In the midst of the Covid-9 Pandemic, several airlines including Southwest and American Airlines decided to stop serving alcoholic beverages on their planes until further notice. These policy changes came on the heels of a spike in unruly passengers, some of whom even assaulted flight attendants and other airline staff. Airlines felt that if they could keep their passengers sober, then hopefully they would be more docile in the air. Now, alcoholic beverages are reemerging as an in-flight offering, so what will come next? Airlines must be nervous that passengers will once again become intoxicated liabilities. It is commonly held that people get drunker on fewer drinks thanks to the altitude of flight. This, however, is more folk belief than fact, and now might be an appropriate time to reexamine the assumption. So, do we actually get drunker thanks to altitude on a plane?
Many flyers will indulge in a drink or two on a flight. Alcohol calms the nerves, passes the time, and brings the sophistication of a 187ml wine bottle to a coach class experience. Anecdotally, it may seem true that drinkers get drunker in planes than at local, sea-level pubs, but what are the medical realities? After all, being in a plane changes a lot about getting drunk. Inevitable bathroom runs occur in incommodious closets, muffled jet engines hum for hours, and strangers who want nothing to do with us abound (never mind the fact we sit the entire time). The experience of intoxication is environmental, and a plane is a very harsh environment. Do we actually get drunker at altitude, or do we just feel like it because we are moving 500 miles per hour at 30,000 feet?
The reality is that very few scholarly studies have focused on this specific topic. Altogether, there are only a handful of reports that delve into the intricacies of altitude and its effects on alcoholic intoxication. The studies that do exist sometimes disagree with each other and come to a range of different conclusions. Since the 1960s, the Federal Aviation Administration (FAA) has funded research on several dozen studies focused on alcohol and aviation. Only a handful of them attempted to measure the specific interplay of altitude and intoxication.
One of the earliest studies on the topic, Blood alcohol concentrations as affected by combinations of alcoholic beverage dosages and altitudes, published in 1970, split its subjects into 3 environmental groups and dosed them with alcohol at 2 distinct concentrations. One group breathed ambient air at a simulated altitude of 12,000 feet, another had a breathing mask at simulated 12,000 feet, and the third had a breathing mask at simulated 20,000 feet. These groups were given a bourbon and coke of either 15.8% or 7.9% alcohol by volume. The subjects enjoyed their beverage for 30 minutes, and then had their blood oxygen and blood alcohol content measured over 3 hours. The study concluded that “a significant difference existed when considering the effect of cabin condition on blood alcohol concentration for the high alcohol dose”. The low-dose subjects, however, were consistent across altitude.
This conclusion seems fairly straightforward–altitude exacerbates physical levels of intoxication if alcohol is consumed in high enough quantities–but subsequent studies have cast some doubt on it. A 1985 study showed that response potential was impaired by alcohol, but did not differ with altitude as the study was conducted at two locations with altitudes of 5,280 and 14,264 feet respectively. Later, a 1988 FAA study on alcohol and pilot performance once again noted that inebriation impaired performance, but “no significant effects on performance were obtained due to altitude or to the interaction of altitude with alcohol.” The same authors also noted in a separate study that breathalyzer scores did not indicate any synergies between altitude and alcohol intoxication. The evidence for a change in blood alcohol content with altitude is hardly conclusive.
Since the first round of FAA studies conducted in the seventies and eighties, the question has not been reexamined in depth. Perhaps government funding considers this a moot point—pilots shouldn’t be drunk in the first place, why measure if it matters how high they are drunk? While we may not have solid answers as to if the myth is true or not, we can still ask why it would even be true in the first place?
Some have suggested that we feel drunker at high altitude because both alcohol and low ambient pressure dehydrate the human body. Airplanes have humidity levels under 20%, and the booze we drink is a diuretic, encouraging urination. While this may indeed magnify dehydration, it is unlikely that this influences blood alcohol content significantly. Others have said that human metabolism slows down at higher altitudes. Thus, the body processes alcohol at a slower rate, and it stays in the blood longer. This also seems untrue; even the 1970 study which concluded that high doses at high altitudes produced higher BAC, showed that, after peaking higher, the body then metabolized the alcohol at the usual rate. A somewhat more likely possibility is that low ambient pressure helps air in our bodies expand, effectively increasing the ability of the stomach and intestine to absorb alcohol. While some of these may explain the physiological aspects of intoxication, our perceptions of drunkenness may be explained otherwise.
The environment within a plane, regardless of altitude, likely impacts how we feel, particularly when we drink. Some evidence points to synergies between the experience of G force and alcoholic intoxication; mental performance decreases when the two are combined. The movements of the plane, too, help to disorient us, nauseate us, and keep our eyes moving. When we get up from our seat after 2 hours of asking the flight attendant for whiskey-and-cokes, we may feel more drunk simply because it is difficult to walk down such a small aisle in a vehicle that can move on three axes. In fact, the body is constantly trying to monitor the yaw and the pitch of the aircraft which can be disorienting while sober. Lastly, hypoxia, or lack of oxygen, may contribute to the nuanced sensation of drinking on a plane. Alcohol consumption can actually make it harder for the body to adapt to low oxygen environments.
Before boarding your next flight, think twice before echoing this well-traveled tall-tale. Believing that we get drunker on fewer drinks up at cruising altitude definitely adds to the romantic notions of being served complimentary wine or beer, but it might just be false. That is not to say drunkenness in flight does not feel different than usual. Being enclosed in a fuselage in the sky with no escape escalates the risks associated with drunken behavior without a doubt. For this reason, airlines should always ration their drink service to passengers. Nevertheless, it is great news that in-flight alcohol is coming back.
Collins, William E. Performance effects of alcohol intoxication and hangover at ground level and at simulated altitude. No. FAA-AM-79-26. Civil Aerospace Medical Institute, 1979.
Collins, W E et al. “Some effects of alcohol and simulated altitude on complex performance scores and breathalyzer readings.” Aviation, space, and environmental medicine vol. 58,4 (1987): 328-32.
Collins, W E, and H W Mertens. “Age, alcohol, and simulated altitude: effects on performance and breathalyzer scores.” Aviation, space, and environmental medicine vol. 59,11 Pt 1 (1988): 1026-33.
Freedman, R et al. “Electrophysiological effects of low dose alcohol on human subjects at high altitude.” Alcohol and drug research vol. 6,4 (1985): 289-97.
Higgins, E. Arnold. Blood alcohol concentrations as affected by combinations of alcoholic beverage dosages and altitudes. Vol. 70. No. 5. Department of Transportation, Federal Aviation Administration, Office of Aviation Medicine, 1970.
HOLLAND COOK, CHRISTOPHER CHARLES. “Alcohol and aviation.” Addiction 92.5 (1997): 539-555
Murcko, LaNelle E., and J. Robert Dille. Index to FAA Office of Aviation Medicine Reports: 1961 Through 1976. FEDERAL AVIATION ADMINISTRATION WASHINGTON DC OFFICE OF AVIATION MEDICINE, 1977.
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