Anatomy of a Blackout

“We’re all looking for ways to be close at a distance. Alcohol bridged the gap for me.”

So writes Sarah Hepola, in her new book Blackout: Remembering the Things I Drank to Forget. It’s a memoir of her alcoholism—specifically her propensity to drink to the point of oblivion—but also an empathetic dissection of addiction and American drinking culture, and the blurry lines between the two.

Hepola conveys both the horror in the mysteries left after a night smudged dark by drinking, and the draw of overdrinking that kept her carving out her memory with alcohol. She writes of her perfectionism, and how alcohol freed her from it. How it gave her the courage to ask for what she wanted. She wonders of her alcoholism and her life’s other problems, “What was the source of my sadness, and what was its collateral damage?” Looking for connection through the brown telescope of a beer (or two or 10) is a gamble. It can work. In moderation it often does. Or it can drive people away.

In a way, she’s just following the standard script, if taking it too far. So often, alcohol is how we relate, how we celebrate. There’s something about a night you know is special that makes you want to keep toasting it. Toast it too much, of course, and you won’t remember the thing you were trying to cherish.

* * *

The nadir of Hepola’s book happens in Paris, while she’s on a magazine assignment. She comes to in the middle of a blackout, having sex with a stranger, leaves the room, then goes on a wild hunt for her purse, which it turns out she left in her own room. There’s also a part where a sleazy hotel concierge takes advantage of her after she asks him for help.

“As I lay in my hotel bed, covers pulled up to my neck, I felt the gratitude of a woman who knows, finally, she is done,” Hepola writes of that night. “But I drank on the plane ride home. And I drank for five more years.”

Blackouts were once thought to be the domain of alcoholics alone, a risk factor that amounted to a sort of input/output equation: If blackout, then alcoholic. For that we have E.M. Jellinek to thank—the “father of the modern disease model of alcoholism,” according to Aaron White, the senior advisor to the director at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). In a survey of Alcoholics Anonymous members, Jellinek found that many reported having frequently blacked out, and a link between blackouts and alcoholism became entrenched. Wrongly so, White says. Blackouts are commonly seen in alcoholics, in part because people can build up a tolerance to some of the other negative consequences of alcohol—loss of balance, for instance—but not so much to its effects on memory. Still, White says, “anyone can black out at least once, if you drink in the right way—or the wrong way.”

In a survey he did at Duke University, 51 percent of students who reported ever having consumed any alcohol had experienced at least one blackout. But there have been no more comprehensive population surveys on how common they are. “Blackouts have basically been ignored as a subject of study,” White says. “We don’t have any national data.”

A blackout can mean the total erasure of an entire chunk of time from a person’s memory, an occurrence known as an en bloc blackout. Or they might just forget bits and pieces, in a fragmentary blackout, or a brownout, as some call it. These are more common, White says. Either way, the memories are gone because they were never stored in the first place.

Even during a blackout, a drinker’s short-term memory is generally fine. She can carry on a conversation, though, like a human goldfish, she may quickly forget things and repeat herself. It’s episodic memory where alcohol gums up the works. These are the memories of events—what happened, but also where, when, and with whom. Alcohol impairs the encoding of these contextual memories, which happens in the hippocampus. “Your brain is sending information to the hippocampus, and it falls into a void,” White says. “The hippocampus doesn’t tie it together, or it skips a little bit.” After a fragmentary blackout, being reminded of some of that context might help someone remember what happened. After an en bloc blackout, one will need to rely on the memory of others.

“En bloc blackouts are a specialty of mine,” Hepola writes.

How quickly one’s blood alcohol content rises is the biggest risk factor for a blackout. That means things that make you drunker faster—drinking liquor or drinking on an empty stomach—make you more likely to black out. You’re also more likely to black out if you’re a woman.

* * *

“Books about alcoholism often talk about the ‘hidden drinking’ of women. That’s been the line for decades. Bottles stashed behind the potted plant. Sips taken with shaking hands when no one is looking, because ‘society looks down on women who drink,’” Hepola writes. “I looked up to women who drink. My heart belonged to the defiant ones, the cigarette smokers, the pants wearers, the ones who gave a stiff arm to history.”

The women who drink are not so hidden anymore. Women’s drinking is not only socially acceptable now, it’s often celebrated. Hepola points out the preponderance of “bumbling, blotto heroines” like Carrie Bradshaw and Bridget Jones who started saturating pop culture in the 2000s. In the bull run of American alcoholic excess, the girls now run with the boys. But even if a man and a woman of similar size matched each other shot for shot, the woman would be more likely to black out. Women have less alcohol dehydrogenase in their guts—an enzyme that helps break down alcohol. And they have less free-floating water in their bodies. “That means that it’s like pouring a shot into a six-ounce glass of Coke rather than a 12-ounce glass,” White says.

In general, the gap between men and women is closing when it comes to alcohol use—and not, White says, because women are just drinking more. “Men and women have started to drink more like each other,” he says. Though according to the Centers for Disease Control and Prevention men still binge-drink twice as much as women, in 2013 the CDC declared women’s binge-drinking an “under-recognized problem,” with 14 million women in the U.S. binging three times a month. It is most common in women 18 to 34, and in high-school aged girls. In general, drinking in young people has decreased somewhat in the past decade, White says, but “what’s happening is those who do drink, more of them are going to great extremes … the intensity is going up, and I would guess prevalence of blackouts is going up too. We just don’t measure them.”

The NIAAA’s definition of binge drinking starts at a blood-alcohol concentration of 0.08. Blackouts seem to start at a BAC of around .20. “We think about 50 percent of people will die at a .35,” White says. “So you’re getting up there.”

* * *

There’s a standard script for the role of alcohol in a young American’s life. First, it’s forbidden fruit. Then, a rite of passage, a badge of honor. In college and young adulthood it can feel like a requirement (if one often embraced) for social interaction. Then, hopefully, it becomes a normal, manageable part of the landscape. Unless, of course, it doesn’t.

For Hepola, it didn’t. But when everybody’s binge-drinking, how do you know who’s really addicted? “Any heavy drinker understands the constant redistricting and gerrymandering of what constitutes an actual ‘problem,’” Hepola writes, adding later in the book, “alcoholism is something you must know in your gut.”

“We live in a culture where it’s confusing to figure out whether your relationship with alcohol is healthy or unhealthy. Particularly if you’re young,” White says. “You turn on the TV and you won’t see a commercial that cautions you. We see alcohol promoted in a way that suggests there are no ill effects, that it’s just fun, and of course everybody drinks. And it’s not consistent with reality. We don’t do a good enough job of helping people recognize when they may cross a line.”

Perhaps that contributes to the fact that people in the U.S. who do have drinking problems rarely get help. A recent National Institutes of Health survey found that only 20 percent of adults who met the criteria for alcohol use disorder at some point in their lives ever sought treatment.

Even the dangers of drinking get weirdly reclaimed. A blacked-out night and a confused morning after become funny stories for the next happy hour, tales of youthful adventure rather than near-misses. After one blackout, Hepola writes of texting a friend, “I had sex with some random British dude and woke up on a leaking air mattress.” Her friend replies “Congratulations!”

Someone once told me, “Everything’s either a good time or a good story.” A blackout is neither. And yet a life with holes in it is still seen, in some circles, as exciting. Older people fear cognitive decline more than cancer, while the young spend their nights punching unnecessary holes in their memories.

“What we consider to be consequences of drinking aren’t always consequences to the drinkers,” White says. “[A blackout] can be considered a barometer for how drunk you got, so therefore you must have had a lot more fun.”

There’s a confusion here of what adventure is. Alcohol can fuel a sense of adventure, and make you feel like anything could happen. But a blackout is the reverse. Anything could have happened. “After a blackout, I would torture myself thinking of the awful things I might have said or done,” Hepola writes. “My mind became an endless loop of what scared me the most.”

She is surprised, when she finally quits alcohol for good, that life isn’t instantly better once she can remember all of it.

“I’d spent years losing time, nights gone in a finger-snap, but now I found myself with way too much time,” she writes. “I needed to catapult into a sunnier future, or I needed to slink back to a familiar past, but what I could not bear was the slow and aching present… The blackouts were horrible. It was hideous to let those nights slide into a crack in the ground. But even scarier was to take responsibility for the mess I’d made. Even scarier was to remember your own life.”

* * *

Without alcohol, Hepola rediscovers the introversion she drowned for so many years. On a lunch date, she apologizes to a friend—“Sorry I’m not very interesting.” That people equate “drinking” with “being interesting” makes it even easier to understand the temptation to overindulge for social reasons.

“Drinking is the center of weddings, holidays, birthdays, office parties, funerals, lavish trips to exotic locales,” Hepola writes. “But drinking is also the center of everyday life. ‘Let’s get a drink,’ we say to each other, when what we mean is ‘Let’s spend time together.’ It’s almost as if, in absence of alcohol, we have no idea what to do.”

Alcohol is a balm on the awkwardness of first dates, work functions, and even gatherings with friends, if you’re not quite a textbook extrovert. Throwing a few back quickly might jack up your BAC and put you at risk for blacking out, but before that, it might help you connect with other people. That’s the aspect of alcohol played up in media and in advertisements, and often by drinkers as well.

“That’s what I wanted,” Hepola writes. “An honest conversation … a conversation in which those superficial details faded away and we dared to tell the truth about our own suffering. This was the closeness I had always been drinking toward. I drank for other reasons, so many other reasons, but closeness was the richest reward.”

It’s just that sometimes, in that calculation—trading impairment for connection—that closeness will be forgotten.