To Ruben and his friends, it was just a game.

They called it Knock Out. They would get together and choke one another until – one by one – they passed out. The head rush and the feeling of weightlessness made them laugh. And watching someone shake on the floor until he woke up was downright hilarious.

Sometimes Ruben and his friends would choke each other four or five times a day. “We’d say, You wanna pass out? And then it was on,” Ruben says.

It was fun until the day one of the boys began to have a seizure and had to be hospitalized, Ruben recalls. “It made me realize this ain’t no game. You could go to jail for murder. You could die,” he says.

Ronald Peters, Dr.PH, assistant professor of health promotion and behavioral sciences at The University of Texas School of Public Health at Houston, says this game of suffocation roulette is gaining popularity among children and teenagers.

It is often referred to as the Knock Out, Pass Out or Twitching Game. Children or teens get together or perform this alone by first hyperventilating--breathing rapidly and hard. Then, they cut off one another's or their own air supply until they pass out. Often they use their hands to choke their friends or themselves at the throat. Some have reported compressing the chest of the "player" while their backs are against a wall.

While there is no research data on its prevalence, news reports, Internet documents and discussions with teens reveal that the risky behavior is widespread, Peters says.

Across the country, from California to New Hampshire, there have been reports of young girls and boys accidentally suffocating themselves while playing the game in an effort to get high. And, some youths who are already high on drugs play this game to intensify the drug’s effect.

“Kids are kids.  And, they do this based on the peer pressure they receive from other kids,” Peters says. “They think it’s a game, and they’ll play it with their friends. Because of the euphoric effect, it becomes addictive, and they begin doing it by themselves. They don’t realize that they can die or suffer brain damage.”

‘It’s a drug in itself’

Ruben and two other 16-year-old boys, Jose and Lee, who are in a drug treatment program at Riverside General Hospital in Houston recently talked to Peters about their first-hand experiences with the choking game.

“It is a drug in itself,” Ruben says. “It’s addictive – the head rush, the way it makes your body feel.”

Jose says he liked the feeling of “waking up from a dream” after someone pressed on his chest or wrapped bare hands around his throat to cut off the oxygen to his brain. That was until he learned that this could have tragic consequences.

“It only takes one time for you to die,” Jose says. “You can build up fluid in your chest or become a vegetable and have to be fed through a tube.”

Lee says the choking game is appealing to teenagers in part because it is a free way to get high. It’s also easy to hide because there is no drug test to detect if someone is playing.

Peters says there are warning signs to look for, however:

• Red marks or bruising around the neck
• Bloodshot eyes
• Headaches
• Disorientation
• Items such as knotted T-shirts, belts, rope or bags also could be clues.
• The sound of a thud in the bedroom or against a wall could be the sound of a child falling after playing the choking game alone.

“Ask your kids if they’ve heard of the choking game,” Peters says. “Talk to them about it. Let them know the dangers. We talk to our kids about cigarettes, alcohol and drugs. We need to talk to them about this, too.”

Peters says this dangerous activity usually occurs when children congregate behind closed doors – in their bedrooms or even in an unsupervised area at school. “If you are suspicious, just open up that door and see what your kids are doing,” Peters says.

Anyone can play

Jose stresses that kids with a history of drug problems are not the only ones playing the game. It doesn’t matter if you are a boy, girl, straight-A student or a frequent visitor to detention hall. “If you have a classroom with 20 kids, maybe 18 have tried it,” he says.
 
Troy Jefferson, program manager of child and adolescent services at Riverside General Hospital, says, as far as adolescents are concerned, the choking game is no different than an innocent game of Truth or Dare.

“They have a Superman ego, and they don’t realize the results can be detrimental,” Jefferson says. “The kids who are playing this game are getting younger and younger – 8, 9, 10 years old. We need to catch this before it starts—before someone’s younger brother or sister walks in, sees this and decides to try it, too.”

UPDATED: 5-10-2006

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