Blackout Drunk: A Selection from Malcolm Gladwell’s Talking to Strangers (2019)

“Under certain very particular circumstances—especially if you drink a lot of alcohol very quickly—something happens. Alcohol hits the hippocampus—small, sausage-like regions on each side of the brain that are responsible for forming memories about our lives. At a blood-alcohol level of roughly 0.08—the legal level of intoxication—the hippocampus starts to struggle. When you wake up the morning after a cocktail party and remember meeting someone but cannot for the life of you remember their name or the story they told you, that’s because the two shots of whiskey you drank in quick succession reached your hippocampus. Drink a little more and the gaps get larger—to the point where maybe you remember pieces of the evening but other details can be summoned only with the greatest difficulty.

Aaron White, at the National Institutes of Health outside Washington, DC, is one of the world’s leading experts on blackouts, and he says that there is no particular logic to which bits get remembered and which don’t. ‘Emotional salience doesn’t seem to have an impact on the likelihood that your hippocampus records something,’ he says. ‘What that means is you might, as a female, go to a party and you might remember having a drink downstairs, but you don’t remember getting raped. But then you do remember getting in the taxi.’ At the next level—roughly around a blood-alcohol level of 0.15—the hippocampus simply shuts down entirely. . . .

A thirty-nine-year-old salesman awoke in a strange hotel room. He had a mild hangover but otherwise felt normal. His clothes were hanging in the closet; he was clean-shaven. He dressed and went down to the lobby. He learned from the clerk that he was in Las Vegas and that he had checked in two days previously. It had been obvious that he had been drinking, the clerk said, but he had not seemed very drunk. The date was Saturday the 14th. His last recollection was of sitting in a St. Louis bar on Monday the 9th. He had been drinking all day and was drunk, but could remember everything perfectly until about 3 p.m., when ‘like a curtain dropping,’ his memory went blank. It remained blank for approximately five days. Three years later, it was still blank. He was so frightened by the experience that he abstained from alcohol for two years.

The salesman had left the bar in St. Louis, gone to the airport, bought a plane ticket, flown to Las Vegas, found a hotel, checked in, hung up his suit, shaved, and apparently functioned perfectly well in the world, all while in blackout mode. That’s the way blackouts work. At or around the 0.15 mark, the hippocampus shuts down and memories stop forming, but it is entirely possible that the frontal lobes, cerebellum, and amygdala of that same drinker—at the same time—can continue to function more or less normally. ‘You can do anything in a blackout that you can do when you’re drunk,’ White said. You’re just not going to remember it. That could be ordering stuff on Amazon. People tell me this all the time. . . . People can do very complicated things. Buy tickets, travel, all kinds of things, and not remember. . . .

For physiological reasons, the binge-drinking trend has put women at greatly increased risk for blackouts. If an American male of average weight has eight drinks over four hours—which would make him a moderate drinker at a typical frat party—he would end up with a blood-alcohol reading of 0.107. That’s too drunk to drive, but well below the 0.15 level typically associated with blackouts. If a woman of average weight has eight drinks over four hours, by contrast, she’s at a blood-alcohol level of 0.173. She’s blacked out.

It gets worse. Women are also increasingly drinking wine and spirits, which raise blood-alcohol levels much faster than beer. ‘Women are also more likely to skip meals when they drink than men,’ White says. Having a meal in your stomach when you drink reduces your peak BAC [blood-alcohol concentration] by about a third. In other words, if you drink on an empty stomach you’re going to reach a much higher BAC and you’re going to do it much more quickly, and if you’re drinking spirits and wine while you’re drinking on an empty stomach, again higher BAC much more quickly. And if you’re a woman, less body water yields higher BAC much more quickly.

And what is the consequence of being blacked out? It means that women are put in a position of vulnerability. Our memory, in any interaction with a stranger, is our first line of defense. We talk to someone at a party for half an hour and weigh what we learned. We use our memory to make sense of who the other person is. We collect things they’ve told us, and done, and those shape our response. That is not an error-free exercise in the best of times. But it is a necessary exercise, particularly if the issue at hand is whether you are going to go home with the person. Yet if you can’t remember anything you’ve just learned, you are necessarily not making the same-quality decision you would have if your hippocampus were still working. You have ceded control of the situation.”—Malcolm Gladwell, Talking to Strangers: What We Should Know about the People We Don’t Know (2019)