Blackout Wednesday: What Happens the Night Before Thanksgiving

The Wednesday before Thanksgiving has become a night out in a lot of towns. College students are home, old friends are back in the area, and most people have Thursday off. Somewhere along the way the night picked up a nickname, Blackout Wednesday, that says a lot about how some people spend it.

This guide explains what an alcohol blackout is and why it happens, how much drinking counts as binge drinking, the signs of alcohol poisoning and what to do, what the numbers say about impaired driving in New Hampshire and Massachusetts, and what to do the next day, including how to bring it up with someone in your family.

What an alcohol blackout is

An alcohol-related blackout is a gap in a person's memory for events that happened while they were intoxicated. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), these gaps happen when a person drinks enough alcohol to temporarily block the transfer of memories from short-term to long-term storage, a process called memory consolidation, in a brain area called the hippocampus (NIAAA).

NIAAA describes two types:

• Fragmentary blackouts are the most common. Memories are spotty, with "islands" of memory separated by missing stretches of time. People sometimes call these grayouts or brownouts.
• En bloc blackouts are complete amnesia, often spanning hours. Memories of events do not form and typically cannot be recovered.

A blackout and passing out are two different things. Passing out means falling asleep or losing consciousness from drinking too much. During a blackout, the person is still awake, but their brain is not creating new memories. Depending on how much the person drank, a blackout can turn into passing out (NIAAA).

That is why a blackout is risky even when nothing seems wrong at the time. NIAAA notes that at high blood alcohol levels, impulse control, attention, judgment and decision-making are all significantly impaired, and blackouts come with a sharply increased risk of injuries and other harms.

What makes a blackout more likely

Blackouts can happen to anyone who drinks, at any age and with any amount of drinking experience. NIAAA says they are more likely when someone:

• drinks on an empty stomach
• drinks quickly
• binge drinks
• takes certain medications, such as those for sleep and anxiety

The first three all push blood alcohol concentration up fast. NIAAA adds that women tend to reach higher peak blood alcohol levels than men from each drink, and reach them sooner, because on average they weigh less and have less water in their bodies pound for pound. That helps explain why women appear to be at higher risk for blackouts (NIAAA).

How much drinking is binge drinking?

NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration to 0.08% or higher. For a typical adult, that means five or more drinks for men, or four or more for women, in about two hours. Drinking at twice those levels or more (10 or more drinks for men, 8 or more for women) is called high-intensity drinking (NIAAA).

Those counts use standard drinks. In the United States, NIAAA defines a standard drink as about 14 grams (0.6 fluid ounces) of pure alcohol, the amount in a 12-ounce regular beer at 5% alcohol, a 5-ounce glass of wine at 12%, or a 1.5-ounce shot of 40% distilled spirits. Serving size alone does not tell you how much alcohol is in a drink. NIAAA notes that a 12-ounce craft beer at 10% alcohol counts as two standard drinks (NIAAA), so a strong beer, a big pour of wine or a mixed drink with more than one shot counts as more than one.

Signs of alcohol poisoning, and what to do

An alcohol overdose, sometimes called alcohol poisoning, happens when there is so much alcohol in the bloodstream that the parts of the brain that control breathing, heart rate and temperature begin to shut down. NIAAA lists these critical signs (NIAAA):

• mental confusion or stupor
• difficulty staying conscious, or being unable to wake up
• vomiting
• seizures
• slow breathing, fewer than 8 breaths a minute
• irregular breathing, 10 seconds or more between breaths
• slow heart rate
• clammy skin
• dulled responses, such as no gag reflex
• extremely low body temperature, bluish skin or paleness

If you see these signs, call 911. Do not wait for every sign to appear, and remember that a person who has passed out can die. Blood alcohol can keep rising after someone stops drinking, even while they are unconscious, so assuming they will sleep it off is dangerous. Cold showers, hot coffee and walking do not reverse alcohol overdose and can make it worse.

While you wait for help, NIAAA advises:

• Stay with the person, because they can fall or choke.
• Keep them on the ground, sitting or partly upright, rather than in a chair.
• If they are vomiting, have them lean forward. If they are unconscious or lying down, roll them onto one side with an ear toward the ground.
• Be ready to tell responders what and how much they drank, any other drugs they took, and any health information you know.

Mixing alcohol with opioids or with sleep and anxiety medicines raises the risk of overdose, even with moderate drinking (NIAAA). If opioids might be involved, naloxone is the standard treatment for opioid overdose, and since 2023, when the FDA approved the first over-the-counter naloxone nasal spray, it can be bought without a prescription (FDA). Call 911 first, then give naloxone if you have it.

NIAAA also notes that teenagers and young adults may be at particular risk for alcohol overdose, because they often binge drink or drink at high intensity. That matters on a night when many college students are home.

The drive home, by the numbers

The National Highway Traffic Safety Administration (NHTSA) considers a driver alcohol-impaired at a blood alcohol concentration of 0.08 or higher, and counts a death as alcohol-impaired driving when at least one driver in the crash was at that level. In 2024, 11,904 people died in those crashes nationally, 30% of all traffic deaths, or about one every 44 minutes. The share of drivers in fatal crashes who were alcohol-impaired was three times higher at night than during the day, 31% compared with 10% (NHTSA).

In New Hampshire and Massachusetts, the 2024 counts were (NHTSA):

• New Hampshire: 39 alcohol-impaired-driving deaths out of 133 traffic deaths, or 29%, up from 34 in 2023.
• Massachusetts: 100 alcohol-impaired-driving deaths out of 363 traffic deaths, or 27%, down from 112 in 2023.

NHTSA also found that drivers aged 21 to 24 had the highest share of alcohol impairment among drivers in fatal crashes in 2024, at 28% (NHTSA). Settle the ride home before the first drink: a designated driver who is not drinking, a ride service, or a place to stay the night.

The risk does not end at bedtime. NIAAA notes that during a hangover, attention, decision-making and muscle coordination can all be impaired, which affects driving (NIAAA). Keep that in mind before the Thanksgiving morning drive.

The morning after

If you wake up on Thanksgiving with a hangover and gaps in your memory, a few things help.

Take care of your body first. Hangover symptoms include fatigue, thirst, headache, muscle aches, nausea, sensitivity to light and sound, anxiety and irritability. NIAAA says they peak when blood alcohol returns to about zero and can last 24 hours or longer. People may fall asleep faster after drinking, but their sleep is broken and they tend to wake up earlier, which adds to the fatigue. No remedy has been proven to work, and only time helps. A drink in the morning may dull some symptoms for a while, but it can prolong the hangover. Be careful with pain relievers: acetaminophen combined with alcohol can be toxic to the liver, and aspirin and ibuprofen can irritate the stomach (NIAAA).

Fill in the gaps carefully. Ask someone you trust what happened, rather than guessing. Check that everyone you were with got home, and look at your messages before you send new ones.

Get care if you need it. If you were hurt, hit your head, or think something happened that you did not agree to, you can get medical care even if you do not remember the details.

When a blackout is a warning sign

NIAAA is clear that blackouts are not necessarily a sign of alcohol use disorder. It is just as clear that experiencing even one is a reason for concern, and should prompt a person to think about their relationship with alcohol and talk to their health care provider. Research among college students and young adults has found that the more often someone blacks out, the more likely they are to face other problems from drinking, such as missing work or school, getting injured, ending up in the emergency room, or being arrested (NIAAA).

NIAAA lists eleven questions about the past year that a health care provider might ask to assess alcohol use disorder. A few of them (NIAAA):

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn't?
• Continued to drink even though it was making you feel depressed or anxious, or after having had an alcohol-related memory blackout?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt, such as driving?
• Had to drink much more than you once did to get the effect you want?

Two or three symptoms point to mild alcohol use disorder, four or five to moderate, and six or more to severe. NIAAA says the more symptoms, the more urgent the need for change. Our self-check guide, Am I an alcoholic?, walks through all eleven.

If the answers worry you, help does not have to wait until after the holidays. Alcohol addiction treatment at Clear Steps Recovery includes evening schedules that meet Monday through Thursday, 6 to 9 pm: Evening IOP in Londonderry, NH and Evening Treatment in Needham, MA. Our guide to starting treatment now or after the holidays covers the timing question in more detail.

Talking with a family member afterward

If someone you love blacked out, got into trouble, or scared you on Wednesday night, you may want to say something on Thursday. A few things tend to help the conversation go better:

• Pick the moment. Wait until they are sober and rested, and talk in private, away from the holiday table.
• Start with care, then specifics. Describe what you saw and how it affected you, using your own words and feelings rather than labels.
• Ask, then listen. Ask how they feel about what happened. People are often embarrassed or defensive the day after, and pushing for a promise in that moment rarely helps.
• Offer one next step. A visit to their doctor, a screening, or a phone call you make together is easier to accept than a big demand.

NIAAA's advice for family members is realistic. Your support can make a big difference, but your loved one is responsible for managing their own drinking, changing long-standing patterns takes time and repeated effort, and it is important to take care of yourself too, including through support groups for families (NIAAA). Our family support program explains CRAFT, an approach that teaches families how to encourage a loved one toward treatment.

Where to get help in New Hampshire and Massachusetts

• Emergency: call 911 for signs of alcohol poisoning or any immediate danger.
• New Hampshire: dial 2-1-1 to reach The Doorway, which helps people get into every level of treatment.
• Massachusetts: call or text the Massachusetts Substance Use Helpline at (800) 327-5050, free and open 24/7 (Massachusetts DPH).
• Anywhere in the U.S.: SAMHSA's National Helpline, 1-800-662-4357, free and confidential.
• Clear Steps Recovery: (603) 769-8981, answered 24/7, for an assessment in Londonderry or Needham.