The difference between having a 'good time' and ending up on life-support could be just one drink: If you think your teen may be drinking alcohol, have the conversation

About 18 months ago you may remember quite a remarkable story out of the US that got a great deal of coverage right across the world. Hannah Lottritz, a 21-year-old from Nevada, uploaded a photograph of herself on life-support together with a blog entry titled 'Drinking Responsibly' in an effort to warn others about the risks associated with drinking to excess. The article and the photograph went viral with both being picked up by news agencies across the world. The reason behind her decision to share this disturbing image is clearly explained in the opening paragraph of the piece ...

"I am writing this because I didn’t realize the importance of drinking responsibly until I was waking up from a coma, and I don't want anyone to go through what my family and I went through. I ask that you share this with your friends, family or anyone who may benefit from reading this. If I can help just one person by sharing my experience, then I will be absolutely ecstatic."

Sadly, I meet many young people who have had similar experiences - most who are totally mortified about what happened and many completely mystified by how it happened. As I say to young people, I've never met someone who wanted to end up in an emergency department - every single one of them made a silly mistake, some believing that they drank exactly the same amount as they had done on other occasions and others having just one or two more than usual. It sounds 'pat' but it's true - the difference between having a 'good time' and finding yourself on life-support in hospital could be just one drink ...

Hannah's story is not unusual. She had gone to a music festival and made the mistake of trying to play 'catch-up' with her friends in regards to alcohol. She then drifted away from the people she knew and ended up with another group, who she then promised she could "outdrink". This included skolling whiskey straight from the bottle. From then on she has no memory of what happened and had to rely on friends to fill in the gaps. Shortly after skolling the whiskey, she collapsed and stopped breathing. She was taken to the event's medical tent, intubated and flown to hospital. Her parents were contacted by police and told that she was in a critical condition, suffering from acute respiratory failure and acute alcohol intoxication.  As she says in her article:

"My blood alcohol concentration was .41 when I arrived at the hospital, five times over the legal limit. The doctors thought I was brain dead because I was completely unresponsive. My pupils were sluggishly reactive, I had no corneal reflex and I wasn't responding to verbal or painful stimuli"

What has really upset me in the last year or so is the number of young people who actually wear the fact that they have been taken to hospital like a 'badge of honour'. Somehow they think it is 'cool' to have this experience, with some actually bragging about apparently having their stomachs' pumped. When I see this behaviour I take great joy in letting people know that pumping the stomach is rarely, if ever, used for someone suffering from alcohol poisoning. There's a number of reasons for this, including the fact that it is quite labour-intensive and requires more staff than is normally on hand in an emergency department, but most importantly it is a process that is considered more dangerous than beneficial in most cases. Now to be honest I certainly have heard of doctors and nurses telling young people that their stomach had to be pumped - but according to one nurse I know, this is often done for dramatic effect more than anything!

Of course, their bravado and 'big talk' could simply be due to embarrassment but nevertheless we need to make sure that young people are aware that there is nothing glamorous about ending up in hospital on life-support.
Usually the hospital staff have to cut off the patient's clothing, if they haven't wet or messed themselves, they have vomited and need to be cleaned up and put into a hospital gown. They are then intubated - this is where a small tube is inserted through the mouth or nose, then threaded through the oesophagus and into the stomach. This tube is placed on suction, decompressing the stomach which helps reduce the risk of vomiting. The person is also put on an IV drip to help with hydration. As you can imagine this is all extremely unpleasant and certainly not glamorous.
As Hannah writes in her article ...
"I finally woke up about 24 hours after I arrived at the hospital. I had a tube down my throat and my hands were restrained so I couldn't pull it out. I was unable to talk with the tube down my throat, making it hard to tell my parents and the nurses that it was extremely uncomfortable. I had to pass a respiratory test to prove I could breathe on my own before they removed it. I failed the first respiratory test I took, and I had to wait several hours to take another test." 
Last year I received an email from a young woman named Georgia who found herself in a similar situation. She had got extremely drunk, became unconscious and thankfully due to a couple of her quick-thinking friends, an ambulance was called and she was rushed to hospital. She wanted to share her story, telling me that I could use it in my school talks, but it was what she wrote right at the end of the message that really had an impact on me.

"I drank far too much and I will never forgive myself for my stupid decisions that night. But it is my friends and, most importantly, my Mum and Dad that I feel really bad about. I don't have any memories about the really bad stuff. I blacked out well before I was taken to hospital but it was my friends who had to try to look after me at the party who I put into such a terrible position who had to deal with the situation. My poor parents had to sit my hospital bed for almost 24 hours and be told that I may not make it through the night. I just feel so selfish ..."

As I wrote back to Georgia, it is important that she forgives herself for her error of judgment. She made a mistake, she needs to apologise to those people she feels she needs to say sorry to and then brush herself off and get on with life. Beating yourself up for mistakes like this gets you nowhere. Waking up in a hospital room with tubes down your throat and your parents standing over the top of you in tears must be devastating though ... it's a tough thing to recover from.

So when it comes to alcohol poisoning and the risk of ending up in hospital, what should a parent be saying to their teen in an effort to keep them protected or at the very least, aware of the dangers? Here are just a couple of key points that could be raised:
  • if you're going to drink, make sure you eat something beforehand. Young people need to eat a 'fistful of food' before they go out - that's about the size of their empty stomach. That's enough to keep you protected to some degree, slowing down absorption but not interfering with the actual alcohol experience. Something 'carbohydrate-heavy' like a small bowl of pasta or rice, even a sandwich or burger is best ...
  • it can't sober you up but making sure that water is a part of every alcohol experience your teen has is extremely important. Make sure the first drink they drink is a glass of water (it prepares them for the dehydrating effect of alcohol and also fills them up a little so they are less likely to gulp that first bottle or can down as fast) and try to get them to get into the habit of having another glass between each alcoholic drink. Once again, we usually tell young people this is all about rehydrating but realistically it's most probably more important in that it can help slow their drinking down just a little ...
  • remember that alcohol is like any other drug, it can affect you differently every time you drink it. You could have exactly the same amount of alcohol on two different occasions and have completely different experiences. So many people find this hard to believe and when something does go amiss are convinced that it couldn't be the alcohol that caused the problem. Make sure your teen gets this message early - just because they had a 'good time' when they had a couple of shots last week does not mean it'll necessarily be the same this week!
  • avoid drinking games and shots. Unfortunately, for some young (and even not so young) people this is just part of their alcohol experience and there's little we're going to be able to do to change that. That said, make your views clear on this kind of drinking behaviour - we know that your opinion can actually make a difference
  • when it comes to other people drinking, encourage them to intervene when necessary. People just don't suddenly become drunk and lose consciousness - there will be warning signs. This is a gradual process for most people. If you see a friend who you think is getting into trouble, step in and say something. It's not even about telling them not to drink, saying something as simple as "slow down" could make all the difference. Try to get them away from the alcohol by suggesting you go for a walk together, send them a text to distract them or get others to help you - don't let it get to the stage of having to call an ambulance if you can possibly help it
  • most importantly, make sure they know they have your total support should something ever go wrong and they need to call for help. Many young people don't call 000 because they're frightened their parents may find out - that's so sad and must be devastating for parents to hear. Nobody ever wants their child to be put into a situation where they need to call an ambulance but every parents wants to know that if they were, they'd do it without hesitation!
Having a conversation about alcohol and all the things that can go wrong is never going to be easy. Acknowledging that your teen may be drinking, without necessarily condoning the behaviour, can be extremely difficult but it is necessary. That one conversation could prevent the one person you love most in the world from ending up being transported to hospital and that's worth all the discomfort in the world ...

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