Risky Business – How to Spot & Deal with Alcohol-Drug Interactions

Cold and flu season is upon us. Pharmacies and doctors’ offices alike are filled with people picking up antibiotic prescriptions and over-the-counter products to fight their symptoms. However, a cough or cold won’t always stop someone from going out with friends or family for dinner and drinks. Unfortunately, mixing alcohol and medications can be harmful and dangerous.

Complications caused by drinking-and-drug interactions sent 524,000 Americans to hospital emergency rooms in 2008 alone for treatment (View Source). As a server or bartender it’s not only important to be aware of the risks associated with mixing drugs and alcohol, but also how to spot this risky behavior in your bar and restaurant patrons.

Medications used to treat allergies such as Benadryl and other antihistamines can cause drowsiness, clumsiness or lightheadedness. One should be aware that mixing antihistamines with a few drinks can greatly increase these effects and make it dangerous for driving and may cause the patron to show signs of intoxication much quicker, which could result in disturbances, undesirable behavior or fights.

Over-the-counter (OTC) drugs aren’t the only drugs that can have risky interactions with alcohol. The same holds true for a multitude of prescription drugs including antibiotics, anticoagulants and antidepressants. Effects can range from headache and vomiting to lasting results such as liver damage and risk of overdose.

As a bartender or server, there are a few easy steps you can take in your establishment to help protect against potentially disastrous outcomes associated with drug and alcohol interactions. Every medicine is different, and while only a doctor or pharmacist can definitively gauge the risks and possible interactions in any one individual, there are certain things you should watch for to spot any patrons who may be dangerously mixing medications and alcohol.

  • Keep an eye out for any patrons who are displaying cold symptoms such as coughing, sneezing, or watery eyes. If you notice someone that sounds congested, you can approach them in a conversational way to find out if they are taking something for their cold or flu. You might say something like, “It sounds like you are feeling under the weather. Everyone at my house has been fighting something lately. Have you been sick for a while?” Or maybe, “So, it’s just starting, huh? We’ve been going through the medicine at our house to find something that works. Have you been taking anything for your symptoms?”
  • If the patron is willing to engage in conversation, you could casually remind them that some cough and cold medicines can interact with alcohol, and that they should read the packaging on their medicine to check for any warnings. One example would be, “How is that Dayquil working for you? I might try that next time I get sick, does the packaging list any side effects to mixing it with alcohol? I sometimes have a glass or two of wine with dinner and like to make sure there is no risk in mixing the two.” This may spur the patron to think about how their own alcohol intake can be effected by their medication – sometimes a friendly reminder is all it takes.
  • While every drug is different, warning labels on many common OTC medications indicate that side effects can occur if one ingests 2-3 alcoholic beverages a day with medicines. As such, watch your customers and keep track of any excessive drinking (in this case, more than one or two drinks) if you know or suspect they are mixing. You should encourage your customer to eat, bring them a glass of water with their alcoholic beverages, and maybe suggest a low or no-alcoholic beverage instead.
  • If you suspect that your patron may have mixed medications to the point of concern or possible interaction, you should treat them just as you would with someone who has had too much to drink. Alert your manager or supervisor so that they can intervene if necessary.
  • If your customer moves into the ‘danger zone’ and you need to stop alcohol service, remain calm and express concern for their safety when letting them know you need to cut them off.
  • Offer to call them a cab if they appear to be drowsy, unfocused or clumsy in their movements. A person in this state is in no condition to get behind the wheel of a car. Read more about you right and obligation given a certain set of circumstances to serve/sell or not to serve/sell in our blog post, “Are You Committed to Public Safety?”

Alcohol and drug interactions are a risky business that can easily be avoided with a little bit of knowledge and forward thinking. Protect yourself by using common sense and reading labels the next time you drink, and share that message with those around you.


What situations have caused you alcohol-drug interactions have you witnessed and how did you intervene?

© 2011 National Hospitality Institute®, TAM® of Nevada

Are You Prepared for the Holiday Blues?

During November, December and January, the holiday blues can affect many people causing them to self-medicate or turn to drugs and alcohol for relief. The odds of having drugs in your establishment are not only greater during the holidays, but also with the rise in non-medical use of prescription drugs. If you work in or run an establishment that serves or sells alcoholic beverages for on-premise or off-premise consumption, you should always take precautions to safeguard your company, yourself and your community. 

As you know, drugs bring unwanted trouble into an establishment, such as: negative press/media, violence, fights, overdoses, higher levels of intoxication, etc. Because the holiday months are peak periods for drug and alcohol use, you should pay even more attention and observe what is going on around you.

Illicit drug use is widespread. Here are some national and Nevada specific stats that are alarming and we’ve included links to pictures of these drugs so that you can identify them when you see them.

  • In 2009, an estimated 21.8 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. [2009 National Survey on Drug Use and Health (NSDUH)] 
  • Nevada ranks 4th in the nation in non-medical use of prescription pain relievers in people ages 18 to 25. [2006 National Survey on Drug Use and Health (NSDUH)]
  • The most commonly misused pain relievers are: Vicodin (acetaminophen and hydrocodone), OxyContin (oxycodone), Tylenol 3 (acetaminophen and codeine phosphate), and Percocet (oxycodone and acetaminophen). 
  • In the years 2002 through 2006, Nevada ranked highest in the nation aged 12 or older reporting methamphetamine use in the past year. [2006 National Survey on Drug Use and Health (NSDUH)] 
  • Marijuana was used by 76.6 percent of current illicit drug users and was the only drug used by 58.0 percent of them. [2009 National Survey on Drug Use and Health (NSDUH)] 
  • In August 2007, an NSDUH report on worker substance use indicated that 28% of full time workers (age 18 to 64) in the accommodations and food services, arts and entertainment industry had used illicit drugs in the past month.  [2007 National Survey on Drug Use and Health (NSDUH)] 

So, how can you keep drugs out without having to search and frisk everyone who comes through your doors?

  • Partner with local authorities and train your staff—Local law enforcement are your partners and can help you provide training to your employees.
  • Communicate expectations—Make sure that your new employee orientation and employee handbook covers ways to handle drugs in your establishment. Clearly state that drug use is not tolerated and give employees information about who to notify when someone (whether a guest or a colleague) is using illegal drugs on the establishment’s property.
  • Increase your security staff—Your security staff should be present, visible to your guests and well-trained in detecting the behaviors and indications of drug use.
  • Estimate BAC—Remember to calculate the BAC (Blood Alcohol Concentration) of your guests. If you notice that someone is showing the effects of the alcohol sooner than you expected, then you should be cautious as they may be taking prescription pain relievers or using some other substance.
  • Encourage reporting of suspicious behavior—You need the eyes and ears of your employees if you are going to keep drugs out of your establishment. Heighten their awareness and give them observation tips so that they are monitoring their surroundings and reporting suspicious or unusual behavior to security or management. Don’t forget to reward your employees for reporting concerns. What gets rewarded, gets repeated.
  • Post information about illicit drug use at your establishment—Hang posters about drug use and abuse and your company’s policies for illicit drug use at your establishment in restrooms and employee break rooms. 

What measures do you take to keep drugs out of your establishment?





© 2010 National Hospitality Institute®, TAM® of Nevada

Big Holiday Parties Are Upon Us!

Everyone is getting revved up for the holiday season and big holiday parties! What does that mean to you as a server, seller, security officer, operator or establishment owner?  You need to be prepared.

  1. Servers, sellers , managers and owners – Make sure your alcohol education card (TAM Card®) is current and in your possession. If your TAM Card® has expired, make sure you retake the training and get your new card before the busiest part of the holiday season is here.
  2. Servers — Be on your toes and observe those in your establishment. Watch how much you are serving and how often. Do the math and keep track of estimated Blood Alcohol Concentration (BAC) levels. Be sure that your guests are getting enough food and water while they are enjoying their alcoholic beverages. If one of the guests in the group you are serving becomes intoxicated, make sure that they have a safe ride home. Designated driver services and taxis can help get people home safely and without risk to themselves or others.
  3. Sellers — When you have customers coming into your retail store to purchase alcohol, make sure that they are not already intoxicated when you sell to them. Also, inform your employees to beware of potential third party sales and keep an eye out for any minors that are hanging out in your parking lot and approaching patrons about buying them liquor.
  4. Security Officers — Big party nights equal higher energy levels, increased levels of excitement and overindulgence. Be visible and interact with your establishment’s guests to defuse potential issues. Be extra diligent when checking IDs to ensure that you keep the underage out of your 21 and over establishment!
  5. Operators and Owners — Safeguard your establishments by letting your staff know your expectations for properly handling certain situations, like when they need to cut people off and what to do with minors who are trying to enter your establishment. With extra law enforcement out and about over the holidays, you want to make sure that all your servers, sellers and security staff have their alcohol education cards (TAM Cards®) on them at all times.

Guests are also responsible for keeping themselves in check. However, we all know that alcohol lowers inhibitions and affects good judgment, which means there are times when you need to step in and take control of certain situations.

Remember, hospitality is all about creating a fun experience and maintaining a safe environment for your guests and patrons. To achieve these goals, you may have to cut someone off or refuse to serve or sell to a guest because their behavior is negatively affecting the experience for others.

We would love to hear from you! What recommendations do you have for keeping the holidays fun and safe for your guests this season?

© 2010 National Hospitality Institute®, TAM® of Nevada

Beware of Binge Drinkers

CNN.com recently reported an uptick in binge drinking. Some speculate that it may be caused by the jobless rate and economic woes. Binge drinking can result in alcohol poisoning, which occurs when a lot of alcohol is consumed in a short period of time. With Vegas being the place where people go to let loose and go a little crazy, binge drinking can be a big problem. If you are serving someone who is college-aged or if you find out that your customer may have been playing drinking games or front-loading before going out, then take precautions when serving. Think about how much more to serve and how quickly. You might also want to suggest food or water to help slow down the rate of consumption and absorption.

Why should you worry about binge drinkers and watch for those who may be headed down the path of alcohol poisoning?

  1. Someone who drinks a fatal dose of alcohol will eventually stop breathing.
  2. People, who survive an alcohol overdose, can suffer irreversible brain damage.
  3. A person’s blood alcohol concentration can continue to rise even while unconscious. Even after someone stops drinking, alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body.
  4. A person who appears to be sleeping it off may be in real danger.

Critical signs of alcohol poisoning include confusion, passing out and vomiting. The Mayo Clinic offers some additional symptoms and gives suggestions for how to help someone that may be suffering from alcohol poisoning.

Have you ever had a situation where you had to respond to alcohol poisoning? What advice would you give to your colleagues for handling binge drinkers and alcohol poisoning?

© 2010 National Hospitality Institute®, TAM® of Nevada