BBC – Future – Why do only some people get blackout drunk?

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Sarah Hepola has ample experience of this kind of disconnect. She says that, during her blackouts, she could still function, take part in conversations and respond to jokes, in the same way that Goodwin’s subjects could perform calculations. Only those who knew her well could recognise her “glassy-eyed unplugged” look of being in a blackout state. “It was like nobody was home… like I was talking but wasn’t receiving,” she says.

But despite how she may have looked to outsiders, she knows she wasn’t herself. “I definitely think my decisions were impaired,” Hepola says. “I was highly impulsive, wildly unguarded and exhibitionistic, even sexually aggressive at times in ways that didn’t make sense to me the next day… based on what people told me.”

This is why some university policies spell it out more clearly: “An individual may experience a blackout state in which they appear to be giving consent but does not actually have conscious awareness or the ability to consent,” Amherst College warns in its sexual misconduct policy. Similarly Michigan University states: “A person who is intoxicated is legally unable to give consent to sexual activity, meaning that sexual intimacy with someone who is ‘mentally incapacitated’ meets the legal definition of a sexual assault.”

Screening questionnaires about alcohol use now routinely ask about prior blackout experiences

It’s perhaps therefore not surprising that a person who regularly experiences blackouts is also more likely to experience other negative consequences of drinking, from the more mundane (like missing appointments or coming to work late) to the more serious (like having an injury or overdosing from using illegal substances). This makes blackouts a useful marker and predictor of other detrimental behaviour.

For these reasons, questions about alcoholic blackouts are now increasingly being used in screening tools to quickly get at whether someone is a recreational drinker or a problem drinker.

Blackout screening

Mary-Beth Miller, an addiction psychologist at the University of Missouri, found that a simple intervention technique could help blackout drinkers reduce their drinking, a finding she first showed in ex-army veterans and then extended to university drinkers.

The intervention is called “personalised normative feedback”. It is an online questionnaire that asks individuals about their drinking habits, and reports back how much they are drinking compared to others who are similar in age and background. Blackouts, her team found, serve as a “teachable moment after which individuals are more likely to respond to intervention”.

 

Screening questionnaires about alcohol use now routinely ask about prior blackout experiences, which could make it easier to target and find individuals who need help. Simply asking about the amount an individual has drunk was not found to be effective. “If you are screening specifically for blackouts, it makes your screening more specific, instead of trying to intervene with every person who comes into your clinic,” Miller says. 

These interventions are not time-consuming or expensive, making Miller hopeful that she and colleagues can build upon them to develop even more effective interventions. She hopes to encourage a drinking culture where people understand that “you don’t have to get completely wasted to have a good time.”

Some messed-up behaviours get laughed off and normalised

Other researchers hope that asking about previous blackouts will in turn help reduce other types of risky behaviour. “It’s definitely interesting that a blackout is one of the most negative consequences of alcohol, and it might be a canary in the coalmine for more significant problems,” Haas says.

For those who experience regular blackouts, a good first step is to better monitor your own alcohol intake and ask friends around you to do the same. That’s easier said than done. For Hepola, it is only looking back that she could see the warning signs. Even at the time she knew she “didn’t want to be that drunk” – but still couldn’t stop drinking.

 “Some messed-up behaviours get laughed off and normalised and sometimes we get distanced from the emotional and physical damage it [alcohol] causes,” says Hepola.

She has now been sober for eight years and is glad to no longer fall into the black trapdoors of memory loss. It has made her life a lot simpler, she says.  

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