Binge drinking is a pattern of consumption characterized by heavy drinking during a single occasion, leading to intoxication. This pattern of drinking, consisting of at least five drinks per drinking episode for men and four drinks for women, raises concern because of its high correlation with accidents and injuries, such as those incurred when driving while intoxicated. In older adults, binge drinking has significant health implications, such as heart disease. Rates of binge drinking vary by age. It is the most common pattern of alcohol consumption among adolescents, with increasing prevalence through young adulthood, peaking at age 21, and declining through adulthood. For most youth, engaging in binge drinking does not predict the development of alcohol dependence. This pattern changes for older adults, as binge drinking is correlated with patterns of heavy drinking.
Historically, “binge drinking” signified the consumption of large amounts of alcohol over extended periods (i.e., several days). The definition of binge drinking currently describes a shorter drinking episode (i.e., several hours) that raises a person’s blood alcohol concentration high enough to result in intoxication (0.08). While this definition, proposed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), indicates both time course and blood alcohol concentration, most research on binge drinking has not included either specifier. To approximate the amount of alcohol necessary to reach this level of intoxication, the NIAAA has defined a binge drinking episode as five drinks per drinking occasion for men and, to account for differences in body size and metabolism, four drinks for women. Similarly, adolescent research has encouraged decreasing the quantity to three drinks for adolescent girls. In the United Kingdom, binge drinking has been defined as eight or more units of alcohol per drinking episode for men and six or more for women.
During adolescence and young adulthood, the majority (90%) of alcohol consumption is in the form of binge drinking. Recently, 11% of 8th graders, 30% of 12th graders, and 40% of college students reported binge drinking within the past 2 weeks to 1 month. These rates have been consistent for the past few decades. However, historically prevalent gender differences are no longer evident across adolescents and young adults. In terms of culture, Native Americans have the highest rates of binge drinking, followed by Caucasian, Hispanic/Latino, biracial/multiracial, Asian American, and African American students.
Around age 22, rates of binge drinking decline. Binge drinking has a low prevalence across adult samples (15%), with the lowest rates found among those age 55 years and above. Nevertheless, of the alcohol consumed by adults, in the United States approximately 75% is in the form of binge drinking. Almost half of all binge drinking episodes occur among adults with alcohol dependence. Of the non-heavy drinkers who engage in binge drinking, most do not have repeated episodes during their adult years.
The majority of adolescents and young adults who engage in binge drinking do not face alcohol dependence during adulthood. In addition, most people who engage in binge drinking naturally reduce this behavior without formal intervention. However, adolescents and young adults who continue binge drinking into adulthood face a greater likelihood of developing alcohol dependence. Brief interventions, including motivational interviewing and harm reduction approaches, have been found to effectively catalyze reductions in binge drinking and related consequences across people of all age groups. Moreover, reductions in binge drinking achieved during adolescence and young adulthood have been found to have preventive effects during adulthood.
Several factors place adolescents at increased risk for binge drinking, including early initiation of alcohol use and regular drinking, age, other substance use, peer context, other risk-taking behaviors, parental monitoring, and academic performance. First, early initiation of alcohol use and regular drinking have been found to predict problematic patterns of consumption, including binge drinking, through adolescence, young adulthood, and older adulthood. Second, with increasing age, rates of binge drinking steadily increase. Third, adolescents who use other substances, such as tobacco and marijuana, have evidenced higher rates of binge drinking. Fourth, adolescents who believe that their friends are regular drinkers, frequent drinkers, or binge drinkers are more likely to engage in binge drinking. Fifth, adolescents who exhibit delinquent behaviors, problem behaviors, and high levels of sensation seeking have been found to be more likely to engage in binge drinking. Sixth, adolescents who have parents who do not monitor their behavior have shown increased rates of binge drinking. In contrast, parents who have clearly stated that they expect their child not to drink have adolescents who demonstrate significantly lower levels of binge drinking. Seventh, adolescents who are doing poorly in school, have a negative attitude, or a limited commitment toward school have increased rates of binge drinking.
Several factors have been found to increase the risk of binge drinking during young adulthood, including binge drinking during adolescence, moving away from home, college attendance, peer behaviors, and academic demands. First, studies have found that young adults who engaged in binge drinking during high school averaged 2 to 3 times as many binge drinking episodes per month than those who had no high school binge drinking. Second, moving away from home has been consistently correlated with increases in binge drinking. Third, young adults who attend college evidence higher rates of binge drinking than their non-college-attending peers, particularly when college attendance is coupled with moving away from home. This increase is influenced by several factors within the college environment, including limited parental monitoring, more social environments that encourage heavy drinking, and increased accessibility of alcohol. Fourth, as with adolescents, peer groups influence the binge drinking behaviors of young adults. Specifically, young adults involved with fraternities, sororities, or heavy drinking peer groups have higher rates of binge drinking. Fifth, college semester schedules have been correlated with binge drinking, with increased rates of binge drinking occurring during holidays and school breaks.
During adulthood, there are several risk factors for increased levels of binge drinking, including age of initiation of binge drinking, gender, cultural patterns of alcohol consumption, and heavy drinking. First, adults who began binge drinking before or during high school have increased rates of binge drinking during adulthood. However, it is important to note that this correlation has been highest among adults who consumed large amounts of alcohol at a high frequency during adolescence. Second, although there are no gender differences in binge drinking rates among adolescents, adult men consistently evidence higher rates of binge drinking than do women. In fact, rates of binge drinking have been found to be 3 times as high for men than for women. In addition, men account for 81% of all binge drinking episodes across adults. Third, increased rates of binge drinking during adulthood have been found in cultures where binge drinking is the predominant pattern of alcohol consumption (e.g., Russia, United Kingdom, Ireland), particularly when contrasted with cultures where alcohol tends to be consumed in smaller quantities and during meals (e.g., Mediterranean cultures, such as Spain, Italy, and France). Fourth, most (76%) heavy drinkers report engaging in binge drinking and doing so more frequently than moderate drinkers.
Most negative consequences of binge drinking stem from accidents and injuries incurred during binge drinking episodes. Specifically, several types of accidents and injuries have been found to correlate with binge drinking, including self-harm (falling, being burned, drowning, overexposure, hypothermia, self-cutting, self-injury, suicide), sexual risk taking (multiple sexual partners, sexual behaviors that were later regretted, inconsistent condom use, forced sexual activities, sexual aggression), and interpersonal harm (physical fighting, assault, domestic violence, child abuse). After binge drinking, adolescents and young adults are 10 times as likely to engage in behaviors that result in accidents and injuries. The high rates of accidents and injuries that occur during episodes of binge drinking appear to be a function of the psychological and physical changes that occur during intoxication, including disinhibition; poor decision making; and impaired judgment, communication, and problem solving. In addition, the setting where binge drinking occurs also factors into the potential risk.
Many of the accidents and injuries related to binge drinking stem from driving during or after the binge drinking episode, while people are still intoxicated. Over 80% of alcohol-impaired driving events occur among people who have been binge drinking. Moreover, adolescents have shown a high acceptability of drinking and driving. Specifically, 17% of high school seniors reported having driven after drinking. By college, that rate increases, with 30% of college students stating that they have driven after binge drinking. In addition, rates of driving after binge drinking are higher for college students who live off-campus.
The consequences of binge drinking upon physical health vary across the life span. For adolescents and young adults, the predominant health risks of binge drinking include alcohol poisoning, unintended pregnancy, sexually transmitted infections (including HIV), physical accidents, and injuries. During adulthood, these risks continue, but additional risks accrue, including heart disease, high blood pressure, and poor diabetes control. While studies have found that moderate alcohol consumption benefits the cardiovascular system, binge drinking counteracts these potential benefits and increases one’s chance of mortality. For women, binge drinking during pregnancy may result in fetal alcohol syndrome and fetal alcohol effects.
When the data on binge drinking are examined, several themes emerge. The greatest risk for binge drinking stems from accidents and injuries, particularly as a consequence of drinking and driving. Brief interventions, such as motivational interviewing and harm reduction approaches, have gained empirical support in reducing the frequency of binge drinking across all age groups. Therefore, the provision of brief interventions may curtail the incidence and correlated consequences of binge drinking. Reducing levels of binge drinking during adolescence and young adulthood has salient protective and preventive effects, both in reducing rates of accidents and injuries and in halting developing patterns of heavy drinking. Therefore, the development of broad-reaching efforts, such as the facilitation of discussions about alcohol use and the provision of brief interventions in medical settings, may help reach the majority of youth who may be engaged in binge drinking but who would otherwise not come to the attention of health professionals. Due to the high concordance between binge drinking and patterns of consistent heavy drinking among adults, assessment and treatment for alcohol abuse and dependence may be the most effective intervention strategy for adults.
Adolescents, Substance Abuse and Treatment; Alcoholism; College Students, Alcohol Use and Abuse; Cultural Aspects; Driving Under the Influence; Experimental Substance Use
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