At the end of a hectic day at work, many choose to get ‘one for the road’ to relax, get rid of stress or socialise with friends. Sadly for some, ‘one for the road’ becomes ‘one too many’. The results are many, but when drinking becomes a binge and degenerate into blackouts or passing out, health experts say it’s time to look into the mirror and sober up.Whereas many people interchangeably use the two conditions, the difference is stark. Dr David Basangwa, a senior consultant psychiatrist at Uganda-based Butabika Mental Hospital, in a past interview, said alcohol-induced blackout is when consumption of alcohol impacts on the brain so that one cannot remember memory formed more than two minutes previously.Scientists believe such a memory is stored in the brain but retrieving it becomes difficult as impairment called amnesia sets in. So one can engage in conversation, do so many activities, including driving, eating, fighting, but they will not be able to recall what happened. Someone else would have to remind them of their behaviour.Dr Basangwa said passing out, on the other hand, is when an individual loses consciousness due to a dangerously high blood alcohol concentration.  Someone passed out could appear to have fallen asleep, but cannot be woken up. For instance, a drunk man fell off a taxi motor near Alpha Palace Hotel in Remera last weekend and proceeded to sleep away as the motorists tried to wake him up. That is passing out.Dangerous conditionsDr Basangwa said both conditions are highly dangerous to both the alcohol consumer and those around them. "A blackout means impairment in judgment, decision-making, and impulse control. This means you make reckless decisions without knowing what you are doing. So a blacked out person can pick up fights, engage in sexual activities with strangers, or even becoming a public nuisance,” he said.Because a blacked out person remains active, one would think passing out is a much better condition for the alcohol consumer. However, Dr Basangwa does not see it that way."Alcohol use leading to passing out is very dangerous. If affects breathing, causes vomiting, but at worst, when you pass out, you first fall asleep before you gradually become unconscious, making you susceptible to the gag reflex where you end up sucking your own vomit, and choking on,” the psychiatrist said.In a 2011 survey by Duke University Medical Centre, researchers concluded that women are at greater risk during a blackout than their male counterparts.But do not limit this to women per se. Chances of being robbed or mugged by thugs, with bodily injuries or death are higher for people who are drunk. For women, it can lead to rape and exposure to HIV infection."During a blackout, an individual is capable of participating in salient, emotionally charged events but will have no recollection of what has occurred. Many students in the study indicated that they later learned they had engaged in a wide range of risky activities during their blackout,” the study says.American scientists, in a study, also found that pre-drinking can lead to blackouts and worse consequences.Pre-drinking is a trend especially among young people. It is planned drinking at home or another setting before heading off to a bar. The drinker does not want to spend as much money on alcohol where it is sold quite expensively, such as in high-end clubs. Often, they will buy cheap liquor at a supermarket and down it quickly before they go to a club or bar. It’s a deliberate intent to get drunk—before they have to pay outrageous bar and club drink prices. The practice is dangerous due to the rapid consumption of alcohol, which can increase the risks of hangovers, blackouts and alcohol poisoning.Blackouts are also dangerous because they indicate that a person may have a problem with alcohol abuse. Excessive alcohol consumption can be detrimental to physical and mental health. Too much drinking can lead to chronic diseases, accidents, legal problems, interpersonal problems and death. Who is at risk of blackout?Dr Basangwa said blacking out is not limited to heavy consumers as there are many factors, both natural and others that can effect the conditions, in as much as it is with passing out."Our level of alcohol retention and management is not the same. One bottle can make a man dizzy but it might take four for another to feel the effect. So this is, first, about how one’s brain is able to contain the toxicants in alcohol, and secondly, other factors,” he said.Dr Basangwa said a blackout can occur even among social drinkers, and it is heightened when one drinks on an empty stomach. Studies show that on an empty stomach, 20 per cent of alcohol is absorbed directly from the stomach and reaches the brain in less than 60 seconds.Studies also show that drinking to the point of passing out can happen fast. A person can drink enough to cause them to pass out, but not pass out for a while longer, possibly continue to drink because of the time the body needs to process alcohol. Dangers of alcoholDr Chaste Uwihoreye, a clinical psychologist in Kigali, said alcohol dependence affects people psychologically to the point that they cannot do anything before having a shot or more of alcohol."Alcohol is a drug like others and if consumed too much or regulary, it becomes an addiction. Once one starts depending on it, it becomes hard for them to even do their work without first taking some alcohol. If they don’t take alcohol, sometimes they end up with withdrawal effects such as shaky hands, trembling and insomnia,” he said.Dr Uwihoreye said at some point alcohol addicts start acting like they are mentally disturbed because alcohol affects the brain as well. It also damages the liver if consumed in large quantities, could increase risk of hypertension and ulcers according to the clinical psychologist.