8 things parents need to tell their teens about alcohol and vomiting

The response to last week's blog that asked parents 'Would your teen know what to do if something went wrong at a party?' was amazing! Well over 20,000 people read the piece over a 2-day period and the content seemed to really resonate with parents. The incredibly sad story of the 15-year-old girl who choked to death on a bed while being watched by four of her friends is particularly powerful and, as a result, many readers forwarded the link to their teens. Amongst all the comments was one that I found particularly interesting:

" … Death by vomiting is a real danger. I must have been lucky as a young bloke to not have died. My life was saved several times whilst vomiting unconscious. I had good mates who looked after me. A wife who saved my life three times. I no longer drink at all. The fun aspect disappeared long before I got the help I needed. I don't think all that much has changed over the past 50 odd years ... I quite like young folk. Times change. Kids don't. I believe a lot of oldies forget their youthful years."

What a great comment – "Times change. Kids don't." … Of course, he's absolutely right – nothing really changes - it's just that we now know far more about the potential risks. As a result, we can try to ensure our kids are far more informed than we were and hopefully, if they do get into trouble, at least they'll have a better idea what to do!

Getting drunk and subsequently vomiting is not something new. When I talk about the potential risks around alcohol in schools, teachers often come up afterwards and say something like, "I was so lucky" or "How did we ever make it through? We did all those things and were never aware of what could have gone wrong". Unfortunately, getting drunk and dying as a result is not new either. Deaths caused by choking on vomit after a heavy drinking session have been happening since man first started using alcohol. A number of famous people have died this way, including Led Zeppelin drummer, John Bonham, who reportedly drank 40 shots of vodka and subsequently choked to death in his sleep and of course, AC/DC lead singer, Bon Scott who passed out in a friend's car and inhaled his own vomit.

Most people have vomited at least once in their lives and many have a great 'vomit story' – particularly relating to alcohol! Even though it is incredibly unpleasant, it is important to remember that there is a reason for this bodily function. So, what is that reason? Why do we vomit when we drink too much?

Most alcohol is metabolized by the liver, where an enzyme called alcohol dehydrogenase (ADH), breaks it down into acetaldehyde, a toxic chemical that can make a person feel sick. This is then broken down by another enzyme into acetate, which is excreted. Although acetaldehyde is usually broken down quite rapidly, when you drink alcohol it builds up in the body, causing nausea. When you drink too quickly, these toxins accumulate, and your body gets the message that it needs to get rid of them. You then vomit – expelling the contents of the stomach, including the toxins!

If a young person is going to look after someone who is vomiting, they've got to have an understanding of why it is happening … Now trying to explain all about ADH and acetaldehyde is going to bore them to death and many won't understand it. So, although this is an oversimplification, a good way of explaining what is going on is as follows ... When you drink too much, alcohol 'turns off' the brain areas that control consciousness and breathing, resulting in unconsciousness, coma and, in extreme cases, death. You've been poisoned! Our bodies try to protect us from getting that far by making us vomit and getting rid of unabsorbed alcohol before it reaches the brain. It prevents further poisoning and in the process, save your life.

When it comes to educating teens about anything I'm of the view that we should 'start from where they're at', i.e., begin by talking about something they've experienced themselves and when it comes to alcohol, that's vomiting! Even if they've never drank alcohol, most young people who have attended a party or met a group of friends in a park on a Saturday night have seen someone else drink too much and end up being sick. If it's not their friends, it'll be a family member. That's why a conversation about alcohol and vomiting is far less likely to be 'shut down' by your teen. They're going to know what you're talking about and there's a better chance they're going to listen.

So, what should you be telling them? Here are 8 key points about alcohol and vomiting that every young person should know:

• vomiting can be life-threatening. Although many look back at a night of vomiting and laugh about their experience, it is vital that teens understand that it can be extremely dangerous. Apart from choking to death, dehydration and salt imbalances are the biggest concerns in most vomiting episodes
• if someone is vomiting, or it looks as though they may start, stay with them – never leave them, not even for a few seconds. It can take just seconds for someone to choke on their own vomit, so it is vital you stay with them and monitor them closely at all times
• don't force them to drink lots of water. For some reason, young people (and adults too) believe that water is going to fix everything. Of course, if they are not vomiting and just feel unwell or nauseous, ensure they replace lost fluids. It is also important to ensure they rehydrate once they have finished vomiting, but if they're forced to drink water while they are being sick, it is highly likely that they will simply vomit it back up relatively quickly. Soak a t-shirt or cloth in cold water and have them suck on that in between vomits. That way, they are still rehydrating, as well as getting rid of the horrible taste in their mouths
• vomiting won't sober someone up. Getting rid of unabsorbed alcohol from your stomach is not going to sober you up. Certainly, some people report that immediately after vomiting they can feel clear-headed and some even believe they are now sober enough to drive! This effect is believed to be due to the flood of endorphins that are released when vomiting but usually disappears quite quickly
• never prop a drunk friend onto a toilet bowl to vomit. Too often, people end up with a range of facial injuries (losing teeth, breaking their noses, etc) when left lying over a toilet and either pass out or fall to sleep, smashing their faces onto the porcelain. Drunk friends should be taken to a safe and well-lit place and given a plastic bucket or bowl
• try to keep them comfortable - if they are feeling sick they are likely to be feverish. Putting a cold compress (or even a cold-water bottle) on the back of the person's neck can reduce their temperature and make them feel a little better. On the other hand, if they start to feel cold, make sure there is something warm to wrap around
• if you see blood in the vomit, call 000 immediately. Although, this can be caused by something as simple as the person biting the inside of their mouth or tongue, it could also be something far more serious, such as retching tearing the small blood vessels of the throat or the oesophagus. This usually looks like small red streaks in the vomit, like nose bleed blood. Although this may not be life threatening there is no way of knowing for sure without seeking medical attention
• if in any doubt, call 000. It's hard to be too specific here as everyone is different when it comes to what constitutes a 'medical emergency' but 'if it doesn't feel right, it usually isn't!'. As a parent, make it clear to your child that you support them in their decision to call 000, then they need to call you. Even if the ambulance arrives and the situation has resolved itself – it's better to be safe than sorry.

How do you know if a person is just drunk or actually suffering from something much more serious - like alcohol poisoning? It's difficult, but if you see one of the following, call 000 immediately – this is not something an adult can deal with, let alone a teenager:

• the person is unconscious and can’t be awakened by pinching, prodding or shouting
• the skin is cold, clammy, pale or bluish or purplish in colour, indicating they are not getting enough oxygen
• the person is breathing very slowly, if there are more than 10 seconds between breaths – this is an emergency
• vomiting without waking up

Many parents reading this will remember a drunken night out when they were in their teens (or early 20s) when everything went wrong. We usually learn by our mistakes and a night of vomiting after a big drinking session can often lead to long-term changes being made when it comes to alcohol. Sadly, that one drunken night can sometimes result in a death. We need to make sure our kids know more than we did. This is not necessarily going to be an easy conversation but it's an important one ... Remember, if you want to have a better chance of success, frame the conversation around looking after a friend and avoid talking about their own drinking behaviour (that's another conversation altogether!) ...

If parents are interested in learning more, there are two fact sheets specifically developed for young people on the DARTA website that may help. One is called 'How do you look after a drunk friend?' and the other is 'How do you look after a drunk vomiting friend?'