High Spirits: the impact of alcohol at altitude

With alcohol being behind so many unruly passenger incidents, Beth Blair examines the impact of alcohol in the bloodstream and explains how altitude can result in behavioural differences that would not be experienced on the ground.

With the media buzz in the United States surrounding the long awaited stewardess-inspired television series, Pan Am, starting this September, passengers are yearning for the times when air travel was civilised, flight attendants wore pillbox hats and white gloves and every passenger was served a hot meal. While much of the glory days are gone there is one element that has endured…the alcoholic beverage.

Anyone who spends time in airports and on airplanes will witness passengers drinking for a number of reasons, including anxiety, celebrations, or simply habit. Onboard the aircraft, cocktails, wine and beer are free flowing in first class and sometimes complementary for economy class and nearly every flight with a beverage service has alcohol available.

Unfortunately, the good times spirits can bring can also cause a major disturbance. Virgin America Captain Henry Biernacki points out that drinking does not always begin during flight. “The first one is normally taken before the door closes at the airport and often even before the security lines.” It should come as no surprise considering how major airports are guaranteed to offer a wide selection of bars to choose from and airlines provide airport lounges for their elite flyers, where alcoholic beverages can be obtained. Many such lounges are self-service where passengers can take as much alcohol as they like.

Take the incident at Minneapolis-St. Paul International Airport in May 2011. 23-year-old Megan Biersach was denied boarding on a U.S. Airways flight to Salt Lake City because she was drunk and crying. The news triggered Biersach to go ballistic which resulted in her spitting in the face of police officers, biting a policeman’s arm and saying she had rabies and AIDS. The bartender at Icescape, the airport bar where she had been drinking, told police he had served Biersach three vodka and sevens, and three tequila shots. She also falsely accused three men at an airport bar of sexual assault. At one point she revealed she was on anti-psychotic drugs which added another dimension to the story.

In August of this year a Russian journalist was removed from a Simferopol-Moscow flight before take-off due to unruly behaviour suspected of being caused by alcohol. A test proved the would-be passenger was indeed intoxicated.

Luckily, airline employees recognised the unstable behaviour in these two cases and were able to prevent the passengers from boarding. But that’s not always the case.  Again in August this year, an 18-year-old Jet Blue passenger Robert “Sandy” Vietze urinated on the floor near an 11-year-old girl which caused frenzy in media headlines, which originally reported that he had urinated on the child. An investigation revealed the underage man (age 21 is the legal drinking age in the United States) had consumed five to six beers and two rum and cokes at a bar prior to flying. According to reports, the young man was an elite member of the US Ski Team and could face a $1,000 fine and/or a year in jail if convicted. In addition, his behaviour has potentially ruined his career as he was removed from the Ski Team and a possible spot at the 2014 Winter Olympics.

On the morning of 30 August, shortly after take-off, a London-bound British Midland flight returned to Moscow Domodedovo Airport due to an intoxicated female passenger’s inappropriate behaviour, which included an erotic dance. The passenger’s disturbance caused a 10 hour delay, inconveniencing all passengers onboard.

As you can tell from these stories, often the “one drink” leads to several and often to intoxication and if passengers are not denied boarding, the drinking continues in-flight. So does altitude have a compounding effect on alcohol?

“This has been a controversial subject over the years,” says Dr Richard Dawood, Medical Director of the Fleet Street Clinic in London and the Editor of the book Travellers’ Health. “Both alcohol and reduced oxygen pressure impair performance and produce symptoms that can be similar (headache, for example). The question is whether or not these are additive. There is reasonable evidence to suggest that this is indeed the case. At a cellular level, alcohol impairs oxygen metabolism, and the same amount of alcohol may have an enhanced effect at flying altitudes.

“Under hypoxic (reduced oxygen) conditions, other factors may also magnify the effects. These include smoking – smokers become hypoxic more easily and may also suffer symptoms as a result of nicotine withdrawal – and a variety of other medical conditions including lung and heart disease.

“Another effect of alcohol is that it promotes fluid loss from the body, whilst creating an illusion of fluid intake. Spirits and strong alcoholic drinks result in a net fluid loss, whereas the effects from more diluted drinks may be neutral. Passengers tend to become more dehydrated in the air, because of a net shift of fluid from the circulation into the tissues, and from reduced intake during the journey; alcohol makes this worse, reducing well-being and increasing the risk of complications such as DVT.”

The Holiday and Health Factors

“People tend to forget the importance of maintaining one’s health while travelling,” says Biernacki. “Although, someone may be on a vacation, health and safety are still of utmost importance.”