In your case I would take notice of the smell of alcohol, but if you don't show any other signs of being impaired the you would be OK. If you start staggering a bit, then we might have an issue.
It is true that there are other medical issues that can cause mimic being drunk or high, but we can also sort that out. If need be we can call the medics. Usually we will talk to you and we can figure things out. Those type of cases are rare anyway. In the case of your friend he's better having someone along anyway from a safety standpoint. If the plane has to be evacuated, would he be able to get himself off the plane? That's a key question we have to think about too.
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