Understanding the Warning Signs and Risk Factors

If you drink too much or take a higher than usual/necessary dose of a drug, you’ll begin to feel the effects before too long. You may become sleepy, confused, nauseated, or you may have trouble breathing. If you lose consciousness, your situation just went from bad to worse.

Alcohol or drug overdoses may be an accident, or they can be used intentionally. However it happens, anyone who suffers from an overdose will need immediate medical intervention, likely including a visit to the emergency room or hospitalization. In addition, the medical staff may suggest rehab if they suspect that a substance abuse dependence is responsible for the condition.

Overdoses don’t just happen out of the blue. Instead, several factors contribute, such as not storing drugs properly or following dosage instructions correctly. You or others in your family may have a history of drug misuse or even addiction, or there may be a history of mental health disorders. It’s important to pay attention so that you can know the reason for an overdose - it should be seen as a signal that someone needs help, rather than an indictment that they cannot be helped.

What is a Drug Overdose?

An overdose is when someone takes more of a drug or alcohol than their body can handle. It can happen after someone has taken the same drug many times; it can also be caused by mixing drugs with alcohol. This can increase the negative effects exponentially, causing the person to lose consciousness before they even realize something is wrong.

While you or someone else may not believe that mixing a beer with a narcotic drug is a dangerous thing, it’s a potentially fatal combination. Both narcotic drugs and alcohol are depressants for your central nervous system (CNS). That is, they slow down your body’s breathing and heart rate. You can’t think as quickly or efficiently and your heart or lungs may give out altogether, leaving you no way to call for help.

If you have mixed alcohol and narcotics before and continue to do so, you’ll soon begin to suffer the more permanent effects of this behavior. For instance, if you stop breathing, someone may need to call for medical personnel to perform rescue breathing so that your brain receives oxygen again. If you stop breathing often enough, brain cells begin to die—and they can’t be regenerated or replaced. Once those cells are gone, they are gone. Even a single overdose event can cause long-term brain damage if there isn’t someone close enough to begin CPR within six minutes.

If the combined drugs and alcohol in your system increase quickly enough, you may also vomit. If you have passed out, you don’t know this is happening—and if even if you’re breathing is fine, if you’re lying on your back, you can breathe the vomit into your lungs. This makes it impossible for you to breathe, and even CPR may not help.

Effects of Tolerance on Overdose

Tolerance simply means that, over several weeks, months, or even years your body gets used to the presence of alcohol or drugs. Eventually, your body responds defensively and the dosage you’ve been taking doesn’t give you the same effects as before. Users then tend to increase how much they take in order to get those same levels of effect again.

And, if they continue to use or drink, they’re going to find that, over time, they have to increase how much they use. This will happen more and more often the longer they continue to use. At some point, it will be too much.

Different organs adjust and develop drug or alcohol tolerance in their own ways. Take your brain for instance, you immediately realize when you feel less drunk or high. If you want to feel just as drunk as you did before, you drink more.

But what you don’t see is that, inside your body, damage is slowly taking place. It’s accumulating and increasing within the organs that most commonly deal with the poisons in your body. Your liver is one of those organs. If you become dependent on alcohol, over time your body will feel less and less of the same effects that it used to feel. So, you begin to drink more and more. And your liver is damaged every time you do so. Eventually, it stops performing as it is supposed to, leading to various conditions, which can be fatal.

Not every person’s body becomes tolerant at the same rate. Your genetics may cause you to become tolerant of alcohol more quickly than it causes the person down the street. Also, your living situation affects your ability to become tolerant. So, if you are looking for a good drunk or high and you don’t respond to the same amounts as you did before, you’re going to drink until you feel just as drunk. If this continues on a regular basis, you’re going to run into problems you can’t fix with another drink.

Risk Factors

A risk factor is something that makes it more likely that, at some time during your substance use, you will suffer from an overdose. Some are features that are unique to you, such as your body size or age. Others depend on whether you use other substances and still others rely on any health issues you may have. Either on their own or in combination, these can set you up for one or more overdoses and other complications.

Recognizing Risk Factors

Several risk factors include:

  • Gender:
    Boys and men are more at risk of drinking heavily
  • Age:
    The younger you are, the more likely you are to drink too much
  • Tolerance:
    If you already have a high tolerance, you are at risk
  • Body size:
    If you are taller and heavier, you’re less at risk than someone who is lighter and shorter
  • Health conditions:
    A health issue, such as diabetes, puts you at a higher overdose risk
  • Binge drinking:
    If you engage in this behavior, you’re already at high risk of an overdose
  • Aggressive behavior at a young age:
    You may feel the need to artificially reduce your aggressiveness
  • Lack of parental supervision:
    Away from your parents, you may feel free to use drugs
  • Poverty:
    This community risk factor may lead you to blunt your negative feelings
  • Availability of substances:
    If something is freely available, you may choose to indulge
  • Substance use in peers:
    If you see friends using, you’re more likely to use

Recognizing Risk Factors

If you know or love someone who is dependent on substances, you may already have seen them suffer from an overdose. This should put you on the lookout for future incidents.

Or, it may be that you are dependent on one or more of your substances of choice. If you have experienced an overdose, you know what to look for. This may make you more sensitive to the risks that others around you are taking, and you should be watchful of them as they are using, so that you are aware enough to notice if they are struggling or experiencing an overdose.

If you are working in a social service, medical, or law enforcement profession, you may come into close contact with addicts fairly regularly. If, for instance, you operate a treatment facility, you are likely more than familiar with the signs and symptoms of drug overdose. You’d also be well-versed in the risk factors that someone with a substance use disorder may face. For instance, if you know they are using a prescription medication, you may be more watchful.

There are a variety of situations in which it is useful to be keenly aware of the risk factors for drug use and overdose. Parents should be on the lookout. Teachers keep their eyes open when they supervise children at school or see them at extracurricular events. Those who work in emergency situations know the signs and those who work with people in precarious situations should keep up to date on new forms of drug use and the signs of, not only addiction but also overdose and risk factors for overdose.

Symptoms & Signs of an Overdose

Prescription Medication (Including Opioids)

If you are using a prescription medication in ways that are not recommended, you’re at high risk of suffering from an overdose. Not every prescription medication overdose leads to the same symptoms. Narcotic medication overdoses lead to one set of symptoms, while stimulant overdoses lead to a different display of symptoms.

If the prescription medication you are using is a narcotic, such as hydrocodone, it is a central nervous system depressant. That is, it slows down your heart rate and breathing. Any prescription narcotic overdose or even regular use can be potentially dangerous. Be aware of these symptoms:

  • Shallow breathing
  • Dilated (large) pupils
  • Cold, skin that is moist to touch
  • Skin is blue-tinged
  • Pulse is weak and thready (difficult to feel)
  • Loss of consciousness; coma

You may also experience stomachache, stomach upset, headache, confusion, or chest pain. You’re in the most danger if you lose consciousness. If you develop seizures, you need immediate medical attention. Even if you don’t have a seizure or go into a coma, you could still be permanently disabled.

If you see someone who is having symptoms, look for blue-tinged skin or a weak pulse. Some overdose symptoms are similar to what the person experiences when they take the correct dosage.

Illicit Drug Overdose (Heroin, Cocaine, Others)

If you know someone who regularly uses illicit drugs such as cocaine or heroin, you need to know what an overdose looks like.

Opioid overdose:

  • Awake, can’t talk
  • Breathing is very shallow and slow or has stopped
  • Doesn’t respond to stimuli outside their body
  • Skin tone, beds of fingernails, or lips looks blue-purplish, or grayish for those with darker skin
  • Limp body
  • Vomiting
  • Gurgling breathing sounds (death rattle)
  • Skin is damp
  • Pulse is slow or nonexistent

Cocaine overdose:

  • Fast heart rate
  • irregular heart rhythm
  • Extremely high blood pressure
  • Perspiring (sweating)
  • Confused
  • Nausea
  • Severe anxiety and psychosis
  • Tremors (shaking)
  • Seizures
  • Stroke


  • Diarrhea
  • Drowsiness (sleepy)
  • Disoriented (confusion)
  • Hallucinations
  • Coma


  • Analgesia (doesn’t feel pain)
  • Hyperthermia (high body temperature)
  • Hypothermia (low body temperature)
  • Stops breathing
  • Loss of memory
  • Blurry vision, large pupils
  • Slurred speech
  • Clumsy
  • Seizures
  • Fast breathing
  • Sensory distortions (feeling sight with fingertips)
  • Speech doesn’t make sense
  • Memory loss
  • Coma
  • Stroke
  • Death


  • Psychotic reactions (loses touch with reality)
  • Lack of judgment
  • Loss of coordination (can lead to injury)
  • Chest pain, fast heartbeat, or heart attack
  • Uncontrollable shaking or possible seizures
  • Skin is pale
  • Lack of responsiveness
  • Sudden high blood pressure and headache

Alcohol Overdose

An alcohol overdose is more commonly referred to as alcohol poisoning. This is a dangerous, potentially fatal condition and should not be ignored. If you see a friend or loved one in this condition, call emergency services immediately. Even if your friend or loved one doesn’t have every symptom, call 911 for immediate emergency medical intervention.

If you know the details for your friend (how much and what kind of alcohol they drank), provide this to paramedics. Never leave an unconscious person who has overdosed on alcohol alone. If you rolled them to their side, they may still roll onto their back if you leave them alone. Additionally, never try to make them vomit—they could choke. Try to sit them up. Better yet, try to keep them awake.

What Can be Done?

No matter the substance a friend has ingested, you may be able to sense that they are in serious trouble. Even if you aren’t sure, if you cannot wake them you should call for help immediately. Many forms of overdose can lead to an inability to breathe, which can lead to brain damage or death.

An overdose can happen with any type of substance, from alcohol all the way up to heroin. Accidental overdoses are just as potentially fatal as intentional overdoses. Intentional overdoses are one of the more common ways to attempt suicide and medical personnel need to be aware of this so your friend can get the help they need.

When you see symptoms such as dilated pupils, difficulty breathing, no breathing, nausea, vomiting, blue/gray lips or fingers, confusion, chest pain, dilated pupils, fast heartbeat, unusual aggression or violent behavior, seizures, dizziness or loss of consciousness that means it’s time to act right now.

Stay calm. This is hard but do your best. Call 911. As you are talking to the dispatcher, remember everything you can about what your friend has ingested and how much they had. The dispatcher will tell you to provide first aid. Keep doing this until emergency personnel get there. If your friend overdosed on an opioid, you could give them Narcan if you have any on hand. If you know CPR, ask the dispatcher before providing it.


For people who realize a friend or loved one (or even a stranger) is in the middle of an overdose, all 50 states have a Good Samaritan law. This allows them to call emergency services to help any person who is overdosing. Someone who is almost unconscious can’t call 911; they need a friend or even a stranger to intervene.

After the emergency has ended, there is the worry that a person who helped out may find themselves in the unexpected position of being sued because they helped. These Good Samaritan laws in all states protect them from both criminal and civil penalties. These laws can be used if someone has been hurt; they can be used if you see that another person or someone you know is in serious trouble from various substances.

Specifically, these laws offer immunity for calling a fire truck or ambulance to provide medical assistance in the middle of an emergency.


Emergency Treatment

When EMTs arrive to help your friend or loved one, the first thing they do is to check for the signs of an overdose, be it an opioid overdose or another substance.

Every team of EMTs brings a large amount of medical equipment with them. One of these is equipment that allows them to help the person breathe by performing mouth-to-mouth breathing. If your friend can breathe but isn’t conscious, the EMTs put them into the recovery position so their airway doesn’t become obstructed.

Once they know what your friend overdosed on, they can administer medications to help. If, for instance, your friend overdosed on an opioid, the EMTs will administer Narcan, which is a medication that halts the effects of opioids for a period of time. It will give them a chance to get your friend to the hospital and reduce the effect of the drug in their system.

While they examine your friend, EMTs will also look for clinical signs of overdose. If your friend is suffering from alcohol poisoning, the EMTs will look for those signs; they will be familiar with alcohol poisoning or ethanol toxicity. They will administer treatments to help your friend until they can get them to the hospital.


Detoxification or detox is literally the body’s process of removing toxins or poisons that are making you or your friend sick. In the case of alcohol poisoning, detox is helping you to manage, safely, your withdrawal symptoms as your body rids itself of the alcohol. You’ll feel withdrawal symptoms after you stop drinking or using drugs; some may cause more immediate effects, but many will hit up to two days after the last time you used.

Because withdrawal can be so dangerous, medical professionals have the option to administer medications that make the process less painful. Detoxing or going cold turkey at home can potentially be fatal. It’s much safer to check yourself into a detox program that will supervise as you go through withdrawal.

If you are severely addicted to substances, any form of detox will be much more difficult. During your detox, after you are evaluated, you’ll be stabilized so the process will be much safer. You’ll still feel some symptoms. That is unavoidable. You may be anxious, nauseated, have trouble sleeping, or have mood swings.

Does Overdose Mean You Need to Go to Rehab?

This question may be lurking in your mind. A drug overdose happens because of a dependence on one or more substances. Because overdoses are potentially fatal, your doctor may suggest that you spend some time in rehab.

If your body and mind have developed a tolerance to your drug of choice, you’ll begin to use more of it. Eventually, you suffer from an overdose. Once you are discharged from detox, you have already begun the basics of rehab. Detox is not rehab but emptying your system of whatever you are addicted to is the first step that must be followed before you can even think about rehab. You need to learn why you are addicted and how to complete your recovery.

While you may feel physically fine, you may have processes going on in your mind that helped push you into abuse and overdose. If you are suffering from depression, anxiety or another mental disorder, entering a rehab that offers “dual-diagnosis” treatment will help with your addiction and your mental issues.

Rehab may give you a new reason for recovery and a better life.