Many people binge drink, which is defined as having 5 or more drinks in a short period of time for men and 4 or more drinks in a short period of time for women. An average "drink" contains about half an ounce of pure ethyl alcohol; this is the approximate amount of ethanol in a 12 oz. beer, a 4 to 5 oz. glass of wine, or a 1.25 oz. shot of hard liquor. Although some people who binge drink suffer from alcohol dependence (alcoholism), many do not have problems controlling their drinking other than their binges.
Of major concern is binge drinking by college students. College age individuals often report consuming more than 5 drinks during a binge. In fact, 60% of binging men in this age group consume 10 or more drinks per binge and about a third of college age women have 8 or more drinks during a binge, i.e., at least double the definitional limit. One study reported that about 7% of male college freshmen consumed 15 or more drinks per binge. This amount is approaching the number of drinks that can lead to coma or death.
The Centers for Disease Control and Prevention (CDC) recently reported differences in binge drinking behavior among people in various age groups. Using data collected in 2010, they discovered that about 28% of 18 to 24 year olds and 25 to 34 year olds binged during the previous month. These 2 age groups consumed 9.3 and 8.4 drinks per binge, respectively. Both groups averaged about 4 binges a month.
As people aged, the proportion who engaged in binge drinking decreased. About 19% of 35 to 44 year olds and 13% of 45 to 64 year olds binged during the previous month. The prevalence of binge drinking was lowest (3.8%) among those 65 years and older. The number of drinks consumed per binge also declined with age; those 65 years of age and older drank an average of 5.7 drinks per binge.
Although the prevalence of binge drinking and the number of drinks consumed per episode decreased with age, the frequency of binge drinking did not. In fact, it was highest (5.5 episodes per month) in the 65 and older age group.
The bottom line is that binge drinking is very common. The consequences are both costly and harmful. The CDC reports that over half of the 80,000 deaths attributed to alcohol use each year are related to binge drinking. Excessive alcohol use costs society over $200 billion annually, and 75% of these costs are related to binge drinking. Taxes on alcohol recover only a very small amount of the financial burden to society.
What are the dangers of binge drinking? The list is long and includes motor vehicle accidents, violence, suicide, alcohol poisoning (leading to coma and sometimes death), unplanned pregnancies, birth defects related to maternal alcohol use, high blood pressure, heart attacks, and sexually transmitted diseases.
Another serious complication of binge drinking is called a memory "blackout." Contrary to popular notions, a blackout has nothing to do with loss of consciousness. Rather, a blackout refers to a period of time in which a person is awake and can perform complex tasks (e.g., hold a conversation, drive a vehicle), but for which there is no later recollection. A blackout is thus a memory "gap." It results from the acute ability of alcohol to prevent new memory formation in the brain. The risk of experiencing a blackout is related to a person's blood alcohol level and the rate of increase in blood alcohol. Consuming a lot of drinks in a short period of time (binging), particularly on an empty stomach, increases risk. After a blackout, a person has no memory of what happened during the period of time that their brain's record button was blocked. Since a blackout occurs when one is highly intoxicated, it often happens when a person is exhibiting poor judgment and diminished impulse control. A lot can happen during a blackout. Not knowing what happened can be frightening and potentially very harmful, both medically and legally.
In moderation, alcohol is enjoyed by many and may have some health and social benefits. The problem with alcohol is that perhaps 20 to 25% of those who drink either have bouts of heavy drinking (binges) or develop more chronic drinking related conditions such as alcohol abuse and alcohol dependence. Alcohol dependence involves a rewiring of the brain's reward circuits and is associated with defects that involve thinking (cognition), emotion, and motivation. Once this rewiring has occurred, it is very difficult to reverse and is associated with occupational, social, and medical problems.
Individuals who have left home for college are prone to drink heavily. This is a significant issue on college campuses across the country. Elderly individuals who binge do so often, yet they may fall below the radar in that their friends and family may not be aware of or concerned about their drinking habits. We all need to be careful with alcohol use and to watch out for family members and friends when they binge drink or when they have a habit of drinking too much too often. Individuals of all ages should be encouraged to seek help before heavy drinking results in dangerous consequences or leads to alcoholism.
This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.