Advice to Law Enforcement Personnel

Law enforcement officers and public safety personnel are commonly called to intervene in situations in which a person is behaving abnormally and appears to be drunk. This appearance can be misleading. Law enforcement personnel encountering apparently drunken people should err on the side of a medical evaluation before attributing the behavior to alcohol alone.

• Possible illness: A person can be both drunk and sick, or drunk and injured, at the same time. Without a careful medical assessment, it may be impossible to separate the effects of alcohol from those of illness or injury. This means that it may not be possible to judge a person who appears to be drunk from one who may be critically ill. This does not mean that every person who appears to be drunk needs to be taken to a hospital.
  
  
  • If family members or friends are available to provide a medical history and testify that they have been with the person while he or she was drinking, and there is no reason to suspect anything but a bit too much alcohol, then this person does not necessarily need to go to an emergency department.
    
    
  • If the person is incoherent and the medical history and recent events are unclear, then the person should be taken to the hospital.
  
  
• Condition looks like intoxication: Low blood sugar levels in diabetics may make a person appear drunk. (The law enforcement official should call an ambulance if this is the case.) Some over-the-counter antihistamines have been shown to impair a person's ability to drive. Their sleepiness may cause weaving and erratic driving that may suggest the person behind the wheel is drunk. Various psychiatric disorders might loosely give the appearance of the person being drunk. A medical illness involving decreased oxygen delivery to the brain, such as a pulmonary embolism or various poisonings, may appear as drunken behavior.
  
  
• Suspected head injury: A closed head injury (concussion) in a drunken person who has fallen may be the real cause of the person's nonresponsiveness. A drunk person's fall tends to result in far more injury than a sober person's fall. A sober person, perhaps tripping on something, tends to break the fall with a reflex reaction such as putting out the hands. Individuals who are drunk lack this reaction and tend to hit their heads.
  
  
• Possible suicide attempt: One of the most common substances swallowed in a suicide attempt is alcohol. It is difficult, but not impossible, to commit suicide with alcohol alone. This is because more often than not people knock themselves out before they consume a lethal level. Far more commonly, people use alcohol to loosen up in preparation for the lethal act itself. This means that when encountering an intoxicated person, consider not only the possibility of medical illness or injury, but also the possibility of self-poisoning.
  
  
  • The poisoning can be unintentional. A person desperate for alcohol may inadvertently substitute a nonethanol alcohol such as rubbing alcohol, windshield wiper fluid, or even antifreeze—not realizing or caring about the toxicity.
    
    
  • More commonly, a suicidal, drunken person has taken his or her own medications or those of a family member.