Binge drinking
Encyclopedia
Binge drinking or heavy episodic drinking is the modern epithet for drinking alcoholic beverages
with the primary intention of becoming intoxicated by heavy consumption of alcohol over a short period of time. It is a kind of purposeful drinking style 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 or last up to several days. Due to the long-term effects of alcohol
misuse, binge drinking is considered to be a major public health issue.
Binge drinking is associated with a profound social harm, economic costs as well as increased disease burden. Binge drinking is more common in males, during adolescence and young adulthood. Most binge drinkers are not familiar with the risks associated with binge drinking. Heavy regular binge drinking is associated with adverse effects on neurologic, cardiac, gastrointestinal, hematologic, immune, musculoskeletal organ systems as well as increasing the risk of alcohol induced psychiatric disorders. Up to one third of adolescents binge drink, with six percent reaching the threshold of having an alcohol related substance use disorder
. Approximately one in twenty five women binge drink 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.
(male), or four or more drinks (female), on one occasion. 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 as drinking more than twice the daily limit, that is, drinking eight units or more for men or six units or more for women (roughly equivalent to five or four American standard drinks, respectively). Controversy remains on how to best define binge drinking, as some people feel that the official definition is too broad and/or fails to take into account the context in which the drinks are consumed.
Other, less common definitions are based on blood alcohol concentration (BAC). For example, the National Institute on Alcohol Abuse and Alcoholism
(NIAAA) recently redefined the term "binge drinking" as any time one reaches a peak BAC of 0.08% or higher as opposed to some (arguably) arbitrary number of drinks in an evening. However, even that definition is not without controversy. One study showed that university students often have numerous different definitions of "binge drinking" depending on their own drinking habits, with drinkers having significantly higher definitions than nondrinkers. 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 one can remain relatively sober if the four or five drinks are spread out widely over the course of a long evening on a reasonably full stomach.
In the United States
, sometimes the term "extreme drinking" or "industrial-strength bingeing" is used to describe a more severe form of (single-evening) binge drinking; it is often defined as ten or more standard American drinks on a single occasion (sometimes as eight drinks for women). If done over 2 to 3 hours, a typical adult would have a peak BAC of at least 0.20%.
are known potent risk factors for suicide. Binge drinking is commonly associated with damaged and lost friendships, accidents, law-breaking (especially vandalism
and violence
), arguments, neglect of obligations, and other acts that are later regretted. Binge drinking is also associated with an increased risk of unplanned sex, unprotected sex, unplanned pregnancies, and an increased risk of HIV infection. 10 percent of women and 19 percent 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 percent report physically hurting others as a result of their drinking. Almost 16 percent of binge drinkers report being taken advantage of sexually, and 8 percent report taking advantage of another person sexually as a result of alcohol within a 1 year period. 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.
than non-binge drinkers, though the direction of causality remains unclear. Heavy and regular binge drinking during adolescence is associated with an increased risk of alcoholism. Approximately 40 percent 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 (ICD-10, harmful use/dependence syndrome). Other risk factors which influence the development of alcohol abuse
or alcoholism
include, social and genetic factors. Several researchers have found that starting drinking 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 percent 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 (and other) 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 additionally adolescents who binge drink more commonly drink drive or are the passenger of a drunk driver. It has been found that 50 percent of all head injuries in adolescents in the USA 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 4 times higher among binge drinkers than non-binge drinking adolescents.
Earlier sexual activity, increased changing of sexual partners, higher rate of unwanted (teenage) pregnancy, higher rate of sexually transmitted diseases, infertility, alcohol-related damage to the fetus is associated with binge drinking. Female binge drinkers are three times more likely to be victims of sexual assault; 50 percent 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, particularly 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, though whether such outcomes carry over to humans remains unclear.
. Impairments in spatial working memory and pattern recognition tasks also have been found in heavy binge drinkers. Impulse control is also impaired in binge drinkers, especially female binge drinkers. Additionally, immediate and delayed recall of verbal and visual information is impaired; conversely, semantic organizational ability is better in binge drinkers compared to non-binge drinkers. Studies in adolescents have shown that regular binge drinking may cause long-lasting cognitive impairments, though the threshold needed to produce significant effects remains unclear. Cognitive impairment in adults is also unclear, as one study found no association between binge drinking and cognitive impairment.
Binge drinking regimes are associated with causing an imbalance between inhibitory and excitatory amino acids and changes in monoamines release in the central nervous system, which increases neurotoxicity and may result in cogitive impairments, psychological problems and in long-term heavy binge drinkers may cause irreversible brain damage in both adolescents and adults.
While several rat studies indicate that alcohol is more toxic during adolescence than adulthood, some researchers believe that it remains unclear whether this is also the case in humans. Though heavy binge drinking adolescent humans show impaired brain activity during memory tests and underdeveloped brain structures compared to adolescents who did not binge drink, they argue that these findings are similar to adult alcoholics who did not abuse alcohol during adolescence. Extrapolation from animal studies to humans is notoriously difficult, and a review by the group Choose Responsibility
concluded that alcohol's long-term damage to cognitive processes was the same regardless of whether heavy drinking commenced during adolescence or later.
, alcohol-related birth defects as well as alcohol-related neurodevelopmental disorders. The affected children after birth can suffer mental retardation
and problems with learning, memory, attention, problem solving and problems with mental health and social interactions. Deformities in facial features, skeletal and body organs as well as a smaller head circumference are also sometimes present in these children. Studies in sheep indicate that fetal neurotoxicity induced by alcohol may be due to acidaemia and hypercapnia
. Binge drinking three or more times during pregnancy has been associated with an increased risk of stillbirth
.
. Binge drinking increases the risk of stroke by 10 times. In countries where binge drinking is commonplace, rates of sudden death on the weekend in young adults and middle aged people increase significantly. The withdrawal phase after an episode of binge drinking is particularly associated with ischaemic stroke as well as subarachnoid haemorrhage and intracerebral haemorrhage in younger men. In individuals who have an underlying cardiac disorder a binge on alcohol increases the risk of silent myocardial ischaemia as well as angina
. Binge drinking has negative effects on metabolism, lipid profile, blood coagulation and fibrinolysis, blood pressure and vascular tone and is associated with embolic stroke and acute myocardial infarction
. Due to these risks experts believe that it is extremely important to warn people of the risks of binge drinking. Binge drinking by people who would otherwise be considered to be light drinkers is associated with an increased risk of cardiovascular problems and mortality. Binge drinking increases cardiovascular toxicity due to its adverse effects on the electrical conduction system of the heart and the process of atherothrombosis.
may rupture if overfilled and not emptied; however, urination can alleviate this problem. This can occur in the case of binge drinkers who have consumed very large quantities, but are not aware, due to stupor, of the need to urinate. This condition is very rare in women, but does occur. Symptoms include localized pain and uraemia (poisoning due to reabsorbed waste). The recovery rate is high, with most fatalities due to septic blood poisoning
. A person is more likely to urinate while passed out before the bladder ruptures, as alcohol relaxes the muscles that normally control their bladder.
The reasons for binge drinking by children and adolescents include;
Other causes include feeling more grown up and fitting in with peers and to increase the chance of sexual encounters. Some also drink to alleviate stress or anxiety.
Risk factors for binge drinking among adolescents include; low socioeconomic status, large amount of disposable (pocket) money, sensation/novelty seeking, low self-control, delinquency and having delinquent friends. Other risk factors include: Using alcohol as a coping strategy for emotional problems (more common in adolescent girls), 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.
. The findings in humans have been largely concordant with animal studies. Such animal studies find that heavy and regular binge drinking causes neurodegeneration in corticolimbic brain regions areas which are involved in learning and spatial memory, such as the olfactory bulb
, piriform cortex
, perirhinal cortex
, entorhinal cortex
, and the hippocampal dentate gyrus
. A study in rats found that a heavy 2 day drinking binge caused extensive neurodegeneration in the entorhinal cortex
with resultant learning deficits. While brain damage from binge drinking is known to occur as a result of binge drinking patterns, it is unclear how long drinking sessions last and how regular binge drinking is done to cause brain damage in humans. One study found that humans who drank at least 100 drinks (male) or 80 drinks (female) per month (concentrated to 21 occasions or less per month) throughout a 3 year period had impaired decision making skills compared to non-binge drinkers. Repeated acute withdrawal from alcohol which occurs in heavy binge drinkers has been shown in several studies to be associated with cognitive deficits as a result of neural kindling
; neural kindling due to repeated withdrawals is believed to be the mechanism of cognitive damage in both binge drinkers and alcoholics. Neuronal kindling also leads to each subsequent acute withdrawal episode being more severe than previous withdrawal
episodes.
Blackouts
, a form of amnesia which occurs in binge drinkers may be due to suppressed hippocampus
function with rebound NMDA (glutamate) activity combined with excessive glucocorticoid release induced by the stress of repeated intoxication followed by acute withdrawal/abstinence is the proposed mechanism of neural kindling leading to neurotoxicity of structures involved in learning and memory within the brain of binge drinkers. Frontal lobe processing may become impaired as a result of binge drinking with resultant neurocognitive deficits and impaired working memory.
Alcohol suppresses brain function during intoxication; but upon withdrawal rebound effects occur in the glutamate/NMDA system and with excess glutamate activity glucocorticoid
release; due to the repeated intoxication, followed by acute withdrawal a neurotoxic effect develops which damages the central nervous system, leading to persisting impairments in verbal and nonverbal cognitive abilities as well as impairment of spatial orientation. Due to developmental processes occurring during adolescence including myelinization and restructuring of the synapses, adolescents are thought to be more vulnerable to the neurotoxic effects of alcohol.
Age and genetic factors influence the risk of developing alcohol related neurotoxicity
. Adolescence, especially early adolescence (i.e. before age 15), is a critical and delicate developmental stage for specialised neuronal and synaptic
systems mature. This critical developmental stage is where life long adult traits e.g., talents, reasoning and complex skills mature; however alcohol and in particular binge drinking may disrupt and interfere with this developmental process. Adolescence is also a period of development characterised by a high level of novel seeking, thrill seeking and risk taking behaviour and thus alcohol and other drug experimentation and abuse is common. An adolescent rat study found that a relatively short exposure to high levels of alcohol resulted long-lasting changes in functional brain activity with corresponding abnormalities in EEG brain waves which persisted into adulthood, including persisting disturbances in sleep EEG with a reduction in slow wave sleep. These EEG findings are similar to premature aging. According to one review of the literature, if the developmental stage of adolescence is similar to the developmental stage of the fetus with regard to sensitivity to the neurotoxic effects of alcohol, and if long-lasting or permanent damage to the brain occurs similar to what animal studies suggest, then this represents a major public health issue due to the high levels of alcohol use by adolescents.
asserted that lowering the legal drinking age
to 18 (presumably) was one way to curb the "culture of dangerous binge drinking" among college students. This idea is currently the subject of controversy. Proponents argue that the 21 law forces drinking underground and makes it more dangerous than it has to be, while opponents argue that lowering the age may only make the situation worse.
Adolescents who misuse alcohol can benefit from interventions aimed at risk reduction. For more severe cases a psychotherapeutic intervention involving parents or guardians is recommended. An effective strategy of intervention for adolescents whose binge drinking leads to admission to hospital, e.g. for alcohol poisoning or injury, is manualised brief interventions at the hospital in one to four counselling sessions each lasting 30 to 60 minutes conducted by trained staff. Evaluation of personal pattern of drinking and associated risks and an emphasis on personal responsibility in a non-condescending manner is recommended during the intervention; discussing and informing/educating the adolescent of possible negative short and long-term consequences of drinking
is recommended. The setting of goals and rules to achieve those goals is also recommended during intervention with problem binge drinking adolescents.
Increasing public information and awareness regarding the risks of binge drinking, conducting interviews in emergency departments of young people suspected of harmful drinking patterns and trying to persuade them to accept individual counseling in youth addiction counseling services are effective strategies for reducing the harm of binge drinking. Encouraging recreational training activities such as adventurous training activities such as climbing or driving can be an alternative "natural buzzes" to alcohol misuse. Additionally the provision of educational content about the risks of binge drinking and a risk assessment are beneficial during intervention with young binge drinkers and a referral in the case of an alcohol use disorder for specialised help.
Men are more likely to binge drink (up to 81 percent of alcohol binges are done by men) than women and men are also more likely to develop alcohol dependence than women. People who are homozygous for the ALDH2 gene are less likely to binge drink due to severe adverse effects which occur even with moderate amounts of alcohol consumption.
Centers for Disease Control and Prevention (CDC) released a study in October 2011 that showed that in the United States, binge drinking costs society $223-billion a year, which amounts to $2 per drink. These costs include health care costs for alcohol-related issues, including liver cirrhosis, loss of work productivity, proper damage due to drunk driving, and expenditures related to criminal acts.
Drink
A drink, or beverage, is a liquid which is specifically prepared for human consumption. In addition to fulfilling a basic human need, beverages form part of the culture of human society.-Water:...
with the primary intention of becoming intoxicated by heavy consumption of alcohol over a short period of time. It is a kind of purposeful drinking style 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 or last up to several days. Due to the long-term effects of alcohol
Long-term effects of alcohol
The long term effects of alcohol range from possible health benefits for low levels of alcohol consumption to severe detrimental effects in cases of chronic alcohol abuse...
misuse, binge drinking is considered to be a major public health issue.
Binge drinking is associated with a profound social harm, economic costs as well as increased disease burden. Binge drinking is more common in males, during adolescence and young adulthood. Most binge drinkers are not familiar with the risks associated with binge drinking. Heavy regular binge drinking is associated with adverse effects on neurologic, cardiac, gastrointestinal, hematologic, immune, musculoskeletal organ systems as well as increasing the risk of alcohol induced psychiatric disorders. Up to one third of adolescents binge drink, with six percent reaching the threshold of having an alcohol related substance use disorder
Substance use disorder
Substance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder"....
. Approximately one in twenty five women binge drink during pregnancy, which can lead to fetal alcohol syndrome
Fetal alcohol syndrome
Fetal alcohol syndrome is a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy. Current research also implicates other lifestyle choices made by the prospective mother...
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
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
. A large number of adolescents who binge drink also consume other psychotropic substances.
Definition
Binge drinking is defined as episodic excessive drinking. There is currently no world wide consensus on how many drinks constitute a "binge", but in the USA, the term is often taken to mean consuming five or more standard drinksAlcohol equivalence
Alcohol equivalence is a system of standard drink sizes of various alcoholic beverages. The amount of alcohol that is contained in a standard drink varies widely by country.-New Zealand:...
(male), or four or more drinks (female), on one occasion. This is colloquially known as the "5/4 definition", and depending on the source the timeframe can vary. In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, binge drinking is defined as drinking more than twice the daily limit, that is, drinking eight units or more for men or six units or more for women (roughly equivalent to five or four American standard drinks, respectively). Controversy remains on how to best define binge drinking, as some people feel that the official definition is too broad and/or fails to take into account the context in which the drinks are consumed.
Other, less common definitions are based on blood alcohol concentration (BAC). For example, the National Institute on Alcohol Abuse and Alcoholism
National Institute on Alcohol Abuse and Alcoholism
The National Institute on Alcohol Abuse and Alcoholism , as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems...
(NIAAA) recently redefined the term "binge drinking" as any time one reaches a peak BAC of 0.08% or higher as opposed to some (arguably) arbitrary number of drinks in an evening. However, even that definition is not without controversy. One study showed that university students often have numerous different definitions of "binge drinking" depending on their own drinking habits, with drinkers having significantly higher definitions than nondrinkers. 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 one can remain relatively sober if the four or five drinks are spread out widely over the course of a long evening on a reasonably full stomach.
In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, sometimes the term "extreme drinking" or "industrial-strength bingeing" is used to describe a more severe form of (single-evening) binge drinking; it is often defined as ten or more standard American drinks on a single occasion (sometimes as eight drinks for women). If done over 2 to 3 hours, a typical adult would have a peak BAC of at least 0.20%.
Health effects
Acute intoxication, such as binge drinking, and alcoholismAlcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
are known potent risk factors for suicide. Binge drinking is commonly associated with damaged and lost friendships, accidents, law-breaking (especially vandalism
Vandalism
Vandalism is the behaviour attributed originally to the Vandals, by the Romans, in respect of culture: ruthless destruction or spoiling of anything beautiful or venerable...
and violence
Violence
Violence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...
), arguments, neglect of obligations, and other acts that are later regretted. Binge drinking is also associated with an increased risk of unplanned sex, unprotected sex, unplanned pregnancies, and an increased risk of HIV infection. 10 percent of women and 19 percent 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 percent report physically hurting others as a result of their drinking. Almost 16 percent of binge drinkers report being taken advantage of sexually, and 8 percent report taking advantage of another person sexually as a result of alcohol within a 1 year period. Binge drinking can cause adverse effects on the body including effects on blood homeostasis
Homeostasis
Homeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
and its circadian variation, cardiac rhythm, ischaemic heart disease
Ischaemic heart disease
Ischaemic or ischemic heart disease , or myocardial ischaemia, is a disease characterized by ischaemia of the heart muscle, usually due to coronary artery disease...
, blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
, white blood cell
White blood cell
White blood cells, or leukocytes , are cells of the immune system involved in defending the body against both infectious disease and foreign materials. Five different and diverse types of leukocytes exist, but they are all produced and derived from a multipotent cell in the bone marrow known as a...
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
Ketoacidosis
Ketoacidosis is a metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids. The two common ketones produced in humans are acetoacetic acid and β-hydroxybutyrate....
can occur in individuals who chronically abuse alcohol and have a recent history of binge drinking.
Adolescence and young adulthood
The high levels of binge drinking among young people and the adverse consequences which includes 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 4/5+ drinks on more than 3 occasions in the past 2 weeks are statistically 19 times more likely to develop alcoholismAlcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
than non-binge drinkers, though the direction of causality remains unclear. Heavy and regular binge drinking during adolescence is associated with an increased risk of alcoholism. Approximately 40 percent 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 (ICD-10, harmful use/dependence syndrome). Other risk factors which influence the development of alcohol abuse
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...
or alcoholism
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
include, social and genetic factors. Several researchers have found that starting drinking 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 percent 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 (and other) 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 additionally adolescents who binge drink more commonly drink drive or are the passenger of a drunk driver. It has been found that 50 percent of all head injuries in adolescents in the USA 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 4 times higher among binge drinkers than non-binge drinking adolescents.
Earlier sexual activity, increased changing of sexual partners, higher rate of unwanted (teenage) pregnancy, higher rate of sexually transmitted diseases, infertility, alcohol-related damage to the fetus is associated with binge drinking. Female binge drinkers are three times more likely to be victims of sexual assault; 50 percent 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
Hippocampus
The hippocampus is a major component of the brains of humans and other vertebrates. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation. Humans and other mammals have two hippocampi, one in...
brain region, particularly 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, though whether such outcomes carry over to humans remains unclear.
Central nervous system
Heavy binge drinkers tend to have delayed auditory and verbal memory and deficits in executive planning function and episodic memory, which are similar to deficits seen in Korsakoff's syndromeKorsakoff's syndrome
Korsakoff's syndrome is a neurological disorder caused by the lack of thiamine in the brain. Its onset is linked to chronic alcohol abuse and/or severe malnutrition...
. Impairments in spatial working memory and pattern recognition tasks also have been found in heavy binge drinkers. Impulse control is also impaired in binge drinkers, especially female binge drinkers. Additionally, immediate and delayed recall of verbal and visual information is impaired; conversely, semantic organizational ability is better in binge drinkers compared to non-binge drinkers. Studies in adolescents have shown that regular binge drinking may cause long-lasting cognitive impairments, though the threshold needed to produce significant effects remains unclear. Cognitive impairment in adults is also unclear, as one study found no association between binge drinking and cognitive impairment.
Binge drinking regimes are associated with causing an imbalance between inhibitory and excitatory amino acids and changes in monoamines release in the central nervous system, which increases neurotoxicity and may result in cogitive impairments, psychological problems and in long-term heavy binge drinkers may cause irreversible brain damage in both adolescents and adults.
While several rat studies indicate that alcohol is more toxic during adolescence than adulthood, some researchers believe that it remains unclear whether this is also the case in humans. Though heavy binge drinking adolescent humans show impaired brain activity during memory tests and underdeveloped brain structures compared to adolescents who did not binge drink, they argue that these findings are similar to adult alcoholics who did not abuse alcohol during adolescence. Extrapolation from animal studies to humans is notoriously difficult, and a review by the group Choose Responsibility
Choose Responsibility
Choose Responsibility is a non-profit organization in the United States that promotes public awareness of the dangers of excessive and reckless alcohol consumption by young adults. The main goal is to lower the minimum drinking age by educating the public. It was founded and is directed by Dr...
concluded that alcohol's long-term damage to cognitive processes was the same regardless of whether heavy drinking commenced during adolescence or later.
Pregnancy
Binge drinking is a more important factor rather than average alcohol intake, with regard to the severity of alcohol induced damage to the fetus. Alcohol has definite long-term adverse effects on the fetus, in particular impaired attentional skills and may lead to psychiatric disorders when the child grows up. Approximately one in five nonpregnant women binge drink and one in twenty five pregnant women binge drink. Binge drinking during pregnancy is associated with fetal alcohol syndromeFetal alcohol syndrome
Fetal alcohol syndrome is a pattern of mental and physical defects that can develop in a fetus in association with high levels of alcohol consumption during pregnancy. Current research also implicates other lifestyle choices made by the prospective mother...
, alcohol-related birth defects as well as alcohol-related neurodevelopmental disorders. The affected children after birth can suffer mental retardation
Mental retardation
Mental retardation is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors...
and problems with learning, memory, attention, problem solving and problems with mental health and social interactions. Deformities in facial features, skeletal and body organs as well as a smaller head circumference are also sometimes present in these children. Studies in sheep indicate that fetal neurotoxicity induced by alcohol may be due to acidaemia and hypercapnia
Hypercapnia
Hypercapnia or hypercapnea , also known as hypercarbia, is a condition where there is too much carbon dioxide in the blood...
. Binge drinking three or more times during pregnancy has been associated with an increased risk of stillbirth
Stillbirth
A stillbirth occurs when a fetus has died in the uterus. The Australian definition specifies that fetal death is termed a stillbirth after 20 weeks gestation or the fetus weighs more than . Once the fetus has died the mother still has contractions and remains undelivered. The term is often used in...
.
Sudden death
Binge drinking is also associated with strokes and sudden deathSudden death
In a sport or game, sudden death is a form of competition where play ends as soon as one competitor is ahead of the others, with that competitor becoming the winner. Sudden death is typically used as a tiebreaker when a contest is tied at the end of the normal playing time or the completion of...
. Binge drinking increases the risk of stroke by 10 times. In countries where binge drinking is commonplace, rates of sudden death on the weekend in young adults and middle aged people increase significantly. The withdrawal phase after an episode of binge drinking is particularly associated with ischaemic stroke as well as subarachnoid haemorrhage and intracerebral haemorrhage in younger men. In individuals who have an underlying cardiac disorder a binge on alcohol increases the risk of silent myocardial ischaemia as well as angina
Angina
Angina pectoris, commonly known as angina, is chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries . Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries...
. Binge drinking has negative effects on metabolism, lipid profile, blood coagulation and fibrinolysis, blood pressure and vascular tone and is associated with embolic stroke and acute myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
. Due to these risks experts believe that it is extremely important to warn people of the risks of binge drinking. Binge drinking by people who would otherwise be considered to be light drinkers is associated with an increased risk of cardiovascular problems and mortality. Binge drinking increases cardiovascular toxicity due to its adverse effects on the electrical conduction system of the heart and the process of atherothrombosis.
Urinary system
The bladderBladder
Bladder usually refers to an anatomical hollow organBladder may also refer to:-Biology:* Urinary bladder in humans** Urinary bladder ** Bladder control; see Urinary incontinence** Artificial urinary bladder, in humans...
may rupture if overfilled and not emptied; however, urination can alleviate this problem. This can occur in the case of binge drinkers who have consumed very large quantities, but are not aware, due to stupor, of the need to urinate. This condition is very rare in women, but does occur. Symptoms include localized pain and uraemia (poisoning due to reabsorbed waste). The recovery rate is high, with most fatalities due to septic blood poisoning
Bacteremia
Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal....
. A person is more likely to urinate while passed out before the bladder ruptures, as alcohol relaxes the muscles that normally control their bladder.
Acute hazards
The most common risk of consuming massive quantities of alcohol in a short period of time is a dangerously high blood alcohol level. The result is called alcohol poisoning (overdose), which can be fatal. Choking on (or inhalation of) vomit is also a potential cause of death, as are injuries from falls, fights, motor vehicle and bicycle accidents.Cause
In adults, binge drinking is more common in people who have never been married, score a grade B or less in education, and is also higher in adults who have little interest in religion. Culture as well as peer pressure play an important role in driving binge drinking.The reasons for binge drinking by children and adolescents include;
- It's really fun (76%)
- I feel more sociable (65%)
- I feel happy/relaxed (51% each)
- I forget my problems (41%)
Other causes include feeling more grown up and fitting in with peers and to increase the chance of sexual encounters. Some also drink to alleviate stress or anxiety.
Risk factors for binge drinking among adolescents include; low socioeconomic status, large amount of disposable (pocket) money, sensation/novelty seeking, low self-control, delinquency and having delinquent friends. Other risk factors include: Using alcohol as a coping strategy for emotional problems (more common in adolescent girls), 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.
Pathophysiology
Impairments in impulse control in binge drinkers, which is more prominent in female binge drinkers, is due to dysfunction of the frontal lobeFrontal lobe
The frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
. The findings in humans have been largely concordant with animal studies. Such animal studies find that heavy and regular binge drinking causes neurodegeneration in corticolimbic brain regions areas which are involved in learning and spatial memory, such as the olfactory bulb
Olfactory bulb
The olfactory bulb is a structure of the vertebrate forebrain involved in olfaction, the perception of odors.-Anatomy:In most vertebrates, the olfactory bulb is the most rostral part of the brain. In humans, however, the olfactory bulb is on the inferior side of the brain...
, piriform cortex
Piriform cortex
In anatomy of animals, the piriform cortex, or pyriform cortex is a region in the brain.-Anatomy and function:The piriform cortex is part of the rhinencephalon situated in the telencephalon....
, perirhinal cortex
Perirhinal cortex
Perirhinal cortex is a cortical region in the medial temporal lobe that is made up of Brodmann areas 35 and 36. In rats, it is located along and dorsal to the rhinal sulcus. It receives highly-processed sensory information from all sensory regions, and is generally accepted to be an important...
, entorhinal cortex
Entorhinal cortex
The entorhinal cortex is located in the medial temporal lobe and functions as a hub in a widespread network for memory and navigation. The EC is the main interface between the hippocampus and neocortex...
, and the hippocampal dentate gyrus
Dentate gyrus
The dentate gyrus is part of the hippocampal formation. It is thought to contribute to new memories as well as other functional roles. It is notable as being one of a select few brain structures currently known to have high rates of neurogenesis in adult rats, .The dentate gyrus cells receive...
. A study in rats found that a heavy 2 day drinking binge caused extensive neurodegeneration in the entorhinal cortex
Entorhinal cortex
The entorhinal cortex is located in the medial temporal lobe and functions as a hub in a widespread network for memory and navigation. The EC is the main interface between the hippocampus and neocortex...
with resultant learning deficits. While brain damage from binge drinking is known to occur as a result of binge drinking patterns, it is unclear how long drinking sessions last and how regular binge drinking is done to cause brain damage in humans. One study found that humans who drank at least 100 drinks (male) or 80 drinks (female) per month (concentrated to 21 occasions or less per month) throughout a 3 year period had impaired decision making skills compared to non-binge drinkers. Repeated acute withdrawal from alcohol which occurs in heavy binge drinkers has been shown in several studies to be associated with cognitive deficits as a result of neural kindling
Kindling (substance withdrawal)
Kindling due to substance withdrawal, refers to the neurological condition which results from repeated withdrawal episodes from sedative-hypnotic drugs such as alcohol or benzodiazepines. Each withdrawal leads to more severe withdrawal symptoms than the first withdrawal syndrome...
; neural kindling due to repeated withdrawals is believed to be the mechanism of cognitive damage in both binge drinkers and alcoholics. Neuronal kindling also leads to each subsequent acute withdrawal episode being more severe than previous withdrawal
Withdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...
episodes.
Blackouts
Blackout (alcohol-related amnesia)
A blackout is a phenomenon caused by the intake of alcohol or other substance in which long term memory creation is impaired or there is a complete inability to recall the past. Blackouts are frequently described as having effects similar to that of anterograde amnesia, in which the subject cannot...
, a form of amnesia which occurs in binge drinkers may be due to suppressed hippocampus
Hippocampus
The hippocampus is a major component of the brains of humans and other vertebrates. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation. Humans and other mammals have two hippocampi, one in...
function with rebound NMDA (glutamate) activity combined with excessive glucocorticoid release induced by the stress of repeated intoxication followed by acute withdrawal/abstinence is the proposed mechanism of neural kindling leading to neurotoxicity of structures involved in learning and memory within the brain of binge drinkers. Frontal lobe processing may become impaired as a result of binge drinking with resultant neurocognitive deficits and impaired working memory.
Alcohol suppresses brain function during intoxication; but upon withdrawal rebound effects occur in the glutamate/NMDA system and with excess glutamate activity glucocorticoid
Glucocorticoid
Glucocorticoids are a class of steroid hormones that bind to the glucocorticoid receptor , which is present in almost every vertebrate animal cell...
release; due to the repeated intoxication, followed by acute withdrawal a neurotoxic effect develops which damages the central nervous system, leading to persisting impairments in verbal and nonverbal cognitive abilities as well as impairment of spatial orientation. Due to developmental processes occurring during adolescence including myelinization and restructuring of the synapses, adolescents are thought to be more vulnerable to the neurotoxic effects of alcohol.
Age and genetic factors influence the risk of developing alcohol related neurotoxicity
Neurotoxicity
Neurotoxicity occurs when the exposure to natural or artificial toxic substances, which are called neurotoxins, alters the normal activity of the nervous system in such a way as to cause damage to nervous tissue. This can eventually disrupt or even kill neurons, key cells that transmit and process...
. Adolescence, especially early adolescence (i.e. before age 15), is a critical and delicate developmental stage for specialised neuronal and synaptic
Synaptic
Synaptic may refer to:*Synapse, part of the nervous system*Synapsis, the pairing of two homologous chromosomes*Synaptic , a Linux graphical package management program for APT See also...
systems mature. This critical developmental stage is where life long adult traits e.g., talents, reasoning and complex skills mature; however alcohol and in particular binge drinking may disrupt and interfere with this developmental process. Adolescence is also a period of development characterised by a high level of novel seeking, thrill seeking and risk taking behaviour and thus alcohol and other drug experimentation and abuse is common. An adolescent rat study found that a relatively short exposure to high levels of alcohol resulted long-lasting changes in functional brain activity with corresponding abnormalities in EEG brain waves which persisted into adulthood, including persisting disturbances in sleep EEG with a reduction in slow wave sleep. These EEG findings are similar to premature aging. According to one review of the literature, if the developmental stage of adolescence is similar to the developmental stage of the fetus with regard to sensitivity to the neurotoxic effects of alcohol, and if long-lasting or permanent damage to the brain occurs similar to what animal studies suggest, then this represents a major public health issue due to the high levels of alcohol use by adolescents.
Diagnosis
For the purpose of identifying an alcohol use disorder when assessing binge drinking, using a time frame of the past 6 months eliminates false negatives. For example it has been found that using a narrow 2 week window for assessment of binge drinking habits leads to 30 percent of heavy regular binge drinkers wrongly being classed as not having an alcohol use disorder. However, the same researchers also note that recall bias is somewhat enhanced when longer timeframes are used.Prevention
Binge drinking is considered harmful, regardless of a person's age, and there have been calls for healthcare professionals to give increased attention to their patients drinking habits, especially binge drinking. Some researchers believe that raising the legal drinking age and screening brief interventions by healthcare providers are the most effective means of reducing morbidity and mortality rates associated with binge drinking. Programs in the United States have thought of numerous ways to help prevent binge drinking. The Centers for Disease Control and Prevention suggests increasing the cost of alcohol or the excise taxes, restricting the number of stores who may obtain a license to sell liquor (reducing "outlet density"), and implementing stricter law enforcement of underage drinking laws. There are also a number of individual counseling approaches, such as motivational interviewing and cognitive behavioral approaches, that have been shown to reduce drinking among heavy drinking college students. In August 2008, a group of college presidents calling itself the Amethyst InitiativeAmethyst Initiative
The Amethyst Initiative is an organization made up of U.S. college presidents and chancellors that in July 2008 launched a movement calling for the reconsideration of U.S...
asserted that lowering the legal drinking age
Legal drinking age
Laws about the legal drinking age cover a wide range of issues and behaviours, addressing when and where alcohol can be consumed. The minimum age alcohol can be legally consumed can be different to the age when it can be purchased. These laws vary among different countries and many laws have...
to 18 (presumably) was one way to curb the "culture of dangerous binge drinking" among college students. This idea is currently the subject of controversy. Proponents argue that the 21 law forces drinking underground and makes it more dangerous than it has to be, while opponents argue that lowering the age may only make the situation worse.
Treatment
Due to the risks especially in adolescents, of cognitive impairments and possible irreversible brain damage associated with binge drinking, urgent action has been recommended. There is some evidence that interventions by employers such as, health and life-style checks, psychosocial skills training and peer referral, can reduce the level of binge drinking. In the USA brief motivational interventions have shown some benefit in reducing future binge drinking.Adolescents who misuse alcohol can benefit from interventions aimed at risk reduction. For more severe cases a psychotherapeutic intervention involving parents or guardians is recommended. An effective strategy of intervention for adolescents whose binge drinking leads to admission to hospital, e.g. for alcohol poisoning or injury, is manualised brief interventions at the hospital in one to four counselling sessions each lasting 30 to 60 minutes conducted by trained staff. Evaluation of personal pattern of drinking and associated risks and an emphasis on personal responsibility in a non-condescending manner is recommended during the intervention; discussing and informing/educating the adolescent of possible negative short and long-term consequences of drinking
Long-term effects of alcohol
The long term effects of alcohol range from possible health benefits for low levels of alcohol consumption to severe detrimental effects in cases of chronic alcohol abuse...
is recommended. The setting of goals and rules to achieve those goals is also recommended during intervention with problem binge drinking adolescents.
Increasing public information and awareness regarding the risks of binge drinking, conducting interviews in emergency departments of young people suspected of harmful drinking patterns and trying to persuade them to accept individual counseling in youth addiction counseling services are effective strategies for reducing the harm of binge drinking. Encouraging recreational training activities such as adventurous training activities such as climbing or driving can be an alternative "natural buzzes" to alcohol misuse. Additionally the provision of educational content about the risks of binge drinking and a risk assessment are beneficial during intervention with young binge drinkers and a referral in the case of an alcohol use disorder for specialised help.
Epidemiology
Binge drinking is more common in men than it is in women. Among students in the USA approximately 50 percent of men and 39 percent of women binge drink. Racial differences exist among binge drinking with Hispanics followed by white people having the highest level of binge drinking. Individuals of African descent have a lower level of binge drinking followed by those of Asian descent. In the case of Asians their low level of binge drinking may be due to the presence of the aldehyde dehydrogenase gene (ALDH2, Chromosome 12) in many (but by no means the vast majority) that results in poor metabolism of alcohol which leads to severe adverse effects such as facial flushing.Men are more likely to binge drink (up to 81 percent of alcohol binges are done by men) than women and men are also more likely to develop alcohol dependence than women. People who are homozygous for the ALDH2 gene are less likely to binge drink due to severe adverse effects which occur even with moderate amounts of alcohol consumption.
Social and culture
Binge drinking costs the UK economy approximately £20 billion a year; 17 million working days are estimated to be lost due to hangovers and drink-related illness each year. The cost of binge drinking to employers is estimated to be £6.4 billion and the cost per year of alcohol harm is estimated to cost the National Health Service £2.7 billion. Urgent action has been recommended to understand the binge drinking culture and its aetiology and pathogenesis and urgent action has been called for to educate people with regard to the dangers of binge drinking.Centers for Disease Control and Prevention (CDC) released a study in October 2011 that showed that in the United States, binge drinking costs society $223-billion a year, which amounts to $2 per drink. These costs include health care costs for alcohol-related issues, including liver cirrhosis, loss of work productivity, proper damage due to drunk driving, and expenditures related to criminal acts.
Further reading
- MacLachlan, Malcolm and Smyth, Caroline (eds.). Binge Drinking And Youth Culture. Liffey Press (October 15, 2004). ISBN 1-904148-42-5.
- Walters, Scott and Baer, John. Talking with College Students about Alcohol: Motivational Strategies to Reduce Abuse. Guilford Press (October 13, 2005). ISBN 978-1-59385-222-1.
- Wechsler, Henry and Wuethrich, Bernice. Dying to Drink: Confronting Binge Drinking on College Campuses. Rodale Books (August 17, 2002). ISBN 1-57954-583-1.
External links
- Eliminating high-risk drinking: report
- Global Status Report on Alcohol 2004 by the WHOWorld Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
. - Alcohol Concern Factsheet 20: Binge drinking
- Binge Drinking on College Campuses
- Alcohol time bomb set to explode Australia's binge-drinking
- BBC Headroom: Drinking too much?