Understanding Constitution Damage/Drain

One of the first things I noticed flipping through the new Southlands Bestiary (Pathfinder) by Kobold Press is the number of monsters that do Constitution ability damage. Over the years I've heard so many complaints from players regarding ability damage and drain, this surprised me a bit. However, I think a well-informed GM can use these monsters to good effect at the table.

First, let's explore what ability damage and drain mean. Ability damage is damage done to one's ability score. Rather than subtracting from the score, you keep track of the damage separately. Get enough damage and you accrue penalties to your checks. Specifically, for every two points of damage done to an ability, you apply a -1 penalty to skills and statistics listed with the relevant penalty. However, your actual ability score remains the same, meaning you don't lose access to spells, feats, and the like.

Ability drain, on the other hand, reduces the relevant ability score. Instead of applying a penalty, you go through your entire character sheet and readjust all skills and statistics related to this ability. Additionally, points lost through ability drain tend to be harder to regain than healing from ability damage. Unless otherwise noted, a character can regain 1 point of ability damage per day. No such natural healing happens with ability drain.

Given how central ability scores are to the game, these general rules help explain why ability damage and drain in general can make players a bit upset but it's important to note that Constitution drain can be particularly thorny. For example, both ability damage and drain can have the effect of lowering one's Fortitude save modifier, often the save type needed to end ongoing Constitution damage or drain or to protect oneself from future reductions. Additionally, Constitution damage or drain reduces both current and total hit points, which means even if the character can deal with the reductions to Constitution abilities, their survivability is lessened. These hit points do not refresh until the ability score damage is healed or the drain reversed. Oh, and unlike the five other ability scores, being reduced to 0 Constitution through ability damage or drain results in character death.

Finally, Constitution is rarely the first or even second most important ability score for most classes. While it's generally advisable to not make it your dump stat (hit points are useful for everyone after all), it's going to be rare for it to be the highest ability score. (For more information on classes that use the various ability scores, see this great Google doc https://docs.google.com/document/d/1o91Z-s0R7Vf2Ujj1lFqGC5W--9JOyU0I6uC9...) While it's true that getting enough ability damage or drain in the five other score types will still take you out for a while, with Constitution it will kill you dead.

What this all means is that Constitution ability damage and drain easily can lead to an unintended death spiral. To understand, let's look at one of the monsters in Southlands Bestiary, the venomous mummy, a CR 5 monster. It has two abilities that do Constitution damage. One, toxic smoke, happens when the mummy is suffers a particular type of damage. It essentially creates an aura around the creature and any character within it must make a Fortitude check with a DC of 17. If a character fails, it takes 1 Constitution drain or 1d3 Con damage and faces making Fortitude saves for the next 5 rounds. To cure, it must make 2 consecutive saves.

If the effect is drain instead of damage, with every failure the player may need to rework their character sheet. If their ability score was even, this would kick them down one modifier tier. In addition, if there are any feats, spells, or other abilities they have that have a Constitution ability score prerequisite AND your ability score falls below that, you lose access to those items. Thus, the next round when you make a check, you are likely to be in a worse position than you started and yet have to make the same DC.

If the effect is damage instead and the 1d3 gets maxed, you are facing a situation where after two rounds you are taking a -3 penalty to your Fortitude saves plus dealing with a 3 times your hit dice reduction in hit points, and since it's from your current, it's as if the enemy had hit you for damage. And remember, the 2 saves must be consecutive.

Also, it's essentially a 10' aura which means multiple party members could be affected by this. This doesn't even take into account that the mummy has a second ability that also does Con damage, Selket's Venom. This affliction is spread by touch, including through the mummy's slam attack. The effect is 1d6 Con and 1d6 Dex. With an onset of 1 minute, it's unlikely to affect the current encounter but unlike toxic smoke, it continues until cured and no number of consecutive saves will cure it, only the removal of the curse will. The frequency is 1/minute and it requires that both the curse and the poison be removed, and I believe the curse has to be lifted first. While it doesn't say so explicitly, similar scenarios in the Core Rulebook say both spells must be done within 1 minute.

So imagine this scenario, the characters are in a tight crypt when they awaken the venomous mummy. Figuring that "burn it with fire" is always a good response to such foul creatures (hey, it's vulnerable to fire, right?), they light the mummy on fire. This releases the toxic smoke. Half the party is exposed, in particular the melee fighters. Two of them fail their saving throw, starting the up to six rounds of Con drain or damage. At least one of them also gets venom on them, meaning after the combat, that character is facing making a saving throw every minute. Their Fortitude save may already be penalized or reduced due to the toxic smoke and now they are facing the likelihood of an additional -1 penalty each minute, and possibly -2 or -3. Plus, they only have so many Constitution ability points to begin with and when they hit zero they are dead.

The main spells required in this case are remove curse and neutralize poison. Remove curse is a third level spell for bards, clerics, and paladins, and a fourth level spell for sorcerers and wizards. Neutralize poison is a third level spell for druids and rangers and a fourth level spell for alchemists, bards, clerics, oracles, inquisitors, paladins, shamans, and witches. Thus, unless you have a bard, cleric, or paladin in the party, it is unlikely that one character can both end the curse and neutralize the poison. Additionally, clerics don't get fourth level spells until 7th level and they'll only have two 3rd level spells at that level (perhaps more with a high Wisdom score). Paladins don't get 4th level spells until they are level 14 and bards don't get them until 10th level. That's not to say that there aren't other ways potentially to overcome this, but remember this is listed as a CR 5 monster.

If you want to revert the damage or drain, you have a few options available to you. Lesser restoration will cure 1d4 points of ability damage to one ability score. It's a first level spell for paladins and a second level spell for alchemists, clerics, oracles, druids, inquisitors, and shamans. However, it does nothing for ability drain. Restoration will cure all ability damage and restores all points permanently drained from a single ability score. It's a fourth level spell for alchemists, clerics, oracles, inquisitors, paladins, and shamans and requires diamond dust worth 100 gp. Greater restoration will cure all temporary ability damage and restores all points permanently drained from all ability scores. It's a level 7 spell for clerics, oracles, and shamans and requires diamond dust worth 5000 gp.

Another option is for a character to spend 8 or more hours providing long-term care. It requires a heal check. If it is successful, 8 hours will help up to 6 characters recover 2 ability points and 24 hours will allow them to recover up to 4. However, you cannot give long term care to yourself.

Additionally this isn't the only creature that does Constitution ability damage or drain. Out of the 99 monsters listed in the table of contents, I counted 23 that have some ability to affect a character's Constitution. One example, the Dau (CR 5) require a Fortitude save after a touch attack. Failure results in 1d6 points of Constitution drain. The amphiptere (CR 3) attempts to poison creatures it bites or stings. Poisoned creatures that fail their Fortitude save take 1d2 Con damage until they save. Any creature that takes 4 or more points of Con damage are also fatigued until at least one of those damage points are healed.

One thing to keep in mind is that the three people who heard me describe these monsters wanted to go up against them. So don't take this post as being negative on the product, it's definitely useful and will scratch the itch of some players. In fact, here are some game types where this sort of bestiary might be well-received:

• Some types of tournament play
• Games with experienced players who crave a challenge and/or something new
• Adventures that use the Mythic Adventures rules since it often gives player characters resources they wouldn't otherwise get. For example, cure light wounds heals some ability score damage in addition to increasing the healing.
• Campaigns that are more liberal about giving out items, especially as a reward for exploration. For instance, maybe parts of the area where a venomous mummy can be found have staves or potions to give the party more resources. However, I'd still suggest talking about this upfront rather than surprising players with it after they've dealt with something they feel is unfair.

So don't be afraid to use monsters like these, just try to go in with eyes wide open. Have fun! And if you have a story about ability damage/drain monsters you'd like to share, feel free to do so in the comments.

Notes: A huge thanks to Michael Phillips (Twitter|Website) for being willing to review my rough draft and do a quick soundness check. Venomous mummy artwork by the always awesome Jared von Hindman.