Most alcohol treatment clinicians use the term binge drinking to mean a drinking spree that lasts several days—an episode known colloquially as a “bender.” Such drinking is often a diagnostic sign of alcoholism or severe alcohol dependence.
In recent years, medical and public health researchers have defined binge drinking more broadly as the consumption of five or more alcoholic drinks on a single occasion. Some researchers specify a threshold of four or more drinks for women, who typically experience alcohol-related problems at lower consumption levels.
Researchers classify a person as a binge drinker if that individual has five or more (or four or more) drinks at least once during a particular time period, typically pegged at 2 weeks or a month. Critics call this research definition too expansive, especially in light of its pejorative connotations. One problem is that the definition fails to differentiate between a true bender and lower levels of heavy alcohol use, which can lead to public misunderstanding when news headlines proclaim binge drinking rates.
In addition, the definition does not account for the drinker’s body weight, the pace of alcohol consumption, or whether food is eaten at the same time. As a result, a man of 240 pounds who had one drink per hour would still be labeled a binge drinker even though his blood alcohol concentration (BAC) would remain below high-risk levels commonly associated with mental and physical impairment.
Accordingly, in 2004, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a U.S. federal agency that sponsors alcohol research, redefined a binge as a pattern of drinking alcohol that brings BAC to .08 percent (i.e., .08 gram of alcohol per 100 grams of blood) or above. This level was chosen because all 50 U.S. states have laws that define a BAC of .08 percent or higher as impaired driving. For the typical adult, a binge would result from consuming five or more drinks (male), or four or more drinks (female), in about 2 hours. NIAAA also distinguished binge drinking from both risky drinking, which involves reaching a peak BAC between .05 percent and .08 percent, and a bender, which involves 2 or more days of sustained heavy drinking.
Although the NIAAA definition is more precise, researchers have not yet embraced it, in part because of its complexity but primarily to ensure that their research can be compared with prior studies. Growing numbers of researchers no longer use the term binge drinking when describing alcohol use that merely exceeds the five-drink (or four-drink) threshold, but no alternative term has taken its place. The Journal of Studies on Alcohol, a leading periodical in the field, requires authors to use the term heavy, episodic drinking, but this is too cumbersome for everyday use. In this entry the phrase heavy drinking is used.
The Behavioral Risk Factor Surveillance System (BRFSS), a health survey organized and supported by the U.S. Centers for Disease Control and Prevention (CDC), defines heavy (binge) drinking as having five or more drinks on at least one occasion in the preceding month. The BRFSS for 2001 found that an estimated 14 percent of U.S. adults 18 years and older (22 percent of men, 7 percent of women) engaged in heavy drinking.
The heavy drinking rate for persons ages 18 to 20 years, who are younger than the U.S. legal drinking age, was 26 percent. Among persons of legal age, those ages 21 to 25 years had the greatest heavy drinking rate at 32 percent. The rate declined with increasing age: For those ages 26 to 34 years, the rate was 21 percent; for those 35 to 54 years, 14 percent; and for those 55 years and older, 4 percent. Heavy drinking rates by racial/ethnic group were as follows: Hispanic, 17 percent; white, 15 percent; and black, 10 percent.
The Monitoring the Future Study (MTF), an annual survey of U.S. middle school and high school students, defines heavy (binge) drinking as having five or more drinks in a row in the past 2 weeks. In 2005, the MTF reported that 28 percent of high school seniors (Grade 12) had engaged in heavy drinking, compared with 21 percent of students in Grade 10, and 10 percent of students in Grade 8. Historically, heavy drinking reached its peak in 1979, with a rate of 41 percent among high school seniors.
Heavy drinking is of particular concern at U.S. colleges and universities. The Harvard School of Public Health’s College Alcohol Study (CAS) defines heavy (binge) drinking using the 5/4-plus standard. In 2001, an estimated 44 percent of students attending 4-year institutions reported drinking at that level at least once during the 2 weeks preceding the survey. About one half of these students (23 percent) drank heavily three or more times during that period.
Heavy drinking is associated with increased mortality and morbidity. For example, an estimated 1,700 U.S. college students die each year from alcohol-related causes, including alcohol poisoning, interpersonal violence, and unintentional injury. Roughly 80 percent of these deaths are due to alcohol-related traffic crashes. Heavy drinking is also associated with poor academic performance, unprotected sex, vandalism, and other problems.
Several environmental factors are known to affect heavy drinking rates. Higher alcohol prices—brought about by increasing state excise taxes or eliminating “happy hours” and other low-price promotions— result in lower consumption and fewer alcohol-related problems. Likewise, communities with fewer alcohol retailers per capita also experience fewer alcohol-related problems. Responsible beverage service programs—involving identification checks to prevent underage customers from obtaining alcohol and procedures to avoid overservice—can also lead to lower alcohol use.
Based on data from the CAS, heavy drinking by underage U.S. college students is lower in communities where age 21 is the legal minimum age to buy alcohol. Heavy drinking by underage students is also lower in those communities where four or more of the following six laws are in place: keg registration, a .08 percent BAC per se law (that defines the legal limit by which alcohol-impaired driving is defined), and restrictions on happy hours, open containers, beer sold in pitchers, and billboards and other advertising.
- DeJong, William. 2001. “Finding Common Ground for Effective Campus-Based Prevention.” Psychology of Addictive Behaviors 15:292-96.
- Johnston, Lloyd D., Patrick M. O’Malley, Jerald G. Bachman, and John E. Schulenberg. 2006. Monitoring the Future National Survey Results on Drug Use, 1975-2005, vol. 1, Secondary School Students. NTH Publication No. 06-5883. Bethesda, MD: National Institute on Drug Abuse.
- National Institute on Alcohol Abuse and Alcoholism, Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism. 2002. “A Call to Action: Changing the Culture of Drinking at U.S. Colleges.” Washington, DC: National Institutes of Health.
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