Call 999 now if they cannot be woken by a loud voice and a gentle shake, if their breathing is slow, shallow, irregular or absent, if they are having a seizure, or if they have said they are going to end their life. You do not need to be certain. Being wrong costs you an ambulance call and an awkward hour.
There are four different emergencies in this house and they do not look alike. Work out which one you are looking at.
One: an overdose, or something close to it
We Are With You lists the signs. They do not wake "when you talk loudly to them or gently shake them by the shoulders". Their "breathing is slow, shallow or irregular, or they are not breathing at all". They "look pale and clammy", they are "unable to speak", they "are confused".
Add to that bluish or greyish lips and fingernails, which shows differently depending on skin tone, very small pupils, choking or gurgling sounds, and vomiting while not fully awake.
Snoring that sounds like choking is not sleep. That one catches people out every night of the week.
While you wait:
- **Check the space is safe for you.** Needles, spilled liquid, anyone else in the room.
- **Put them on their side,** in the recovery position, so they do not choke on vomit.
- **Stay with them.** Do not put them to bed and go to sleep yourself.
- **Tell the crew everything.** Talk to FRANK is direct about this: "tell the responders everything you know about the drugs taken, it could save their life."
- **Hand over anything left.** "If an ambulance comes and you have any drugs left, hand them over to the crew as it may help", and FRANK adds that "in most circumstances they won't tell the police."
Naloxone reverses an opioid overdose long enough for help to arrive, and you are allowed to keep it. UK guidance names who can be supplied it without a prescription, including "a carer, a friend, a family member or a peer of someone who uses drugs". You cannot get it at 3am. You can get it tomorrow from a local drug service or a pharmacy. We Are With You is reassuring about the fear that stops people using it: "if someone hasn't overdosed on opioids, naloxone won't harm them."
Two: severe alcohol withdrawal
This is the emergency almost nobody warns families about, and it arrives when the drinking stops rather than when it is happening.
The NHS says to call 999 for severe symptoms of alcohol withdrawal, "including: hallucinations, severe tremors, seizures or fits". UK clinical guidance puts the timing on it: "alcohol withdrawal symptoms generally start within 6 to 24 hours after stopping drinking and can last around a week", and "delirium tremens usually emerges between day 2 and 3 (occasionally up to day 5) of alcohol withdrawal in a person with severe alcohol dependence".
Delirium tremens looks like agitated confusion, seeing or hearing things that are not there, heavy shaking and a racing heart. It is a medical emergency.
The practical consequence for you is the opposite of the advice you have been given everywhere else. If they drink daily and shake in the mornings, do not empty the house. The same guidance says people with potential or diagnosed dependence "should be advised not to stop drinking suddenly as this can lead to dangerous acute withdrawal". Get a GP or a free local alcohol service to plan the stopping instead. It feels like doing nothing. It is the version that does not end in an ambulance.
Three: they have said something about ending their life
Take it at face value. Ask directly whether they are thinking about suicide, because asking plainly does not put the idea there, and vague concern gets a vague answer.
If there is immediate danger, call 999. If it is not immediate but it is real, NHS 111 has an urgent mental health option, and Samaritans is **116 123**, free, any hour, for them or for you.
The UK's first gambling guideline is worth knowing here even if gambling is not your situation, because it says something specific about timing. It instructs clinicians to recognise that "gambling and gambling-related harms can be a dominant risk factor for suicidal ideation and suicide attempts, even in the absence of other risk factors", and that "the risk may be highest immediately after a gambling episode". If money has just gone, that is the window to stay close.
Four: the danger in the room is a person
Some people reading this at midnight are not supporting someone who needs help. They are frightened of someone, and the substance is part of how they are being controlled.
- **999** if it is happening now.
- **National Domestic Abuse Helpline**, run by Refuge: **0808 2000 247**, free, 24 hours a day.
- **Men's Advice Line**: **0808 8010 327**, Monday to Friday 10am to 5pm, for male victims and for people supporting them.
- **Galop**, for LGBT+ people: **0800 999 5428**, Monday and Tuesday 9.15am to 8pm, Wednesday to Friday 9.15am to 4.30pm, closed 1pm to 2pm daily and at weekends. It is not a 24 hour line, so keep the domestic abuse helpline for the night.
[When it is not addiction, it is abuse](/guides/supporters/when-it-is-not-addiction-it-is-abuse) helps you tell the two apart. You do not have to have decided anything to ring.
What is not an emergency, but is not nothing
Most nights are this. They are drunk or high, they are safe, and nothing is technically happening except that you cannot sleep.
That is a GP conversation this week, not an ambulance tonight. Get the car keys, move medicines out of reach, sort the children first, eat something, and do not start the conversation. Nothing said at 1am to someone intoxicated survives to the morning, except the part where you both said something unforgivable. [What to do tonight when someone you love is using](/guides/supporters/what-to-do-tonight-when-someone-you-love-is-using) covers the long night in detail.
Common questions
**What if I call 999 and I am wrong?** Then you were wrong, and an ambulance crew has had a wasted hour, which is a thing they are used to. The asymmetry is not close. Hesitating because you might look silly is the most common reason people wait too long.
**Will the police get involved if drugs are in the house?** FRANK's guidance is to hand any remaining drugs to the ambulance crew because it may help, and that "in most circumstances they won't tell the police". We cannot promise you an outcome. We can tell you that not calling is the larger risk.
**Can I have them sectioned, or forced into treatment?** We are not going to give you a legal answer on a page, and most of the sites promising one are selling private beds. If there is immediate danger to them or to anyone else, call 999. For everything else, the route with actual evidence behind it is something you learn and do, which is in [how to raise it without a row](/guides/supporters/how-to-raise-it-without-a-row).
**They refuse to go to hospital. What now?** If they are conscious and refusing, call 999 anyway and say exactly that on the phone. The call handler will tell you what to do. Do not physically fight someone into a car.
**Should I pour their drink away while they are asleep?** Not if they drink daily and get shaky or sick without it. Sudden withdrawal in someone physically dependent can be dangerous, and this is the single most repeated piece of bad advice aimed at families.
Sources
- [We Are With You, signs of a drug overdose](https://www.wearewithyou.org.uk/advice-and-information/advice-for-you/signs-of-a-drug-overdose). The overdose signs, and that naloxone does no harm if no opioids were taken.
- [Talk to FRANK, what to do in an emergency](https://talktofrank.com/get-help/what-to-do-in-an-emergency). Telling responders everything, and handing over what is left.
- [NHS, alcohol support](https://www.nhs.uk/live-well/alcohol-advice/alcohol-support/) and [GOV.UK, clinical guidelines for alcohol treatment](https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/16-alcohol-care-in-acute-hospitals). When to call 999 in withdrawal, the timings, and the warning against stopping suddenly.
- [NICE NG248, gambling-related harms](https://www.nice.org.uk/guidance/ng248/chapter/recommendations). Suicide risk as a dominant factor, and highest immediately after an episode.
