The worst that some people expect from a night of binge drinking is a blackout and bad hangover. But what many don't know is that they can die from alcohol poisoning.

One cause of fatal alcohol poisoning is the view of binge drinking as a rite of passage. For example, while pledging to a fraternity at the Massachusetts Institute of Technology, a freshman named Scott Krueger died after his blood alcohol level rose to 0.41 percent. That was the equivalent of about 16 shots in one hour for Krueger.

Binge drinking is common on college campuses. In 2001, the College Alcohol Study from the Harvard School of Public Health found that 44 percent of college students classified themselves as binge drinkers (drinking at least four drinks in a row for women and five for men at least once in the last two weeks). About one in five said they were frequent bingers--bingeing at least three times in the past two weeks. These findings were almost identical to results from companion surveys in 1993, 1997 and 1999.

Alcohol poisoning quickly affects bodily functions that sustain life. As a depressant, alcohol affects breathing, heart rate and blood pressure. When people drink too much in a short time, the areas of the brain that control these functions can be sedated--literally put to sleep. If that happens, people can die because breathing mechanisms shut down or people choke on their own vomit.

"It is peak blood alcohol concentration which leads to respiratory arrest or aspiration of vomit and death," said Alex Wagenaar, director of the Alcohol Epidemiology Program at the University of Minnesota School of Public Health in Minneapolis. In turn, many factors affect peak blood alcohol concentration. Examples are gender, weight, percentage of body fat, and pace of drinking.

In a 1999 review of research on alcohol-impaired drivers, Ralph Hingson and his coauthors from the Boston University School of Public Health detail the influence of such factors.

For example, a man who weighs 170 pounds and consumes four drinks on an empty stomach would reach a blood alcohol concentration of .08 percent in one hour. However, a 137-pound woman drinking on an empty stomach would only need to consume three drinks in one hour to reach the same blood alcohol concentration.

To put these figures into perspective, remember that the legal limit for drivers in most states is a blood alcohol concentration of .10 percent. (Seventeen states have lowered that limit to .08 percent.) And, even moderate drinking--typically defined as one drink per day for women and two drinks per day for men--can impair the ability to drive.

We can respond to the problem of binge drinking on two levels. One is knowing appropriate emergency procedures. Signs and symptoms of alcohol poisoning include:

• Unconsciousness or semi-consciousness.
• Slow breathing--eight breaths or less per minute, or lapses of more than eight seconds between breaths.
• Cold, clammy, pale or bluish skin.
• A strong odor of alcohol.

If you encounter someone with these signs or symptoms, call 911. Then gently turn this person on his or her side. This helps to prevent choking after vomiting.

A second response is to prevent binge drinking. We can support campus policies that discourage drinking, such as providing alcohol-free residence halls and restricting pledging activities by fraternities and sororities. We can also reinforce abstinence from alcohol as the norm. The fact is that most college students drink moderately or not at all.

The National Council on Alcoholism and Drug Dependence (NCADD) has published a pamphlet dedicated to preventing alcohol poisoning titled "Drinking Too Much Too Fast Can Kill You." To get a copy, contact NCADD at (212) 269-7797 or visit its web site at www.ncadd.org/pubs/index.html.

--Published October 21, 2002