Alcohol poisoning is a serious yet avoidable issue that kills at least 6 people per day in the United States alone. So what are you doing about it?
It usually starts as a casual night out with friends. Everyone goes out to dinner then decides to take it to the bar. Maybe you have some friends over for beers and mixed drinks during the big game of the season. Or perhaps it’s a frat party at a college campus.
Regardless of how the stage is set, the possible result is terrifyingly similar: death from alcohol poisoning can cause a jarring to a seemingly enjoyable afternoon or evening get together.
Do you know what alcohol poisoning looks like? Are you familiar with the signs to look out for when drinking with friends? Read on to find out the 9 top signs that your friend’s alcohol intoxication might have passed alcohol poisoning in order to know whether to call for help.
The Size of a Standard Drink in the United States
According to the Centers for Disease Control and Prevention, a standard drink in the United States is as follows:
- 12 ounces of beer at 5 percent alcohol by volume
- 8 ounces of malt liquor at 7 percent alcohol by volume
- 5 ounces of wine at 12 percent alcohol by volume
- 1.5 ounces of hard liquor at 40 percent alcohol by volume or 80 proof
While these are general guidelines to go by, it is difficult to know exactly how many ounces of each you are consuming. When you are out to the bar it is nearly impossible as every bartender makes drinks a little differently.
When you’re in for the night with friends, it might be a smart idea to keep track of how much you’re drinking throughout the night. Since you’re in, it’s easier to keep better track of how much you’ve consumed compared to when you’re out for the evening at the bar or the club.
What is the Definition of Binge Drinking?
Binge drinking is defined as consuming 4 or more drinks for women or 5 or more drinks for men within the course of two hours. This type of drinking generally leads to a blood alcohol concentration (BAC level) past the legal limit of 0.08.
Of adults in the United States who binge drink, the majority report having a minimum of 8 drinks on a binge. This results in even higher rates of blood alcohol concentration and trips to the emergency room.
What Is Alcohol Poisoning?
The most comprehensive alcohol poisoning definition comes from the National Institute on Alcohol Abuse and Alcoholism (a.k.a. the NIAAA).
According to the NIAA, the alcohol poisoning definition is:
A potentially deadly type of overdose…
Alcohol poisoning occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support function—such as breathing, heart rate, and temperature control—begin to shut down.
As you might imagine, the symptoms of alcohol poisoning go far beyond simply feeling sick, vomiting, and a lack of coordination. In fact, the effects of alcohol poisoning can cause seizures, coma, and even death, not to mention a host of other physical effects that can have serious impacts like dehydration.
But what is really happening here when someone starts showing alcohol poisoning symptoms? How is the body actually reacting on a fundamental level?
A Look at The Internal Effects of Alcohol Poisoning
When it comes to alcohol, the body has a number of systems designed to help us break down this powerful compound.
Stomach enzymes, for example, start deconstructing and changing alcohol immediately after it enters our system. And while it does help a bit, the bulk of alcohol breakdown happens in the liver.
Once alcohol is absorbed into the bloodstream, it flows through the chief filtration organ, the liver. Here the liver blasts alcohol with a barrage of enzymes to continue the breakdown even further.
The alcohol that isn’t broken down continues through the body’s circulation system until the liver eventually breaks it down entirely.
But once alcohol consumption overpowers the amount of alcohol we can break down, then the trouble begins.
First of all, the liver can only process so much at a time. And when you’re filling your body with alcohol, it can’t break down other compounds like fats. As a result, the fat in your blood can build up, resulting in severe liver damage.
As the liver becomes less able to break down the alcohol, it can spread to almost every internal organ in your body as it flows through your blood stream.
In fact, alcohol’s effects are so far reaching that they can even impact the body’s hormone system as well.
The symptoms of alcohol poisoning, then, occur when your blood alcohol content (BAC) is so high that it begins shutting down your body’s most important automatic processes like respiration.
The heart, lungs, liver, kidneys, stomach, and brain are all impacted by alcohol poisoning.
That’s why the answer to “can you die from alcohol poisoning?” is a resounding YES – so many vital internal are all affected by this powerful drug.
Overview of the Effects of BAC Levels on the Body
Obviously the more you drink, the more significant an impact the alcohol has on your body. Researchers have broken down a general timeline of the effects alcohol has on the body as well as the BAC levels at which alcohol poisoning symptoms start to show.
- 0.02-0.039% – No loss of coordination, mild euphoria, minimization of shyness. Relaxation sets in.
- 0.04-0.059% – Feelings of well-being and relaxation, inhibitions lower, sensations of warmth. Euphoria takes hold. Minor impairment of judgment, memory, and lower caution.
- 0.06-0.99% – Slight impairment of balance, hearing, speech, vision, and reaction time. Lowered judgment and self-control. Impairment to reasoning and memory.
- 0.10-0.129% – Significant impairment of motor coordination and absence of good judgment. Slurred speech may start. Balance, peripheral vision, and hearing are impaired.
- 0.13-0.159% – Gross motor impairment. Lack of physical control. Vision is blurred and balance is difficult. Euphoria reduces and dysphoria (a feeling of being unwell) begins to set in.
- 0.160-0.199% – Dysphoria takes over and nausea sets in. This is the “sloppy drunk” point.
- 0.20-0.249% – Ability to walk is significantly diminished, absolute mental confusion. Nausea and vomiting. Possible blackout.
- 0.250-0.399% – Alcohol poisoning. Potential loss of consciousness.
- 0.40%+ – Onset of coma, possible death due to respiratory arrest.
As you can see, alcohol poisoning sets in once you have reached a relatively high BAC level. Still, it is entirely possible to accidentally reach if you aren’t paying attention to how much you are consuming and how quickly you are consuming it.
How Many Standard Drinks Does it Take to Get to the Point of Alcohol Poisoning?
There is no hard-and-fast rule on how many drinks gets an individual to the point of alcohol poisoning. There are multiple factors that influence how quickly someone’s blood alcohol concentration (BAC) level rises:
- Body fat percentage
- Tolerance to alcohol
- Type(s) of alcohol consumed
There are a few others such as genetics which may play a role, but these are the main five factors to consider. The time it takes to reach a dangerous or lethal blood alcohol concentration level varies from person to person.
Ultimately, binge drinking is the most common cause of quick alcohol intoxication and eventual alcohol poisoning. If you avoid binge drinking, you cut down significantly on your chances of potentially developing alcohol poisoning.
What Is the Considered “Moderate” Alcohol Consumption?
The absolute best way of avoiding the effects of alcohol poisoning and, ultimately, alcohol poisoning death is by drinking in moderation. But what does drinking in moderation really mean, exactly?
According to the 2015-2020 Dietary Guidelines for Americans from the U.S. Department of Health and Human Services and U.S. Department of Agriculture, drinking in moderation is defined as “up to one drink per day for women and up to two drinks per day for men.”
In general (though the way everyone’s body processes alcohol is unique), this is considered to be the limit of a “healthy” level of drinking. The Dietary Guidelines are quick to point out, however, that it does not advise anyone to start drinking alcohol.
By keeping your alcohol consumption moderate though, you can virtually eliminate any threat of feeling the effects of alcohol poisoning entirely.
How Alcohol Poisoning Impacts the United States
The Centers for Disease Control and Prevention gathered some facts on alcohol poisoning in 2015. In the United States alone:
- 30 percent of deaths are attributed to alcohol dependence (alcoholism)
- Most alcohol poisoning deaths are among non-Hispanic whites
- Alaska has the most deaths per million people
The binge drinking culture pervading our society today contributes to the astronomical rates of alcohol poisoning in the United States. With so many people drinking so much in such a small amount of time, it is surprising there aren’t greater amounts of complications.
The basic fact of alcohol poisoning: obviously, the more you drink, the closer you get to too high of a BAC level, and you are at extreme risk for alcohol poisoning or death.
9 Signs of Alcohol Poisoning to Look For
The symptoms of alcohol poisoning can in fact be deadly.
That’s why it’s important to be able to identify when a friend is struggling with the effects of alcohol poisoning. He or she may need to receive treatment as soon as possible. This may limit the impact that alcohol has on their system.
The following are some common signs of alcohol poisoning, and what you should look for.
1. Mental Confusion
Mental confusion is generally one of the first signs of alcohol poisoning that sets in. The person is confused either about what is taking place in conversations, whom they are with, or where they are. This is due to the fact that alcohol has such a damaging effect on the brain.
This side effect can also go a step further. Blackouts are very typical when someone has been poisoned with alcohol. A blackout occurs when the individual appears to be functioning as normal. However, the following day, they have no memory of anything that occurred. Drinking on an empty stomach can result in a blackout, but simply consuming too much can as well.
Experts refer to blackouts as being “drug-related amnesia.” Researchers indicate that having frequent blackouts is a good indicator of alcoholism. Also, for someone who has an impaired liver, more alcohol is able to reach the brain quicker. This can result in faster blackout instances.
In some cases, frequent blackouts may cause long-term damage to the brain. Both short and long-term memories may eventually be impacted negatively. There are two types of blackouts and they are:
En Bloc Blackouts: These have occurred when someone has the inability to recall anything that occurred during intoxication. Sometimes people can remember information when they’re given hints. However, someone with en bloc blackouts will not be able to at all.
Fragmentary Blackouts: People suffering from this type may be able to recall some information from the intoxication. However, other memories will be absent. It is possible for these individuals to recall information when prompted.
Experts believe that women may be more susceptible to blacking out than men. Their tolerance for alcohol tends to be much lower, yet they often try to drink enough to keep up. This may make them more at risk for alcohol poisoning.
Another sign of alcohol poisoning is a state of stupor is when someone is conscious but unresponsive. They may be breathing and moving but do not respond to any external stimuli. This is often referred to as being in a “drunken stupor.”
According to the Merriam-Webster Dictionary, this condition is marked by a dulled sensibility. In some cases, sense can be completely suspended. It is a mental condition during which a person completely lacks in spontaneous movements. Drinking alcohol is a tremendous shock to the system; especially when it done excessively.
When someone is in a stupor, they may respond to extreme pain. They may not be able to talk, and may appear rigid. Their eyes will be open and they’ll be able to follow objects around. Although, the individual will appear to be very sleepy.
Health24.com refers to the drunken stupor as being the “legless phase.” They indicate that at this point BAC levels are at a dangerous level. The individual may be nauseous, and unable to move parts of their body. They may feel jittery and their reflexes are severely impaired.
It’s important for people to be able to turn over onto their stomachs in this phase. If they happen to vomit, they could aspirate, which can be fatal. Many times, people who are in a stupor from alcohol poisoning are unconscious.
3. Alcoholic Coma
If the person falls into a coma, this is an alarming sign of alcohol poisoning that needs immediate medical attention. An alcoholic coma is a state of unconsciousness. It is impossible to wake someone up who is in a coma, even with the most powerful stimuli.
An alcoholic coma can go one of two ways. Sometimes people will eventually wake up from them on their own, following treatment. Other times, they may not wake up at all. If they don’t, they enter into a persistent vegetative state. People who fall into an irreversible coma may become brain dead.
An alcoholic coma is often referred to as acute alcohol poisoning. The outlook for this condition is grim. Oftentimes, people assume that someone in this state has just had too much to drink. As a result, they’re left to sleep it off. This is one of the most dangerous effects of alcohol poisoning. Someone in an alcoholic coma needs to be hospitalized immediately. Some medications may work to help bring someone out of the coma.
Of course, no one ever starts drinking with the thought that a binge could lead to a coma. However, this is one of the risks they take when they consume too much at one time. The amount of alcohol that it would take to fall into a coma differs for everyone but no matter the amount, it is most certainly one of the most hazardous alcohol poisoning signs.
Usually because the person has lost most control over motor function, the process of vomiting can be dangerous. If this happens while you’re with a friend, stay with them to ensure they don’t choke.
It’s common for someone who has been drinking to be unaware that they have consumed too much alcohol. Fortunately, the body is always aware of what’s going on. Vomiting is triggered in many ways. The brain is notified by the stomach, intestines, bloodstream and even the ears. Once the message is sent, the stomach will expel anything in it in an attempt to clear itself out. This is the primary way that the body protects itself from being damaged. Too much alcohol is toxic, and the body knows this, even if the individual does not.
Alcohol is viewed as being safe to consume because it’s so easy to obtain. Sometimes people are surprised to find out that it can be very irritating to the stomach. If drinking has led to poisoning, vomiting might be one of the first symptoms.
Prior to vomiting, the individual usually feels quite nauseous. The muscles in the stomach are contracting during this time. When someone vomits, the contents of the small intestine are being forced out. The esophageal sphincter should be opening during this time to avoid aspirating anything into the lungs. However, this doesn’t always happen; especially when someone vomits while lying down.
Aspirating can cause choking. If a person is alone, it’s possible they could choke and even die because they can’t breathe. If you notice any alcohol poisoning symptoms in others or yourself, it’s particularly important to avoid sleeping in a position that may lead to choking.
In smaller amounts, alcohol will not lead to seizures. This means that if someone is consuming one or two drinks, there is no cause for concern. However, there is a risk of seizure activity when it is consumed in excess.
Seizures are another dangerous sign of alcohol poisoning. They occur because the normal brain activity is being interrupted. When someone is having seizures, they experience involuntary muscle spasms. Seizures can result from binge drinking episodes, and they often do. They can also occur when someone has one drink with a higher than normal alcohol concentration.
Experts believe that becoming quickly dehydrated can lead to seizures. Alcohol is a substance that can easily lead to dehydration. Drinking too much can also lead to hypoglycemia, which can lead to seizures too.
There are some studies that have shown that alcoholism is connected the development of epilepsy. Research suggests that these individuals are at an even higher risk of seizures if they stop drinking.
People who suffer from alcohol-induced seizures may experience:
- Muscle convulsions
- Muscle stiffness
- Sudden loss of consciousness
- Loss of bowel control
- Loss of bladder control
If you’re with someone who is having a seizure (whether it’s related to alcohol poisoning or not), it’s important to get medical help right away. Call 911 and stay with them until help arrives.
6. Significantly Slowed Breathing
Drinking too much at one time has a profound effect on the way the lungs function. If you’re with someone who is drinking excessively, count their breaths. If they take less than 8 breaths over the course of a minute, this counts as slowed breathing. And if you suspect dangerous levels of drinking, this is one of the most important signs of alcohol poisoning to be on the lookout for.
Alcohol impacts every organ in the body, including the lungs. Research has shown that healthy lungs maintain a delicate balance of bacteria. Alcohol can upset this balance, leaving the individual more susceptible to infections. Nitric oxide is responsible for maintaining this balance. Studies indicate that heavy drinkers have less of it in their lungs. This can lead to extensive breathing problems.
It makes sense that slower breathing rates can be dangerous. Getting less oxygen to the brain can cause long-term problems that may be irreversible.
Binge drinking is a popular activity on college campuses. Studies have shown that people who binge may also have breathing issues. This is because alcohol can affect the balance of nitric oxide levels in the lungs. This is a gas that assists in fighting bacterial infections. People who drink excessively naturally have lower levels of it, which leaves them prone to infections.
7. Irregular Breathing
If the breaths they take last longer than ten seconds, this is considered irregular breathing. Sometimes people experiencing symptoms of alcohol poisoning find it hard to take a breath or catch their breath too. Any changes in breathing patterns need to be reported to a doctor. Breathing problems can become even worse when alcohol is mixed with other drugs. Sometimes people will use opiates and alcohol at the same time. This can be disastrous.
Typically, people who drink too much will fall asleep afterwards. This is because alcohol is a depressant and it makes them tired. Once a heavy drinker is asleep, they are at risk for obstructive sleep apnea. This is a condition that causes the upper air passage to close off or narrow during sleep. This means that people can stop breathing altogether due to alcohol poisoning. Sometimes this will cause people to wake up, but it doesn’t always happen.
Alcohol can also irritate your nasal airway. This can cause serious breathing problems for you while you sleep. Anyone who experiences sudden breathing problems after drinking needs to go to the emergency room. Alcohol-related breathing problems are serious, and should never be ignored.
Hypothermia refers to the lowering of the overall body temperature. Signs of hypothermia include pale or blue-tinged skin caused by low body temperature levels. Heavy drinkers usually never even consider that they could be at risk for hypothermia. This is because alcohol tends to make them feel much warmer than normal. This is actually a myth. Alcohol works in the body by lowering the core temperature.
Hypothermia can occur during alcohol poisoning because of the way the blood vessels are dilated. This happens most to the capillaries that lie right under the skin, near the body’s heat sensors. If the individual is in a colder environment, or if they’re sweating, the body cools too quickly. To make matters worse, alcohol restricts the body’s ability to shiver. This is its first defense against getting too cold.
In chronic alcoholics, hypothermia is common, as is death from this condition. Unfortunately, when someone is drinking, they are much less aware of the cold. Having higher BAC levels can actually act as an anesthetic against it making the effects of alcohol poisoning even more deadly. Someone who doesn’t eat enough food while drinking is at an even great risk.
A rash is another sign. The face, arms, hands, or legs may experience bright, hot flushing that looks like a rash. This occurs because of blood vessels in the body that have become larger than normal. The brain has been impacted with excessive drinking, and it’s not able to regulate their size. This is also one of the most easily observed signs of alcohol poisoning.
There are all different types of rashes that can occur for someone who drinks too much. Sometimes this is a reaction of being allergic to alcohol, or possibly being alcohol intolerant. However, it is usually the result of regular alcohol abuse.
If you are allergic to alcohol, you may have other symptoms aside from the rash. You may suffer from:
- Itchiness of the nose, eyes and mouth
- Hives or eczema
- Swelling of the face or throat
- Problems with your breathing
- Nasal congestion, including wheezing
- Stomach pain
- Nausea or vomiting
- Symptoms of diarrhea
It’s not always easy to tell the difference between an alcohol allergy and intolerance. With an allergy, your immune system overreacts. With intolerance, your digestive system doesn’t process the alcohol the way it should. Either way, a rash could be an indicator of alcohol poisoning.
What Do I Do if a Friend Has Symptoms of Alcohol Poisoning?
It’s important to remember that while you may think you know how to take care of someone and handle the symptoms alcohol poisoning, the only people that truly know how to treat alcohol poisoning are licensed medical professionals.
As such, if you notice any of the preceding signs in a friend while you are out drinking, call for emergency services immediately. This condition can lead to coma, brain damage, and death if left untreated. Seek immediate medical assistance in order to ensure the best chance for your friend’s recovery.
While waiting for medical services to arrive and provide treatment, do the following while you’re waiting:
- Keep them awake and sitting upright if possible
- Give them water if they are able to drink it
- If they’ve passed out, lie them on their side in the recovery position to keep their airway open and continuously check on their breathing
- Keep them warm with extra clothing or blankets
- Stay with them and monitor symptoms in order to inform emergency personnel
You can also do a number of things to help emergency personnel streamline your friend or loved one’s alcohol poisoning treatment. You can, for instance, be ready to tell emergency dispatchers the kind of alcohol consumed, how much was consumed, and how long ago it happened. Having this information on hand can make their alcohol poisoning treatment much more effective.
It is never a good idea to let someone “sleep off” the signs of alcohol poisoning. It is possible for someone to choke on their own vomit in their sleep or suffer respiratory distress or arrest.
Beyond that, once the symptoms of alcohol poisoning have appeared, the only thing that can help is professional medical help. Cold showers, “walking it off,” and coffee won’t stave off the damaging alcohol poisoning symptoms that could end up leading to permanent health consequences.
Complications That Can Result from Alcohol Poisoning
If you notice these alcohol poisoning symptoms and don’t seek help immediately, it can be a potentially fatal mistake. Despite what popular culture has communicated in the past, when an alcohol overdose has occurred, it will take serious medical help to avoid the most detrimental alcohol poisoning effects.
According to the Mayo Clinic, the most common complications of alcohol poisoning include:
- Choking – Alcohol depresses a number of your body’s natural responses such as your gag reflex. Vomiting, one of the most common signs of alcohol poisoning, can end up being fatal for someone who has overdosed on alcohol because it may actually end up clogging their airways. And with a suppressed gag reflex, that vomit may actually cause lethal choking.
- Stopping Breathing – Like opioids, barbiturates, and benzodiazepines, alcohol is a central nervous system (CNS) depressant. And as such, one of the most common alcohol poisoning signs, as with these other drugs, is decreased respiration. When too much alcohol is consumed, it can actually stop your brain from telling your body to breath entirely. In addition to the potential for death, this can also end up causing permanent brain damage due to lack of oxygen as well.
- Severe Dehydration – Vomiting and increased urination can lead to dangerous levels of dehydration. This can not only put extra pressure on already-overworked kidneys but can also lead to low blood pressure, an increased heart rate, and consequently a higher risk of cardiac events.
- Seizures – One of the most dangerous signs of alcohol poisoning is a risk of deadly seizures. Drinking too much alcohol can cause blood sugar levels to drop which may end up resulting in a potentially fatal seizure.
- Hypothermia – Left untreated, alcohol poisoning can end up causing hypothermia, which, can actually lead to cardiac arrest.
- Irregular Heartbeat – Due to the depressant nature of alcohol (which can seriously impact autonomic functions), one of the symptoms of alcohol poisoning is an irregular heartbeat which, if not treated properly can result in death.
- Brain Damage – Alcohol poisoning death isn’t always immediate. In fact, the brain damage sustained due to heavy drinking can slowly degrade your functioning over time rather than all at once. However, this brain damage can end up causing serious problems down the line including cellular damage, mood and memory impairment, and cognitive disruption.
- Death – Finally, each and every one of these complications of alcohol poisoning listed above can end up leading to death.
If you spot the signs of alcohol poisoning above, don’t hesitate, even if you don’t notice all of the symptoms of alcohol poisoning at first. Your hasty contact of professionals may just end up saving a life.
How is Alcohol Poisoning Treated Once in the Hospital?
When someone has been poisoned, treatment is generally quite straightforward. Once the person is in the hospital, they will undergo constant monitoring until the alcohol has cleared from their system.
For mild alcohol poisoning, treatment is mostly supportive in nature. It may include:
- Intravenous fluid administration
- Checking lab values (blood tests, nutrition levels, etc.)
Severe alcohol poisoning treatment at hospital grounds may be a bit more intensive, however. If hands-on treatment is required, doctors may:
- Insert a tube into their mouth and windpipe to keep the airway open, remove blockages (like vomit), and aid with breathing
- Place the patient on a ventilator until they are no longer unconscious (a major sign of alcohol poisoning)
- Fit the person with an intravenous (IV) drip to keep fluids like blood sugar and vitamins at their proper levels
- Fit the person with a catheter to their bladder to drain urine directly and keep them from wetting themselves
Much of alcohol poisoning treatment is simply waiting for the alcohol to run its course through the individual’s system and checking their vitals while it does so. Despite what many people may have heard, alcohol poisoning treatment typically does not consist of stomach pumping either due to the high risk involved in the procedure.
However, if alcohol poisoning is left untreated, it can lead to a variety of incredibly dangerous symptoms that can end up being life threatening. As such, it’s absolutely vital that you contact emergency services if you notice any signs of alcohol poisoning.
How Long Does Alcohol Poisoning Last?
The half-life of alcohol is relatively short but it still takes at least 12 hours for most of the alcohol to clear from your system. The alcohol poisoning symptoms the next day are:
- Body aches and cramps
- Increased heart rate, lower blood pressure
- Chills or lower body temperature
If the person has been treated in a hospital for this condition, the doctors and nurses will have monitored these next day symptoms. They won’t be released from the hospital until they are in a safe and stable condition.
However, the symptoms of alcohol poisoning the next day carry over as one of the worst hangovers you will ever have. Alcohol is a poison and forcing your body to process that much ethyl alcohol at once will cause some significant discomfort the next day.
What Do You Do If You Found Out You Had Alcohol Poisoning?
If you’ve had alcohol poisoning before, you’re familiar with the thoughts of, “I’ll never do that again.” And most often people who get this condition don’t.
But if you’re an alcoholic or struggle with alcohol dependence, this may be the beginning of a dangerous time in your drinking. Especially if you drink alone, this condition can be a life-threatening event if you have no one there to help you.
That’s why it’s so important to know how to identify the signs of an alcoholic, both in yourself and in others. But due to the inherent denial that usually goes hand-in-hand with addiction, doing so can be incredibly tough.
To help you see through that denial and truly recognize the signs that you’re an alcoholic, you can take a short online alcoholism quiz or get in contact with a professional addiction facility.
Ultimately though, getting help for your addiction is the first step in avoiding the deadly symptoms of alcohol poisoning for good.
Getting Help: The Best Way to Avoid Future Alcohol Poisoning
If you think you might have a problem with you drinking, you can seek help from an addiction treatment center. During addiction treatment, you will learn how to live life without needing to rely upon alcohol or drugs to get you through it.
With the help of a supportive community of like-minded individuals along with a set of coping skills and relapse prevention methods, you can begin the path to a happy, healthy, sober life.