The purpose of this document is to provide: (1) a brief background on the various ways that binge drinking has been defined (currently and historically), and (2) a summary of binge drinking patterns in the United States. Binge drinking among adolescents and young adults—both within and outside of college settings—is of great concern given the severity of the associated consequences. Consider these statistics:
- When compared to other types of drinkers, binge drinkers are more likely to experience a number of serious short- and longer-term consequences (U.S. Department of Health and Human Services, 2007, Bonnie & O'Connell, 2004, as cited in “Focus on Student Binge Drinking: The Prevalence and Consequences”, CAPT, 2011). These consequences may be particularly important for underage binge drinkers, a significant number of whom may continue to binge drink into adulthood (U.S. Department of Health and Human Services, 2007, Bonnie & O'Connell, 2004, Jefferis, Power, & Manor, 2005, as cited in “Focus on Student Binge Drinking…”, CAPT, 2011).
- A recent national, longitudinal study found that males who were binge drinkers in adolescence were twice as likely to binge drink in adulthood, and that females who were binge drinkers in adolescence were more than three times as likely to binge drink in adulthood (McCarty, et al., 2004, as cited in “Focus on Student Binge Drinking…”, CAPT, 2011).
- Adolescent binge drinkers are three times more likely than those who do not binge drink to develop an alcohol-related disorder as an adult. The younger a person starts to binge drink, the more his/her risk for developing an alcohol-related disorder is magnified (Hingson & Kenkel, 2004, as cited in “Focus on Student Binge Drinking…”, CAPT, 2011).
- National Youth Risk Behavior Survey (YRBS) data has also shown that underage youth who engage in binge drinking are approximately 11 times more likely than other underage drinkers to engage in additional risky behaviors, like tobacco and other drug use, physical violence, and unsafe sex (Miller et al., 2007, as cited in “Focus on Student Binge Drinking…”, CAPT, 2011).
Understanding the Terminology
The term “binge” originated as a clinical description of a pattern of problematic alcohol use that was characterized by a period of heavy use (usually over a period of several days) followed by a period of abstinence. Over time the term shifted to “binge drinking” which initially was defined as at least 5 drinks consumed during the same drinking session (Cahalan, Cisin, Crosslet, 1965 as cited in Courtney & Polich, 2009). In the mid-1990s, as part of the College Alcohol Study conducted at the Harvard School of Public Health, the definition of binge drinking was modified to 5 or more drinks for men and 4 or more drinks for women on a single occasion within the past 2 weeks (Weshsler, Davenport, Dowdall, Moeykens & Castillo, 1994 as cited in Courtney & Polich, 2009). The different thresholds selected for men and women were intended to reflect different alcohol metabolism rates between the sexes, and to account for the number of drinks that tend to place individuals at an increased risk for experiencing various alcohol-related social, economic, legal, and health consequences (e.g., fights, trouble with police, injuries, drunk driving).
In 2004, the National Institute of Alcohol Abuse and Alcoholism (NIAAA) proposed the following definition for binge drinking: “a pattern of drinking alcohol that brings BAC to 0.08 gram percent or above. For the typical adult, this pattern corresponds to consuming five or more drinks (male), or four or more drinks (female), in about two hours” (Courtney & Polich, 2009). This definition recognizes different thresholds for men and women and defines a specific period of time in which the drinking occurs. Most recent research adhere to this definition, although researchers may assess binge drinking frequency using different time periods (e.g., number of times binge drinking occurred in past two weeks, past month).
Researchers sometimes use the term “heavy episodic drinking” synonymously with binge drinking to characterize a pattern of heavy drinking over a defined (relatively short) period of time (Courtney & Polich, 2009). Researchers also sometimes use a similar term, “risky single occasion drinking” (RSOD) to describe this pattern of drinking. This term has been used more frequently in studies of European adolescents and adults. Cut-off points for RSOD have varied (5+ to 8+ drinks per occasion) at least in part due to differences in standard drink amounts across countries, leading researchers to suggest that RSOD be defined as 60-70 grams of ethanol for men and 40-60 grams of ethanol for women per drinking occasion (Gmel et al., 2010). Finally, the term “risky drinking” has also been used to describe this pattern of drinking. Risky drinking has been defined as consumption of large amounts (greater than 4 standard drinks) of alcohol on a single occasion, as well as drinking in situations likely to result in harm for young people (Gilligan, Kypri & Lubman, 2012).
For the purpose of this literature review, we have used the broadest definition of binge or heavy episodic drinking. The most common definition found in the research was 5+ drinks per drinking occasion (studies did not always distinguish different amounts by gender). When different definitions were used, they are noted in the study descriptions.
Patterns and Rates
Data from SAMHSA’s National Survey on Drug Use and Health (NSDUH) from 2008-2009 reveal that rates of past-month binge drinking for underage youth (age 12-20) in the northeast range from 16.7% (Maryland) to 24.6% (Vermont). In fact, nine of the 11 states in the CAPT’s northeast service area have rates of past-month underage binge drinking that are higher than the national rate of 17.7% . Younger binge drinkers are more likely to drink with their friends and in another person’s home (Mayer, et al., 1998, as cited in “Focus on Student Binge Drinking…”, CAPT, 2011). For youth, binge drinking exhibits seasonal fluctuations, with increasing rates seen around exams and various social occasions, such as homecoming, prom, and various sporting events (Bonnie & O'Connell, 2004, as cited in “Focus on Student Binge Drinking…”, CAPT, 2011).
NSDUH data from 2008-2009 indicate that rates of binge drinking nationally are highest among those aged 18-25 years: less than a quarter of individuals over the age of 26 nationally have engaged in past-month binge drinking (22.3%). While the lowest binge drinking rates are found among older adult populations, Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) data from 2009 still indicate that approximately one in ten (9.7%) older adults (age 55-64) nationally have engaged in past month binge drinking .
When examining data among older adult populations, it is also critical to note that national surveys like the BRFSS and NSDUH may actually underrepresent the amount of binge drinking that occurs among older adults. Recommendations from the National Institute on Alcohol Abuse and Alcoholism suggest that for older adults (60+), binge drinking should be defined as no more than three drinks per drinking day for men, and no more than two drinks per drinking day for women. Both NSDUH and BRFSS define binge drinking using general adult population definitions (i.e., five or more drinks on one occasion for NSDUH; four or more drinks on one occasion period for women, five or more drinks on one occasion for men for BRFSS), meaning that rates of binge drinking, particularly for those aged 60 and over, are likely underestimated.
Courtney, K.E. and Polich, E. (2009). Binge drinking in young adults: Data, definitions, and determinants. Psychological Bulletin, 135 (1); 142-156.
Bonnie, R.J., and O'Connell, M.E., eds. (2004). Reducing underage drinking: A collective responsibility. Washington, DC: The National Academies Press.
Gmel, G., Kuntsche, E., and Rehm, J. (2010). Risky single-occasion drinking: Bingeing is not bingeing. Addiction, 106; 1037-1045.
SAMSHA’s Center for the Application of Prevention Technologies (CAPT), Northeast Resource Team (2011). Focus on Student Binge Drinking: The Prevalence and Consequences.
Gilligan, C., Kypri, K., and Lubman, D. (2012). Changing parental behaviour to reduce risky drinking among adolescents: Current evidence and future directions. Alcohol and Alcoholism, 47 (3); 349-354.
Hingson, R., and Kenkel, D. (2004). Social, health, and economic consequences of underage drinking. In R.J. Bonnie and M.E. O'Connell, Editors, Reducing underage drinking: A collective responsibility. Washington, DC: The National Academies Press, 351-382.
Jefferis, B., Power, C., and Manor, O. (2005). Adolescent drinking level and adult binge drinking in a national birth cohort. Addiction, 100(4), 543-549.
Mayer, R., Forster, J., Murray, D., and Wagenaar, A. (1998). Social settings and situations of underage drinking. Journal of Studies on Alcohol, 59(2), 207-215
McCarty, C., Ebel, B., Garrison, M., DiGiuseppe, D., Christakis, D., and Rivara, F. (2004). Continuity of binge and harmful drinking from late adolescence to early adulthood. Pediatrics, 114(3), 714-719.
Miller, J., Naimi, T., Brewer, R., and Jones, S. (2007). Binge drinking and associated health risk behaviors among high school students. Pediatrics, 119(1), 76-85.
U.S. Department of Health and Human Services (2007). The Surgeon General's Call to Action To Prevent and Reduce Underage Drinking. U.S. Department of Health and Human Services, Office of the Surgeon General.
Developed under the Substance Abuse and Mental Health Services Administration’s Center for the Application of Prevention Technologies contract (Reference #HHSS277200800004C).