Binge drinking
Binge drinking, or heavy episodic drinking, is drinking alcoholic beverages intending to become intoxicated by heavy consumption of alcohol over a short period, but definitions vary considerably.
Binge drinking is a style of drinking that is popular in several countries worldwide, and overlaps somewhat with social drinking since it is often done in groups. The degree of intoxication, however, varies between and within various cultures that engage in this practice. A binge on alcohol can occur over hours, last up to several days, or, in the event of extended abuse, even weeks. Due to the long term effects of alcohol abuse, binge drinking is considered to be a major public health issue.
Binge drinking is more common in males, during adolescence and young adulthood. Heavy regular binge drinking is associated with adverse effects on neurologic, cardiac, gastrointestinal, hematologic, immune, and musculoskeletal organ systems as well as increasing the risk of alcohol induced psychiatric disorders. A US-based review of literature found that up to one-third of adolescents binge-drink, with 6% reaching the threshold of having an alcohol-related substance use disorder. Approximately one in 25 women binge-drinks during pregnancy, which can lead to fetal alcohol syndrome and fetal alcohol spectrum disorders. Binge drinking during adolescence is associated with traffic accidents and other types of accidents, violent behavior as well as suicide. The more often a child or adolescent binge drinks and the younger they are the more likely that they will develop an alcohol use disorder including alcoholism. A large number of adolescents who binge-drink also consume other psychotropic substances.
Frequent binge drinking can lead to brain damage faster and more severely than chronic drinking. The neurotoxic insults are due to substantial amounts of glutamate which are released and overstimulate the brain as a binge finishes. This results in excitotoxicity, a process which damages or kills neurons. Each binge drinking episode immediately assaults the brain; repeat episodes result in accumulating harm. The developing adolescent brain is thought to be particularly susceptible to the neurotoxic effects of binge drinking, with some evidence of brain damage occurring from drinking more than 10 or 11 drinks once or twice per month. A 2020 study found that even a single episode of binge drinking can lead to atrophy of the brain's corpus callosum, from which damage was still detectable by an MRI scanner five weeks later. With prolonged abstinence neurogenesis occurs which can potentially reverse the damage from alcohol abuse.
Definitions
Stolle, Sack and Thomasius define binge drinking as episodic excessive drinking. There is currently no worldwide consensus on how many drinks constitute a "binge".In the United States, the term has been described in academic research to mean consuming five or more standard drinks, or four or more drinks, over a two-hour period. In 2015, the US Centers for Disease Control and Prevention, citing the National Institute on Alcohol Abuse and Alcoholism, defines binge drinking as "a pattern of drinking that brings a person's blood alcohol concentration to 0.08 percent or above. This typically happens when men consume five or more drinks, and when women consume four or more drinks, in about two hours." and estimated that about 16% of American adults met these criteria at least four times per month. One 2001 definition from the publication Psychology of Addictive Behavior states that five drinks for men and four drinks for women must be consumed on one occasion at least once in a two-week period for it to be classed as binge drinking. This is colloquially known as the "5/4 definition", and depending on the source, the timeframe can vary.
In the United Kingdom, binge drinking is defined by one academic publication as drinking more than twice the daily limit, that is, drinking eight units or more for men or six units or more for women.
In Australia, binge drinking is also known as risky single occasion drinking and can be classified by the drinking of seven or more standard drinks and five or more standard drinks within a single day. When BEACH conducted a study which gathered information of people over the age of 18, it defined binge drinkers as those who consumed six or more standard drinks on one occasion whether that be weekly or monthly.
In the Republic of Ireland, the HSE defines binge drinking as more than six units of alcohol in one sitting for both sexes.
Researchers also classify particularly severe binge drinking, called high-intensity drinking, as consuming at least 8 to 12 drinks in a day. Although most people do not drink or do not exceed moderate levels of alcohol consumption, about half of binge drinkers engage in high-intensity drinking at least some times. High-intensity drinking is associated with unhealthful behaviors such as front-loading and with harmful outcomes such as impaired driving and a higher risk of dying that day.
Other, less common definitions rely on blood alcohol concentration. For example, the National Institute on Alcohol Abuse and Alcoholism defines the term "binge drinking" as a pattern of drinking that brings a person's blood alcohol concentration to 0.08 percent or above. Whatever the numerical definition used, heavy drinking or rapid consumption over a short period of time with the intention of becoming intoxicated is often implied when the term is used colloquially, since four or five drinks consumed over the course of a whole day and as an accompaniment to meals will not have the same effects as the same amount consumed over a couple of hours on an empty stomach.
An alternative colloquial term for binge drinking, "going on a bender", formerly implied a drinking spree of several days.
Causes
Culture as well as peer pressure play an important role in driving binge drinking. An increased risk of binge drinking in adulthood has been linked to having a grade point average of B or lower and to being unmarried.A 2007 survey summarised the reasons given for binge drinking by a group of 15- to 16-year-olds in Germany as including:
- "It's really fun"
- "I feel more sociable"
- "I feel happy"
- "I feel relaxed"
- "I forget my problems"
Semi-structured interviews were carried out with 64 14- to 17-year-olds who had an experience of binge drinking. These interviews found that motivations included social facilitation, which was ease in social situations, individual benefits such as getting a 'buzz', and influences of peer pressure and social norms.
Risk factors for binge drinking among adolescents include: low socioeconomic status, large amount of disposable money, sensation and novelty seeking, low self-control, delinquency and having delinquent friends. Other risk factors include: using alcohol as a coping strategy for emotional problems, excessive drinking among peers, poor relationship with parents, alcohol abuse by parents. Genetic conditions combined with a background of negative environmental factors increase the harmful use of alcohol. Additionally, the risk-taking behavior associated with adolescence promotes binge drinking.
Health effects
Acute intoxication, such as binge drinking and alcoholism, is known to be a potent risk factor for suicide. Binge drinking is also associated with an increased risk of unplanned and unprotected sex, unplanned pregnancies, and an increased risk of HIV infection. 10% of women and 19% of men have reported being assaulted as a result of alcohol. Males who drink more than 35 units of alcohol per week report being physically hurt as a result of alcohol, and 15% report physically hurting others as a result of their drinking. Almost 16% of binge drinkers report being taken advantage of sexually, and 8% report taking advantage of another person sexually as a result of alcohol within a one-year period. Heavy drinkers cause approximately 183,000 rapes and sexual assaults, 197,000 robberies, 661,000 aggravated assaults, and 1.7 million simple assaults each year. Binge drinking has been associated with a higher probability of divorce, spousal abuse, and poor job performance. Binge drinking can cause adverse effects on the body including effects on blood homeostasis and its circadian variation, cardiac rhythm, ischaemic heart disease, blood pressure, white blood cell activity, female reproductive hormone levels as well as adverse effects on the fetus. There is also evidence from animal studies that binge drinking causes brain damage. Binge drinking has been associated with lower abdominal pain in women. Ketoacidosis can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking. Alcohol affects brain development quite significantly especially during adolescence when the brain is still developing. The main lobes that are involved in decision making and complex thought processes are undergoing their final development phase during adolescence and binge drinking can negatively stunt the growth of these frontal lobes.Adolescence and young adulthood
The high levels of binge drinking among young people and the adverse consequences that include increased risk of alcoholism as an adult and liver disease make binge drinking a major public health issue. Recent research has found that young college binge drinkers who drink four or more drinks on more than three occasions in the past two weeks are statistically 19 times more likely to develop alcoholism than non-binge drinkers, though the direction of causality remains unclear. This is particularly interesting, as drinking for the sole purpose of getting drunk remains a major health and social problem on college campuses across the United States. Heavy and regular binge drinking during adolescence is associated with an increased risk of alcoholism. Approximately 40% of alcoholics report heavy drinking during adolescence. Repeated episodes of excessive drinking, especially at an early age, are thought to cause a profound increase in the risk of developing an alcohol-related disorder. Heavy drinking is also closely associated with depression. Those with severe depression have higher rates of alcohol abuse than those with low depression. College students who are depressed are more susceptible to use alcohol than college students who are not depressed. In a study conducted at Harvard University, it was found that about 32% of students surveyed were diagnosable for alcohol abuse and about 6% were diagnosed as alcohol dependent. Binge drinking is also becoming an increasing problem in Australian adolescents, the Australian School Students Alcohol and Drug survey conducted by the National Cancer Council discovered that around 33% of students between years 7 and 11 consumed alcohol in the week leading up to the survey, they also found that 10% of the students participated in binge drinking at a consumption level which is considered dangerous to adults. When the survey results were separated into age groups, the findings were that 13% of 15-year-olds and 22% of 17-year-olds had alcohol consumption levels above the daily maximum suggested to adults, and that 20% of 17-year-olds had a consumption level of alcohol considered risky to adults.Other risk factors that influence the development of alcohol abuse or alcoholism include social and genetic factors. Several researchers have found that starting to drink before the age of 15 is associated with a fourfold increased risk for developing alcoholism compared to people who delay drinking until age 20 or later. It has been estimated by some that if the age at which people started drinking could be delayed to age 20, there would be a 50% reduction in the number of cases of alcohol use disorder. However, it is unclear whether this is a causal relationship, or a function of confounding familial factors associated with both age at first drink and propensity for alcoholism.
The main cause of death among adolescents as a result of binge drinking is road traffic accidents; a third of all fatal road traffic accidents among 15- to 20-year-olds are associated with drinking alcohol. Cyclists and pedestrians are likely to have less spatial awareness and concentration while travelling after binge drinking and, also, it is more common that adolescents who binge-drink drive drunk or are the passenger of a drunk driver. It has been found that 50% of all head injuries in adolescents in the US are associated with alcohol consumption. Violence and suicide combine to become the third-most-common cause of death associated with binge drinking among adolescents. The suicide risk in adolescents is more than four times higher among binge drinkers than non-binge drinking adolescents.
Earlier sexual activity, increased changing of sexual partners, higher rate of unwanted pregnancy, higher rate of sexually transmitted diseases, infertility, and alcohol-related damage to the fetus during pregnancy are associated with binge drinking. Female binge drinkers are three times more likely to be sexually assaulted; 50% of adolescent girls reporting sexual assault were under the influence of alcohol or another psychotropic substance at the time.
Adolescents who regularly participated in binge drinking for several years show a smaller hippocampus brain region, in particular those who began drinking in early adolescence. Heavy binge drinking is associated with neurocognitive deficits of frontal lobe processing and impaired working memory as well as delayed auditory and verbal memory deficits. Animal studies suggest that the neurodegenerative effects of alcohol abuse during adolescence can be permanent. Research in humans, which used sophisticated brain scanning technology suggests that in adolescent teenagers, drinking more than four or five drinks once or twice a month results in subtle damage to the teenagers developing brain tissue, in particular the white matter. However, this research is primarily cross-sectional and done with fairly small sample sizes, making causality less certain.
Several studies have been conducted to discover if there is a link between binge drinking in adolescent years and becoming a chronic alcohol consumer when they transition into adulthood. A particular study conducted by the National Longitudinal Survey of Youth found that harmful drinking during adolescent years was significantly associated with the continuation of dangerous levels of alcohol consumption into adulthood. Binge drinking is a way for young adolescents to rely on alcohol as a way to cope with certain stress or depression.
In college, many students will join Greek organizations that revolve heavily around social drinking. For new members, especially in fraternities, binge drinking is heavily encouraged, and underage drinking is commonplace. Over the past few decades, many schools have cracked down on Greek events with strict policies and active monitoring. However, the festivities did not stop, and many members were not only affected during their time in college but also later in life. Studies have shown that both male and female students who were associated with Greek organizations were more likely to develop Alcohol Use Disorder in comparison to their non-Greek counterparts.
A 2023 systematic review highlights the non-addictive use of alcohol for managing developmental issues, personality traits, and psychiatric symptoms, emphasizing the need for informed, harm-controlled approaches to alcohol consumption within a personalized health policy framework.