wanted, planned, or expected, slow down your drinking.
** Try to have at least one low/no booze day every week.
** Don't drink the day after a heavy session -- it won't lessen a hangover, either.
** If you aren't enjoying yourself, stop.
** If drinking to destress, have one shot of vodka and wait twenty minutes before the next one.
** If you know you'll likely have to do something or be somewhere or talk to someone important, stop.
** If you know that you will not like the effects of having this next drink, stop.
** Don't get drunk more than twice a week, and get wasted as little as possible.
* Signs of potential alcohol problems.
** You regularly find yourself drinking more than you think.
** You spend more on booze than you would like.
** You drink just out of habit.
** You pervasively find yourself wanting a drink for no other reason than you just want to drink because you can or you haven't.
** Going without alcohol makes you crave it, or dependably in a much worse mood.
** You conceal the true extent of your drinking.
** You think of a day or occasion without drink as a waste.
** You specifically choose places or activities because of access to alcohol.
** You drink without caring about quality or taste.
** You habitually drink, even when you know you shouldn't.
** You consider alcohol not as a luxury to augment your life, but something to enable it.
** The thought of extended sobriety frightens or angers you.
** You are regularly not only drunk, but also get far more drunk than you would like.
** People express concern to you about your drinking.
** You would take drastic measures to get at liquor.
** If you saw your pattern in someone else, you would be concerned.
** You doubt your self-control.
** People only know the "drunk you" or you don't even know what your sober personality is.
** You regularly use "hair of the dog" to deal with hangovers.
* If you show the above symptoms, don't panic just yet. Step back, hold off on drinking for a little while and reassess why you're drinking and how much. The rule is that you should be in charge of your drinking, not the other way around. Provided you aren't drinking stupid amounts like dozens of standard drinks every single week, if you are in control of yourself and not negatively impacting your life, you're not alcoholic, but you should reduce your intake. If your drinking is out of control and harmfully so, cut back heavily on drinking and find someone to talk to. If you feel like you may be developing a problem, make yourself abstain a few days until the urge fades. It is far better to solve issues early and firmly.
* Alcohol ''can'' be consumed in ways other than by mouth, but doing so is a ''very'' bad idea in that almost all of the ways to do so are ''far'' more dangerous than ordinary drinking (inhalation, rectal, and IV) and the only way that's less dangerous (skin absorption) is also far less effective, requiring more alcohol and having less of an effect. All of these are much less fun than drinking, because you don't even get to taste it, and good luck getting away with butt chugging at dinner! Inhalation carries the general risks of inhalant abuse and lung damage, whereas rectal and IV pose risks of damage to the anus and rectum or veins, respectively, and ''also bypass the liver,'' meaning that alcohol poisoning can ensue, in some cases, with the amount in ''an ordinary drink.'' Using alcohol by inhalation, AssShove, or IV is almost always by definition alcohol abuse (unless it's a one-time experiment done in a manner as safe as possible, or in the case of intravenous alcohol, given in a medical setting as an antidote for some forms of poisoning). Bathing in alcohol such as beer or wine may or may not be a sign of alcohol abuse, but it probably ''is'' a sign that you're throwing away money.
* ''Binge drinking'' is the consumption of five or more alcoholic beverages within a span of 24 hours, generally within the same drinking session (e.g. not four drinks over 10 hours, but four drinks in two hours). If you find that you cannot stop drinking once you've started, that you consistently lose track of how much alcohol you've consumed after several drinks, or that your drinking sessions almost always end with you passing out (and occasionally stop short of that solely because ''you've consumed all the alcohol you could find''), you have almost certainly passed into alcoholism. When excessive drinking goes from being a desire to a compulsion, you have passed beyond the threshold.
* ''Relational problems'' from the use of alcohol is a sign of alcohol abuse. If your use of alcohol causes you to get in fights, engage in violence, or be criticized for your drinking (and the people criticizing you are ''not'' TheFundamentalist), this is likely a warning sign that you need to monitor your alcohol usage. This goes double for people with unpleasant personality shifts after they imbibe: if people begin to empty out of a room when you start drinking or you are outright told that you are mean, vicious, and abusive when drunk, ''you should not drink''. Period. If you doubt that the person telling you this is being truthful, ask around. If the general consensus is that you're an asshole when you're drunk, it's a safe bet that you are a mean drunk. Failure to moderate your drinking in this case can cost you friendships and relationships, strain family relations, give you a reputation that makes you a pariah and possibly even cost you a job if you get verbally abusive at an office party. This goes quadruple for people who become aggressive or violent when drunk: if you gain a HairTriggerTemper when you get loaded and fly off the handle at everything, you should consider not even being near alcohol, as the stakes are far higher here.
* This considering, not only are the above possibilities magnified, but getting arrested is now a very real possibility. So is getting severely injured or even killed if you fuck with the wrong person. Quite a few alcohol-related murder and manslaughter cases have boiled down to "one guy was drunk, attacked the other guy and got beaten to death/stabbed/shot in return". Don't be one of them.
* ''Legal problems'' are another warning sign of alcohol abuse. Not legal problems so much as in "I carried my beer outside the bar and got a ticket" or "someone opened a container in my car" as those aren't necessarily related to your personal usage. If you get a DUI or drunk and disorderly conduct arrest, ''that'' is a major warning sign.
* If you find yourself getting 86'd[[note]]restaurant slang for being ejected as a consequence of bad behavior[[/note]] from establishments, chances are good that you have a problem. If you receive a ban from one, you ''definitely'' have a problem. While not necessarily a legal problem, it can easily turn into it if your behavior is bad enough to get the police called or result in charges being filed. There are exceptions (disputes over tips or bad reviews, someone else in your group started trouble and got everyone kicked out, you failed to meet the dress code, you're associated with known troublemakers and they just don't want to risk more problems), but it's safe to say that the following reasons for ejection or blacklisting ''cannot'' be whitewashed so easily:
** '''Habitually disputing or refusing to pay tabs''' Mistakes do happen. There are also those rare few staffers who are dumb enough to try and sneak in extra charges while hoping that you either won't notice or will be too drunk to have your word taken seriously if you do. We're not talking about those times. These are the times where the charges are all totally legitimate and you were just too drunk to remember ordering half the items. One ejection can be chalked up to a bad night, repeated ejections or an outright ban are cause for concern.
** '''Habitually being rude, belligerent, or verbally abusive''' This ties into the whole mean drunk thing. If drinking turns you into an abusive asshole, quit drinking.
** '''Sexually harassing patrons or staff''' The same goes for this: if drinking turns you into a disgusting lecherous creep, stop drinking.
** '''Being obnoxious''' Obviously, "obnoxious" is kind of a subjective definition. If, however, your behavior while drunk would irritate a reasonable person enough to get them to ask the bouncers to step in and the bouncers agreed that you were being annoying enough to warrant an ejection, you should at least '' '''think''' '' about drinking less. If it takes a certain amount to get you to go from "fun" to "holy shit someone tell that jackass in the flannel shirt with the gauges to shut the fuck up" kind of obnoxious, consider reducing the amount of drinking.
** '''Starting or participating in fights''' As anyone in nightlife can tell you, fights happen. There are times when they may genuinely not be your fault. People do sometimes have to defend themselves against unprovoked attacks from others or get dragged into brawls when they were trying to clear out. Some people look for excuses to fight and/or perceive provocation, slight or insult that's actually entirely inside their minds. However, if you become aggressive when drunk and respond to things that sober people would see as minor annoyances by getting in the faces of others, inviting them out front, informing them that you'll be waiting outside or taking swings at them, the bar staff have every right to ban you for life and/or call the cops. You should absolutely view your first fight-related ban or arrest as a major wake-up call.
** '''Sitting around all day being irritating and disruptive''' Beyond the obvious message of "get a life", sitting on the same stool for most of the day and drunkenly attempting to make conversation pisses off staff and other patrons alike. By that point you have likely long since reached the cutoff point. Staff could be tending to less irritating patrons, who can actually be served. Other patrons don't want to listen to slurred, incoherent and frankly asinine "wisdom". Anyone who has worked in a bar can tell you that being this kind of regular ''will'' wear out your welcome.
** '''Not knowing your limits/ignoring them and consequently attempting to match people who can outdrink you''' Swallow your pride and accept that you're just not going to be able to down quite as many as your squad. If the bar staff opts to kick the entire group out and your friends have to carry you out or leave with you yet '' '''again''' '', it will piss your friends off, even if you don't have a drinking problem otherwise. Enough instances of this and the next time that you try to have a night out with your friends, those same staff will say "you guys can come in, but your buddy is no longer welcome here", provided your friends don't opt to exclude you themselves.
* ''Regret over one's actions while under the influence'' is another major warning sign of alcohol abuse. If your drinking causes you to lose control of your actions or emotions, it may definitely be alcohol abuse. If you regularly find yourself apologizing to people when sober for the things you said and did while you were drunk, you need to take a look at your drinking. This leads back to the whole mean drunk thing; if drinking turns you into an abusive asshole, abstaining and trying to address the underlying issues behind your undesirable personality shifts is a good idea.
** Alternatively ''loss of memory'' or blackouts are ''always'' a major warning sign of alcohol abuse, and a warning sign that alcohol abuse may be becoming alcoholism.
* ''Drinking regularly for DrowningMySorrows'' is another warning sign of alcohol abuse. It should even be taken with far more seriousness than the others. There is a very important saying in the recovery community regarding this: "sorrow knows how to swim."
** Additionally, if you have anxiety problems and regularly find yourself using alcohol to loosen up, you should use that as a wake-up call to address the underlying issues that make you feel like you need to drink to function socially. While this itself isn't outright destructive, it ''is'' unhealthy (if you are not doing so in full awareness that you are using alcohol as medication, if you do have an anxiety disorder, and treating it with the same respect that you would a prescription anxiety medication) and can lead to worse patterns. On the other hand, if your habit of using alcohol as a social lubricant is less "being buzzed and/or drunk makes it easier to function socially" and more "my drunk self is the only side of me that people see because I can't function socially if I'm not wasted", you definitely have a serious problem that requires professional help.
** If you have Bipolar 1 (especially rapid cycling or with severe mood swings such as psychotic mania and suicidal depression), drinking is a ''horrible'' idea regardless of whether you're medicated or not. If you are medicated, know that alcohol interacts horrifically with most meds for Bipolar 1 - the meds and alcohol often amplify each others' effects, so one glass of wine can equal five or your med dose can feel quadrupled - and sometimes alcohol makes the meds ''less'' effective. Unmedicated, heavy drinking can make cycling happen faster, or potentiate a cycle into something far worse (e.g. your mania that was equivalent to a constant cocaine buzz becomes a psychotic breakdown, your depression that was "just" paralyzing and miserable becomes cause for a suicide attempt) If you have Bipolar 2, you should not drink during depressive episodes or if you are on medication. Cyclothymia is probably the ''only'' mood swing disorder where moderate drinking is okay regardless of where you're at - and even there you have to be very careful.
** If you have epilepsy, drinking is one of the worst things you can do. While alcohol does have some anticonvulsant action (it works on GABA), this is ''heavily'' outweighed by its pro-convulsant properties and its tendency to play very badly with most anti-convulsant meds. Drinking even moderately (much less heavily) if you are epileptic is risking seizure events and further brain damage.
** If you are on certain medications that you are advised to not mix alcohol with, ''don't''. This is because the interactions between those medications and alcohol can kill you, make the medications not work or cause other issues. When your doctor or pharmacist tells you that you cannot drink while taking a medication, they are ''not'' saying it to legally cover their ass in most instances - they are saying it because that med has a dangerous interaction with alcohol. If you are uncertain as to whether a medication can interact with even moderate drinking safely or you think the doctor or pharmacist is just making a big deal out of nothing, ''look it up yourself'' before you take a drink.
*** On that note, there are some medications where very limited or moderate drinking ''is'' okay, but heavy, frequent drinking or becoming drunk causes the problem. With those, you ''must'' know your limit. If you can only have one drink, you can only have one drink. If you can only drink once a week, you can only drink once a week. Adhere to it. If you cannot, you shouldn't even begin drinking.
* Physical health problems as a direct result of your alcohol use are a major warning sign that you may have a serious problem with alcohol. If you are clinically malnourished or anemic as a direct result of your drinking or the money you spend on it, if you have abnormal liver function tests or outright develop cirrhosis or alcoholic hepatitis or hepatocellular carcinoma, if you have even ''one'' episode of vomiting blood or passing blood rectally, if you have a seizure, or you or others around you are noticing a sharp decline in mental performance, it's probably time to consider getting treatment.
** More seriously, if you or someone that you know begins to show serious memory issues (''especially'' when coupled with the manifestation of false memories), issues with eye movement, a decline in mental functioning (including hallucinations), an abnormal gait, and any number of deficits with language, motor planning, sensory processing, or executive functioning that occur when not intoxicated or experiencing withdrawal, medical attention should be sought ''immediately'', as these are the hallmarks of Wernicke-Korsakoff syndrome, a life-threatening thiamine deficiency that is frequently present in long-term alcoholics who have largely stopped eating and sustain themselves through drinking.
* ''Dangerous behavior while under the influence'' is another warning sign to be be taken with the utmost seriousness. It means that your(or another person's) irresponsible use of alcohol is ''immediately life-threatening'', as opposed to liver damage or cancer or other long-term effects. If you find yourself getting into even one car accident drunk, walking on a freeway, fighting people twice your size and stronger than you (or even just randomly going up to people and starting shit with them - you never know when someone might be a trained martial artist or have weapons on them), engaging in unwanted or unsafe sex, jumping from windows or other heights, using firearms, attempting or even contemplating suicide, breaking bones or sustaining other injuries requiring hospital treatment or anything similar while drunk, you need to either immediately stop drinking or seek treatment for alcoholism. This is also a major warning sign that you may be self-medicating or triggering another underlying mental illness with alcohol.
''Alcoholism'' is even far more serious than alcohol abuse. Alcohol abuse can become alcoholism and is always a part of it. The difference between alcoholism and alcohol abuse is that alcoholism is a literal physical and emotional ''addiction'' to alcohol itself. Someone who is abusing alcohol but isn't addicted (yet) can, even if they drink problematically, manage their drinking. TheAlcoholic cannot, at least not without outside help and therapy in almost all cases.
* The alcohol abuser may binge drink at every party and may even get busted for DUI leaving one - but he/she can go days without drinking with no ill effect, ''can'' drink moderately, and/or can just go "you know, I don't want to get plastered at ''this'' party." It is a ''want'' for alcohol, even at the expense of one's health or other consequences.
* TheAlcoholic, on the other hand, ''needs'' to use alcohol or will go into a possibly fatal withdrawal syndrome called delirium tremens, cannot stop drinking once he or she begins to drink, even if the circumstances would demand moderation or sobriety. Alcoholic drinking is a need or compulsive behavior - an alcoholic may drink even when they do ''not'' want to do so.
Whether someone can ever drink responsibly again after having been an alcoholic is an issue of [[FlameWar fierce debate]].
One side (that of most therapeutic opinion and of Alcoholics Anonymous) says that complete abstinence is required for anyone who ever reached the point of physical addiction. In some cases, being even short of that threshold is enough according to this side. It insists that any consumption of alcohol after beginning rehabilitation is a relapse.
The other side (championed by Moderation Management, Rational Recovery and some other therapists) postulates that it is ''possible'' for someone who was once an alcoholic to drink responsibly/on a limited basis. Considered are the variables of personal willpower to do so and structured settings to reduce temptation to overconsume or revert to addictive use. That said, with the development of medication treatments that can, if properly adhered to, restore the ability to stop drinking/"have enough," moderation/harm reduction ''can'' possibly be a more viable alternative to abstinence than it was in the past when it relied solely on self-control that an alcoholic almost always by definition doesn't have.
It's also possible that BothSidesHaveAPoint, what with how the legal system and people seeking help for relatives/friends can conflate true alcoholism (where the latter side may or may not be correct, depending on what side of the FlameWar you're on) with non-addictive alcohol abuse/misuse (where the latter side ''is'' the correct first approach)
* [[http://depression.about.com/od/screeningtools/l/blmast.htm The Michigan Alcohol Screening Test]] can also help you determine whether you are an alcohol abuser or an alcoholic. This is the primary screening test for alcoholism.
!! Immediate help (protecting someone who is very drunk)
* ''DO NOT'' overserve, if you are hosting a party or bartending yourself. Realize there is a point at which people ''should not'' consume more alcohol. Don't be afraid to cut them off and supply them with nonalcoholic beverages at least until they've had time to process some of what they've had. If you are a bartender and decide that a customer is too drunk to continue serving but is also too profitable to cut off and lose out on tips, you can at least severely water down their drinks and substitute alcoholic components for non-alcoholic substitutes, as the body loses the ability to perceive alcohol after a certain point anyways. While morally dubious, it IS a win-win situation for you nonetheless. If they don't notice or protest, they'll keep throwing money at you. If they do, they'll look like any other drunken asshole bitching about how weak the drinks are and will get hauled out by the bouncers.
** As a secondary tip for bartenders/servers: alcohol and caffeine are an okay combination but only to a point. After that point, it leads to everything from people being "awake drunk," (e.g. drunk but not aware how drunk they are) to actual heart attacks and poisonings (because both intensify the other's cardiotoxicity). Over two drinks with an energy drink or strong coffee as mixer is generally a very bad idea. If someone is repeatedly ordering such, try to steer them toward something with a non-caffeinated mixer even ''before'' you cut off the alcohol. Also, try to avoid doing Jaegertrains for large groups who order lots of Jagerbombs. While they look impressive and can net handsome tips, it's impossible to keep track of that many people. If one of them decides to drink multiple Jagerbombs and has a bad reaction, your ass ''will'' be on the line.
* If you're a bouncer, odds are good you can sum this passage up instinctively: "Don't be a dickhead and do your goddamn job." Even so, elaboration on the standard societal perception of bouncers is necessary. The perception tends to cleave towards "barely-verbal, troglodytic meathead who only took the job to get a chance to get away with being a violent, power-tripping asshole". This isn't true as a whole, but anyone who has worked in nightlife can tell you there ''definitely'' are bouncers who fit this to a T. You should scrupulously avoid doing anything that could be seen as this. Basically, don't start or join in on fights, don't be a dick to patrons, don't argue with or antagonize drunks, don't blow up at rude patrons (no matter how egregious their misbehavior is), don't drink or do drugs on the job (should be a no-brainer, but, again, this is all too common in the nightlife industry) and listen to what patrons and coworkers are trying to tell you. Failure to do so could get you fired, ruin your reputation and restrict your job options to sketchy, poorly-managed shitholes. It could possibly even cause you to get your ass kicked or cost you your life if you piss off the wrong person.
* ''DO NOT'' let someone drunk get behind the wheel of a vehicle. ''Ever.'' If someone is visibly drunk (or even if they don't seem so but you suspect they have had more than one drink in the last two hours) drive yourself if you're sober, find a sober driver in the group, call a cab or ride service, get on public transit (and keep an eye on the worst-off drunks), let the drunk people stay over at your place until sober. Drunk driving kills and injures many people every year around the world. Even when no one is injured or killed and no property is damaged, people (especially poorer people who can't fight the charges with a lawyer/don't know how to act when arrested) will face life-altering criminal charges and legal trouble. It's entirely stupid and entirely preventable.
** Furthermore, negligence on your part that leads to drunk driving also can have major legal consequences for you. Taking keys at gatherings where people are likely to get piss drunk is customary not just because it's a very easy way to keep people from being able to drive drunk, but also because if you fail to take someone's keys and they subsequently go off and drive drunk (or worse, get into an accident) and they implicate you when asked where they got the alcohol by an arresting officer, you can get in ''serious'' trouble for negligence in the form of arrests or lawsuits. If you could have prevented it and failed to, your ass will be on the line.
* ''DO NOT'' allow someone drunk to use a firearm, fireworks, or pyrotechnics or be in too-close proximity to them. Yes, people do drink alcohol at occasions like holiday parties with fireworks, hunting trips and target shoots, and as performers and audience at shows involving pyro. But if someone is visibly drunk or acting recklessly, that person should be kept away from guns, fireworks, and stage pyro. Many fatal and injurious accidents have occurred as the result of combining drunk people with things that are dangerous even with the utmost care and skill applied.
* If a drunk person or people (or one using any substance for that matter) is in a place where they could fall/jump from a height that could be fatal (e.g. high-rise apartment party, roof...) either keep them in sight at all times and make the hazard harder to access (close the balcony door or the window) or, better yet, walk with them somewhere safer.
* This also applies to other things that are dangerous, or even to things that might not ''seem'' dangerous at first glance. Drunk people (especially those who are also high on a stimulant at the same time, anything from too many Jagerbombs to cocaine or meth) ''can'' be highly inventive in regard to ways to get accidentally injured or killed. If someone could fall on it or fall off of or out of it, get stabbed or cut on it, choke themselves on it or with it, consume it when it shouldn't be consumed, shove it into a bodily orifice, etc, etc - make sure that it's not easily accessible to someone drunk.
** Something a lot of people don't even realize could be dangerous here is ''food''. Specifically hard candies, nuts in shell, sections of soft pretzels, grapes or food that contains inedible garnishes or bones can prove to be hazardous. If you're putting out food for a party where you're expecting lots of people to be drunk, ask yourself if someone could choke on it. If the answer is "yes," either don't serve it, remove the choking hazard or serve it early on before people have the chance to be very drunk. Furthermore, think long and hard before you put out anything that contains common allergy triggers. Sober people are usually very good about remembering what their triggers are and are generally quite capable of administering an epinephrine shot if they carry an [=EpiPen=] on their person. Drunk people are forgetful and easily confused when things go awry. They won't react to sudden changes in the way that they would if they were sober. In short, alcohol-induced forgetfulness and serious food allergies are a ''lethal'' combination. If a drunk person goes into anaphylaxis, their diminished ability to know just what the hell is going on means that death is a ''very'' real possibility.
* Make sure drunk people are not vulnerable to rapists. This means, again, watching out for them until they are either sober or with someone ''they'' previously have known and trust. It means not committing rape yourself. It bears repeating: Drunk people past a certain point of drunkenness are ''not capable'' of consent to sexual activity - even if they are outright verbally requesting it. Furthermore, if you're with someone who is drunk while a known predator is also in their vicinity, keep a close eye on both parties and be prepared to step in the minute that that predator tries to make their move. You could very easily prevent a rape that way.
** Added to this, BDSM play while drunk at any point beyond "slightly buzzed" is generally considered ''not'' SafeSaneAndConsensual. This is because, as noted above, alcohol lowers inhibitions and boundaries beyond what someone sober might draw a line at doing, while, as noted below, being highly drunk makes people nearly insensible to pain - meaning they may well not realize they need to stop and use their SafeWord (or forget it entirely) and get badly injured for real as a result - and passing out in some bondage positions or while doing anything related to asphyxiation has killed people. There is a ''reason'' why most professional BDSM events will either ban alcohol and drug use entirely, or will demand people actually participating be not visibly drunk or high. Whether you're a partner or a professional "worker," it's a good idea to never play with someone beyond "slightly tipsy," and to keep an eye on them to protect them from less ethical people and/or themselves. If someone insists anyway (e.g. they've hired you as a dominant and don't want to "waste their money,") ''at least'' try to placate them with activities that don't require them to know their body's condition or how much pain/pressure they are actually feeling to be safe.
* If someone drunk is being aggressive or overemotional, do your very best to distract them with something that doesn't involve starting a physical fight or harassing/insulting other people. Treat them like you would an unruly, tantrum-prone child: don't attempt to argue with them or convince them that their behavior is unacceptable, because they a). aren't functioning at a level where they can process it and b). don't really give a fuck anyways and very well may just take it as a reason to escalate things. Make simple, direct statements that don't come off as antagonistic, don't argue with them or take the bait if they try to start one, and if they're being aggressive or acting in a threatening manner, make sure that your distraction doesn't piss them off further and can hold for long enough to make them forget why they were angry. Drunks have short attention spans and tend to be forgetful. Use this to your advantage.
** Additionally, if you wind up getting attacked, ''do not'' physically take your frustration out on them. '' '''Don't''' '' fight them any more than you have to to get away from them. You will probably be understandably furious at having to deal with a violent drunk, but once again, drunks do not process pain on the same level that sober people do. They may [[ImplacableMan continually get up again and again]], but the injuries are still the same. Beat the shit out of them and there's a good possibility that they won't realize that they've broken or dislocated a bone, received a major laceration or even that they're bleeding internally (which is normally immensely painful). Again, lots of beating deaths with alcohol as a factor have boiled down to "the victim attacked the offender, got pounded into jelly and was too drunk to know just how badly injured they were". If someone winds up dying by your hands under similar circumstances, you will almost always - almost certainly - be facing manslaughter charges.
* If you have a friend who is a mean, abusive, belligerent or violent drunk and insists on drinking anyways even after having been made aware of their repellent behavior while they were sober and able to process it, you should probably not let them wander out of your sight if they're drunk. Be ready to defuse bad situations and/or break up fights and talk people out of continuing them. You never know if the person they're threatening or loudly insulting has a bad temper, is a skilled fighter or carries guns or knives on them. Even if your friend is steadily wearing away at your patience and desperately needs to accept that they have a problem and need treatment, the last thing you want is for them to wind up getting beaten to a pulp, stabbed or shot. Beating-related deaths or permanently-crippling injuries are particularly common among drunks due to the body's greatly dulled ability to perceive pain while inebriated, which leads to people getting up from injuries or attempting to struggle out of holds that would have a sober person howling in pain.
* Generally, it's best to do your best to keep drunk people from encountering law enforcement. Being drunk is temporary, but a criminal record - or being shot or even sometimes "just" beaten up and tased - is permanent. This ties into several of the above - keeping them away from driving, fights or dangerous activities - but it also means if someone really, really drunk can be kept out of public view or any situation where they are likely to encounter police, it's a good idea to do so.
* Most importantly, '' '''NEVER, EVER, EVER, EVER LEAVE A SEVERELY DRUNK PERSON ALONE.''' '' This encompasses all of the above and the points below. Always make sure an adult who is at least ''somewhat'' sober is keeping an eye on anyone who is overwhelmingly drunk until they sober up. In an absolute pinch "buzzed" people are okay for supervising - in that someone who's only had a couple beers or smoked a little bit of a joint watching someone who is in a far more worse state is better than ''nobody'' watching them.
!! Recognizing alcohol poisoning
* Often, the line between "overwhelmingly drunk" and "alcohol poisoning" is hard to tell at first, especially with milder cases of alcohol poisoning (e.g. those that are likely survivable with minimal intervention aside from observation and protecting the person from suffocation due to vomit or positioning), and sometimes even with moderate and severe cases that ''do'' need hospital intervention to keep the person alive. If someone appears overwhelmingly drunk, you should make sure they have ''no more access to alcohol,'' and possibly use a personal breath alcohol testing device if you have one to make sure they are in safe territory, and observe them for any of the [[http://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/effects-on-the-body/alcohol-poisoning following signs]]- which mean they need to be in a hospital at once.
** Irregular or slow breathing (less than eight breaths a minute)
** Blue-tinged or pale skin
** Low body temperature (hypothermia)
** Stupor – when someone’s conscious but unresponsive
** Unconsciousness – passing out (without being immediately rousable - someone who passes out but is awakened by your talking to them or poking or shaking them probably just needs to be watched until sober so they don't pass out doing something dangerous to them. Someone who ''doesn't'' wake up needs a hospital immediately.)
The following signs are debatable - they could mean alcohol poisoning, but if someone is ''only'' showing these and not worsening to any of the above, they could be fine with observation and no further alcohol - that said, if someone is showing these and even slightly any of the above, or they are severe, it's also a good idea to call EmergencyServices.
** Confusion - If someone is confused to the level of being absolutely unresponsive, they likely do need a hospital, but if they are talking - even if what they are saying is silly or stupid or weird - they are likely not immediately in danger of dying, or at least capable of being taken to the hospital without a call to EmergencyServices.
** Loss of coordination - Can happen with even slightly drunk people (and it's why driving isn't a good idea) but if someone has lost control of even generally involuntary functions or if they have lost bladder or bowel control - they probably need to be in the hospital immediately.
** Vomiting - Can happen with people who are not in immediate danger, but also with people who are in severe danger. If someone is vomiting, do ''not'' let them fall asleep or go to bed until the vomiting has been over for at least a few hours, do not allow them to consume more alcohol, and watch for the far more threatening symptoms - and if they are vomiting heavily enough to become dehydrated (e.g. they've vomited more than a couple times) they also need to be hospitalized, and if it contains blood (it can be tricky to spot the difference if they've consumed multiple red-colored drinks, but blood is a pretty distinctive shade of red), you need to call an ambulance or drive them to the nearest emergency room RIGHT AWAY. If they are showing no other more threatening symptoms and dehydration is the only worry, it's probably a good idea to risk a bit of vomit in your car to drive them yourself, or call for a taxi to the hospital, rather than call EmergencyServices if law enforcement response is a possibility.
*** As another couple of notes on gastrointestinal bleeding and alcohol, if a long-term heavy drinker or alcoholic has prominent abdominal veins (especially in the upper abdomen) they need to be in a hospital '''IMMEDIATELY,''' as this is a symptom of a ''life-threatening'' condition called portal hypertension. If someone (whether a long-term heavy drinker or alcoholic, or just someone who had ''way'' too much to drink or has consumed any amount of alcohol rectally) has rectal bleeding or passes bloody feces - they ''also'' need to be immediately hospitalized.
Whether to call EmergencyServices, a private ambulance or a taxi or drive someone to the hospital yourself/have a sober driver drive them is a very complicated decision. If you have the money or connections for a private ambulance call, it is likely the very best option - medical assistance ensured to arrive solely with no law enforcement response and the person in a safe environment if they do begin experiencing a life-threatening issue. EmergencyServices is best if someone is experiencing life-threatening problems and you ''don't'' have the means for a private ambulance call - and it is ''sometimes'' possible to avoid law enforcement response if you give the person's age as being of legal age and you emphasize that there is no violence or threat of violence. Your/someone else's vehicle or a taxi, however, is the best idea ''if'', and only '' '''if''' '', the person is '' '''not''' '' experiencing any of the life-threatening symptoms (e.g. their breathing is fine and they are not seizing) and the concern is dehydration/sickness/vomiting or similar alone.
!! Getting help in the long term
* [[http://www.aa.org/ Alcoholics Anonymous]] is often considered the best recovery program for those who are alcoholics or severe alcohol abusers. That said, [[http://www.salon.com/2014/03/23/the_pseudo_science_of_alcoholics_anonymous_theres_a_better_way_to_treat_addiction/?utm_content=buffer86760&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer there is major controversy ]] as to whether Alcoholics Anonymous is anywhere near as effective as it claims, or whether it is the best approach. There are also some [[http://orange-papers.org/orange-cult_a0.html#ca_guru_right valid arguments that]] Alcoholics Anonymous could actually be a cult, if not a specifically "religious" one.
* [[http://www.smartrecovery.org/ Smart Recovery]] and [[https://rational.org/index.php?id=1 Rational Recovery]] both are alternatives to AA that take a slightly different approach than AA's traditional 12-step recovery with no focus on the idea of a higher power, whatever it may be.
* [[http://www.moderation.org/ Moderation Management]] is a harm-reduction approach that allows for continued drinking but strictly controlled. It is at odds with much of the recovery community (which, often for very good reasons, demands total sobriety) and has somewhat less successful odds, and is probably more useful for problem drinkers/alcohol abusers than for true alcoholics.
There are also many others, including inpatient rehabs, outpatient rehab programs, one on one counseling, and more. There are programs specially for military members or ex-military (generally, you can find out about these in the US by contacting the Veterans Administration), programs for the LGBTQI community (there's generally meetings listed at community centers), for atheists or secularists who still want to do 12-step but without references to the "higher power," and alternatively, for devout religious believers who want to specify their higher power as their object of worship. There's also harm reduction measures, listed above, whether via MM or via one's own ideas (e.g. thinking about what you can do to reduce alcohol intake or behave responsibly even if planning on getting drunk, for example, substituting a larger liquid volume drink for one with more alcohol, spacing out alcoholic drinks with nonalcoholic ones, making sure one is not driving or doing other hazardous things until sober) - which are especially valuable for alcohol abusers or overusers to ''prevent'' becoming alcoholics.