The Truth Behind Blackout Drinking

The first time I blacked out I woke up in a bathtub. I was twenty two, living in Dublin and one year out of university. My friends – new friends I had met that same night in a bar – were trying to wake me up by running the shower attachment in my face. They had carried me back to their hotel from Burger King, after I passed out on its floor. I had no memory of walking down O’Connell Street, or standing and queuing for chips. Nor could I recall how I drank enough to forget all this in the first place.

This isn’t the average Tuesday night for me. I got through my teens without ever passing out or throwing up or waking up beside a stranger. Even today, I don’t really get hangovers, I just wake up and get back to life. I don’t drink alone, nor do I drink particularly often. Perhaps this is why the results can be so messy when I do.

Blackouts are cruel: they sneak up and pull you down violently. They mercifully steal away embarrassing moments, but replace them with something worse: oblivion. You don’t have to be an alcoholic to suffer blackouts: a well-known set of studies at Duke University in the early 00s showed over half of the 772 students surveyed had experienced them. Passing out is not the same as a blackout: the latter refers specifically to a loss of memory.

Sarah Hepola’s autobiography, Blackout: Remembering the Things I Drank to Forget, features a litany of regrettable nights out, culminating in a painful deliberation on the nature of sexual consent when someone is in blackout mode. Nothing so terrible has ever happened to me, but I sometimes find myself questioning my choices, and revising events to retrofit a sense of agency. Hepola arrives at a brutal truth: “Behold the risk factors for blacking out: a genetic predisposition to holding your liquor, drinking fast, and skipping meals. Oh, and one more: being female.”

Today it feels like alcohol’s gender gap (the idea that men can stomach more than women) is closing – men are being advised to drink less while women are drinking more. But women remain at a biological disadvantage – a paper titled Are Women More Vulnerable to Alcohol’s Effects? by America’s National Institute on Alcohol Abuse and Alcoholism (NIH) explains that women metabolise alcohol differently to men:

“Women have less body water than men of similar body weight, so that women achieve higher concentrations of alcohol in the blood after drinking equivalent amounts of alcohol.” It continues with an ominous list of consequences: “Alcohol-related organ damage, trauma and legal and interpersonal difficulties...”

For several years after that time with the bathtub and the Burger King, I managed to pace myself. I was a nervous, neurotic person that year, prescribed Xanax for panic attacks, but once I started drinking less, overall my life improved. I didn’t get panic attacks, or need to take Xanax anymore. But then the blackouts came back. They were like buses, with several arriving at once.

Last year, during a summer so dark that I starting stalking Ebay for SAD lamps, I counted five blackouts in swift succession. They coincided, oddly, with my most grown-up year to date – one in which I lived away from home, tried to hold down a relationship (it failed) and to work hard at a part-time writing job (that ultimately failed too…). But all of this had brought my panic attacks back, and with it, a valium prescription.

I worked very hard that summer, spending most of it indoors at my laptop. But those few times I allowed myself a night out the results were messy. At one house party I woke up in a cupboard. At another I hopped across the city to three parties, but I only remembered one. At a festival I lost an entire day in memory, one which I had paid €60 to enjoy. I didn’t pass out physically, but snapped back into awareness in a field as the headline act played their final song. I was sitting on my friend’s shoulders.

I tried not to let on to friends how much I’d forgotten, that I remembered the words to Britney’s "Blackout" better than my own. I developed a system of bargaining with myself which seems tragic in retrospect: “At least I woke up at home.” “At least I woke up with my clothes on….” I'd say to myself.

One more blackout this winter offered the final piece of the puzzle. On a first date that was going well, I invited the guy I was with to a house party. That’s all I remember. I woke up the next morning, still at the house party, alone in a darkened room. I was fully clothed, my bag in the crook of my elbow, my coat zipped up as if I’d been ready to leave. I surveyed the room like a crime scene. The door was locked from the outside, and my phone was on its last bar of battery. I could hear birds beginning to sing outside the window.

In the end I managed to call the flat’s owner who told me where I could find some spare keys. On the walk home I marvelled at the cruelty of a thing so unpredictable. Some nights I could knock back shots, Zombies in tiki tumblers and an archipelago of Long Island Iced Teas, all while my memory remained intact. But sometimes whole nights vanished into the darkness after only a couple of drinks. What was it that made the difference?

You’ve probably guessed by now, faster than I did; my benzodiazepines were exacerbating the problem. First the Xanax, then the Valium. The effects when they’re combined with alcohol are greater than the sum of their parts, varying from drowsiness and confusion to depressed vital signs, respiratory difficulty, heart stoppage and coma. And of course memory loss, which for me happened not only if I drank the same day as taking them, but days later.

Diazepam, the group of sedatives both Valium and Xanax belong to, has a half-life up to 100 hours in the body. I’m 5’2 and small: these things stay in my system.

Still, you don’t need to be taking prescription drugs to experience a blackout. Nor do you need to be an alcoholic, or even drink very often. They happen when your blood is saturated. The liver is overwhelmed, and alcohol finds its way to the brain. It blocks long-term memories from forming, triggering a loop of repetition. This is why someone in a blackout is easy to spot when you know the signs: they continue to function, but they can repeat what they’re saying at short intervals. Blackouts also happen at a delay: you’ll finish the bottle, pass the limit and stay upright, then suddenly find that you’re not.

Studies on blackouts have long neglected social drinkers, especially female ones. One paper, titled ‘What Happened? Alcohol, Memory Blackouts and the Brain’, admits that they have mostly involved “direct observation of middle–aged, primarily male alcoholics, many of whom were hospitalised. Scientists offer irritatingly simple (but admittedly practical) advice for how to prevent them: “A rapid rate of increase in blood alcohol concentration is most consistently associated with the occurrence of an alcoholic blackout. Therefore, gulping drinks, drinking on an empty stomach, or drinking liquor (opposed to beer) are risk factors."

Not only are women biologically more likely to suffer blackouts, but we are predisposed to get them most during the wilderness years of our late teens to mid-twenties: in the study above, the blackouts “resolved spontaneously when the subjects graduated college, got married, or successfully entered the adult workforce.”

So it’s simple: we need to drink slowly, eat beforehand, and – if all else fails – maybe try getting married. The other thing to keep in mind is not to be too hard on yourself: “More females (59 percent) than males (25 percent), were frightened by their last blackout and changed their drinking habits as a result.” We can learn something, after all, from the nights we’ve forgotten.