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Crisis Response

Playing the Choking Game

More students are turning asphyxiation into a thrill-seeking activity, but the results can be deadly

The middle school teacher found one boy choking another while two others watched. Demanding that they stop, the teacher took all of the boys to the office for disciplinary consequences. Parents were called immediately, and school counselors met with each student to learn how frequently he played this "game." Parents and their children were educated about the game's dangers, and parents were encouraged to increase supervision of their children. In-service training was scheduled for school personnel to teach them about the behavior.

Youth try it because of peer pressure or the desire to get high.

This is an example of a comprehensive school response to the "choking game," which is also called the "fainting game," "suffocation roulette," and "black out" or "pass out." Adolescents engage in the practice alone or in groups, using belts, hands, plastic bags, and ropes around their neck, or by holding their breath until they pass out.

Disturbing Trends

A report from the Centers for Disease Control and Prevention (CDC) says that choking is on the increase and that youth try it because of peer pressure or the desire to get high, rather than trying to curb anger or depression. It is difficult to get accurate figures on how prevalent the game is, but one recent study found over 50 percent of adolescent boys admitted trying it, with the majority admitting that they played the game alone at times. The Web site of Games Adolescents Should Not Play (, an international not-for-profit organization, estimates that over 250 U.S. children die annually from the game. Many children who die are described as bright, athletic and good.

Choking affects the nervous system, depriving the brain of oxygen and creating a mild state of euphoria that students describe as warm and fuzzy. A high is created just before the loss of consciousness and again during recovery. Young people who choke themselves while alone may pass out and not be able to release the pressure on their neck, and tragedy may be the result.

Most kids learn of the game at school or summer camp or from the Internet. Experts agree that most adolescents are prone to some amount of risk-taking behavior and many, viewing the choking game as harmless, can be easily goaded into trying it.

What You Can Do

Be on the lookout for warning signs, including marks on the neck; changes in personality, such as increased agitation; disorientation after time spent alone; straps, ropes and belts that serve no apparent purpose; bloodshot eyes and flushed face; headaches and concentration problems; loud sounds; and questions about strangulation or suffocation.

All school personnel should be educated about the game, and supervision needs to be increased in isolated parts of the building. Schools often provide leadership to the community about dangerous adolescent behavior through community forums on the dangers of drugs, reckless driving, and drinking and driving, but strategies such as providing information in newsletters and parent training sessions are also needed.

Parents need to be contacted immediately when their child is suspected of engaging in this activity. Parents need to be encouraged to know where their children are, to become more involved in their lives, and to reduce the amount of time their children spend isolated in their rooms.

Prevention vs. Awareness

One issue that is controversial is how much, if anything, should be said to students in group settings about choking. Some educators argue that educating students on the dangers may increase awareness of the game. Each school needs to look at the prevalence of the behavior and provide developmentally appropriate information, but all students can benefit from information about good decision making and personal safety. Schools and communities also need to make sure that all students feel welcome and to increase extracurricular involvement. Communities need to increase the number of healthy activities for children that release endorphins naturally through exercise and supervised outdoor adventure activities.

I implemented the Reality Oriented Physical Experiences Program (ROPES) in my previous school district and directed all aspects of the program for 13 years. The program provides low-element activities geared toward problem solving and communication as well as high elements, which use belaying and climbing equipment to give students an opportunity to improve self-esteem and develop trust in others. More than 100,000 students participated in the program during my tenure. More information is available at

Scott Poland is a contributing writer for District Administration and prevention division director for the American Association of Suicidology.