Debunking the Myth of the “Relaxed Drunk”

Alcohol is a major risk factor for accidental slips and falls (WOA60503) and, contrary to urban myth, the consumption of alcohol does not mitigate the severity of these incidents. The physiological state influenced by alcohol and anxiety creates a perfect storm for accidents. Since retiring from the Centre of Forensic Sciences, I have been involved in several civil cases in which the injured slip/trip/fall victim was suing the property owner where the accident occurred. Interestingly enough, these victims were found to have had a high BAC. [NOTE :The hospital serum alcohol results usually reported as ETHANOL or ETOH in mmol/L can be converted into a BAC of g/100mL by multiplying by approximately 0.004]. As this is such an important issue for personal injury lawyers and coroner’s investigations, I have devoted a whole section in my book – Wigmore on Alcohol – on the subject of slips and falls.

The relative risk (RR) of accidental personal injury increases with increasing BAC, as is shown in the table below (WOA60502).

This risk curve is often steeper in individuals where alcohol and anxiety coexist, as both conditions disrupt normal cognitive and motor functions.

There are numerous reasons why alcohol consumption, particularly when linked with anxiety, is a significant risk factor for accidental slips and falls:

• Increases body sway and postural imbalance (WOA60501, WOA60506): This physical instability is a direct effect that compromises balance.
• Impairs visual tracking for guiding stepping (WOA60507): Alcohol disrupts the coordination between the eyes and limbs necessary for safe movement.
• Impairs ability to assess risky or dangerous situations: This is a critical intersection where alcohol and anxiety converge. Anxiety can cause hyper-vigilance or paralyzing fear, while alcohol impairs judgement, leading to catastrophically poor decision-making in potentially hazardous environments.
• Potentiates orthostatic hypotension (WOA60508): A sudden drop in blood pressure upon standing can cause dizziness and blackouts, leading to a fall.
• Causes a slower and less appropriate reaction (WOA60503-5): Neurological delays prevent the body from reacting quickly enough to prevent a fall.
• Increases drowsiness (WOA60510): Sedation reduces overall awareness and reaction time.

The slower and less appropriate reactions to a fall causes a greater incidence of craniofacial injuries and a greater severity of injury as the protective response of extending out-outstretched hands to break the fall are inhibited by alcohol. This results in a lower incidence of limb injury but a greater force being transmitted to the head when it strikes the ground in intoxicated pedestrians (WOA60504). The myth of the relaxed drunk is dangerously inaccurate.

As professionals in the scientific and legal community, it behooves us to “share the knowledge” and attempt to dispel yet another urban myth – that drunk pedestrians suffer less injury when they fall because they are “relaxed”. We know this to be in error. Understanding the complex relationship between alcohol and anxiety is not just academic; it is essential for properly evaluating liability and the true extent of damages in any personal injury case involving intoxication.

*All the references cited may be found in WOA 2E in the appropriate section according to the number.”