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Binge drinking, or heavy episodic drinking, is drinking alcoholic beverages with an intention of becoming intoxicated by heavy consumption of alcohol over a short period of time. Binge drinking is popular in many 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 use, even weeks.
Binge drinking is harmful, regardless of a person's age, with those involved at increased risk of dangerous if not criminal behavior as well as serious physiological damage, even death. As a result, there have been calls for healthcare professionals to give increased attention to their patients’ drinking habits, especially binge drinking. Prevention of binge drinking, however, depends primarily on psychological factors, such as belief in one's value as a person in full control of one's mind and body, and rejection of the notion that dulling the senses with alcohol is a valid way to experience happiness.
Generally, definitions of binge drinking are based on the quantity of alcohol consumed. However, there is no worldwide consensus on how many drinks constitute a "binge." For example, Stolle, Sack and Thomasius define binge drinking as "excessive episodic consumption of alcohol," without specifying what is meant by "excessive." Indeed, defining binge drinking is complicated in that the time period over which the drinking occurs, the body mass of the person drinking, as well as the quantity of alcohol consumed must all be taken into account. Otherwise, a person could be defined as a binge drinker even if he or she never becomes intoxicated 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. Whatever the numerical definition used, heavy drinking or rapid consumption over a short period of time with the intention of becoming intoxicated is implied in the use of the term.
Therefore, some definitions, albeit less common, rely on blood alcohol concentration (BAC). For example, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines the term "binge drinking" as "a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent - or 0.08 grams of alcohol per deciliter - or higher. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours."
Based on this BAC definition, in the United States the term binge drinking has been accepted as meaning the consumption of five or more standard drinks (male), or four or more drinks (female), over a two-hour period. There is a worldwide consensus that approximates this definition, although the actual number of drinks differ given that sizes of drinks vary by country.
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 (roughly equivalent to five or four American standard drinks, respectively). In Australia, binge drinking is also known as "Risky Single Occasion Drinking" (RSOD) and can be classified by the drinking of seven or more standard drinks (by males) and five or more standard drinks (by females) within a single day.
An alternative colloquial term for binge drinking, "going on a bender," formerly implied a drinking spree of several days:
Bender is a word people use to describe binge drinking. ... binge drinking was considered to be a period of drinking that went on for several days. Usually, a person who went on a binge or a bender was an alcoholic.
Binge drinking as a concept has both a recent and a distant history, having come to refer to two quite distinct phenomena. In its first, "classic," meaning it refers to a pattern of drinking that occurs over an extended period (usually several days) set aside for the purpose. This is deﬁnition is linked to clinical deﬁnitions of the disease of alcoholism, as in Jellinek’s 1960 classification.
"Binge drinking” and “binge drinker” as phrases with the second meaning are comparatively modern, and come a while after the invention of the concept of “binge eating” by psychiatrists to describe eating disorder problems such as bulimia. In this case, the term has come to be used to describe a single drinking session leading to intoxication, often measured as the consumption of more than a certain number of drinks in a single short time period. For example, the term appeared in an article in The Times in 1969, as a contrast to the generally understood term "alcoholic." Psychiatrists clarified that a “binge drinker” as someone who “goes off periodically and gets himself very drunk, perhaps for days on end, but between bouts he may drink little or nothing, and so can argue that he is not addicted." This view of binge drinking as episodic heavy drinking remained through the 1980s and the early 1990s, with a certain recognition that heavy drinking over a short period can lead to dangerous consequences, including driving while drunk and involvement in violent altercations. However, reaching a consensus on how many drinks constitutes this version of binge drinking remains elusive.
- It's really fun
- I feel more sociable
- I feel happy/relaxed
- I forget my problems
Other reasons include feeling more grown-up and fitting in with peers, and to increase the chance of sexual encounters. Some also drink to alleviate psychological stress or anxiety. Risk factors for binge drinking among adolescents include: low socioeconomic status, large amount of disposable (pocket) 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 (more common in adolescent girls), excessive drinking among peers, poor relationship with parents, excessive alcohol use by parents. Genetic conditions combined with a background of negative environmental factors increase the harmful use of alcohol.
Binge drinking impacts both social risk taking and has pathophysiological consequences. Certain groups are at greater risk for serious effects, such as adolescents and pregnant women:
Episodic excessive alcohol consumption is associated not only with somatic complications, but also with traffic accidents and other types of accident, violent behavior, and suicide. The more frequently a child or adolescent drinks to excess, and the younger he or she is, the greater is the risk of developing an alcohol-related disorder (alcohol misuse or dependence syndrome).
Acute intoxication, such as binge drinking and alcoholism, are known potent risk factors 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.
Risks of social harm and drug abuse, including initiation of smoking and incidence of nicotine dependence, as well as a higher probability of divorce, spousal abuse, and poor job performance have all been associated with binge drinking.
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 if the drinker is pregnant, among other serious effects.
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.
Another common risk is a blackout (alcohol-related amnesia), which can cause shame, guilt, embarrassment, harm to personal relationships, injury or death, and is also associated with the loss of personal belongings.
Central nervous system
Binge drinking has the propensity to result in brain damage faster as well as more severely than chronic drinking (alcoholism), due to the neurotoxic effects of the repeated rebound withdrawal effects. During the repeated alcohol free stages associated with binge drinking, a larger amount of glutamate is released than occurs during withdrawal from chronic heavy alcohol use; additionally this extreme release of glutamate happens on a repeated basis in binge drinkers leading to excitotoxicity. The tolerance that occurs during chronic ('non-stop') drinking delays alcohol-related brain damage compared to binge drinking, which induced immediate and repeated insults to the brain.
Blackouts, a form of amnesia that 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. The proposed mechanism of neural kindling leads to neurotoxicity of structures involved in learning and memory within the brain of binge drinkers. 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. 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 that damages the central nervous system develops, 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.
Frequent binge drinking can lead to brain damage faster and more severely than chronic drinking (alcoholism). The neurotoxic insults are due to very large amounts of glutamate which are released and over-stimulate the brain as a binge finishes. This results in excitotoxicity, a process which damages or kills neurons (brain cells). Each binge drinking episode immediately insults the brain; repeat episodes result in accumulating harm.
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 syndrome. 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 is believed to increase impulsivity due to altered functioning of prefrontal–subcortical and orbitofrontal circuits. Binge drinking and alcoholics who have undergone multiple detoxifications is associated with an inability to interpret facial expressions properly; this is believed to be due to kindling of the amygdala with resultant distortion of neurotransmission. Adolescents, females and young adults are most sensitive to the neuropsychological effects of binge drinking. Adolescence, in particular early adolescence, is a developmental stage that is particularly vulnerable to the neurotoxic and neurocognitive adverse effects of binge drinking due to it being a time of significant brain development.
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 cognitive impairments, psychological problems, and in long-term heavy binge drinkers may cause irreversible brain damage in both adolescents and adults.
The bladder may rupture if overfilled and not emptied. Symptoms include localized pain and uraemia (poisoning due to reabsorbed waste). This can occur in the case of binge drinkers having consumed very large quantities, but are not aware, due to stupor, of the need to urinate. This condition is rare, since a person is more likely to urinate while passed out before the bladder ruptures, as alcohol relaxes the muscles that normally control their bladder. However, it does occur: "A new report says binge drinking has increased to such an extent that cases of 'exploding bladders' are on the rise in the UK."
Binge drinking is associated with an increased risk of cardiovascular problems and sudden death: "It is becoming clear that alcohol ingestion can result in profoundly different actions on the cerebral circulation (e.g., vasodilation, vasoconstriction-spasm, vessel rupture), depending upon dose and physiologic state of host." In countries where binge drinking is commonplace, rates of sudden death on the weekend in young adults and middle aged people increase significantly. While regular alcohol consumption has generally been found to be cardioprotective, binge drinking has been found to correlate with "an increased risk of cardiovascular death, particularly sudden death."
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.
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 with an underlying cardiac disorder a binge on alcohol increases the risk of silent myocardial ischaemia as well as angina.
At risk groups
Adolescents and young adults
Adolescence, especially early adolescence (before age 15), is a critical and delicate developmental stage when specialized neuronal and synaptic systems mature. This critical developmental stage is where lifelong adult traits such as 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 characterized by a high level of novel seeking, thrill seeking, and risk taking behavior and thus alcohol and other drug experimentation and abuse is common.
Binge drinking is a way for young adolescents to rely on alcohol as a way to cope with certain stress or depression. Binge drinking during adolescence is associated with injuries and 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.
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 traveling after binge drinking and, also, it is more common that adolescents that binge-drink drive drunk or are the passenger of a drunk driver. It has been found that 50 percent 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 is associated with binge drinking. Female binge drinkers are three times more likely to be victims of sexual assault; half of the adolescent girls reporting sexual assault were under the influence of alcohol or another psychotropic substance at the time. Historically, adolescent boys were more likely to drink and binge drink than girls. However, in recent years alcohol use has declined more among adolescent boys than it has in girls. As a result, more adolescent girls report alcohol use and binge drinking than boys.
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.
Research has shown that 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 continuance of dangerous levels of alcohol consumption into adulthood years.
There is no known safe level of alcohol consumption either when trying to get pregnant or during 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. Binge drinking during pregnancy is associated with fetal alcohol syndrome, alcohol-related birth defects as well as alcohol-related neurodevelopmental disorders. 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.
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 have suggested 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. Others, particularly on college campuses, have recommended lowering the legal drinking age to 18 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 have claimed that lowering the age would only make the situation worse.
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. In addition environmental interventions, 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.
Understanding consumer personality and how people view others is important. In 2009 the Australian Government Department of Health and Ageing spent $53.5 million Australian Dollars on National Binge Drinking Strategy to target young Australians. This campaign titled "Don't Turn a Night Out Into a Nightmare" was delivered to the public over many mass media platforms to show the harms and consequences of risky single occasion drinking (RSOD) as binge drinking is defined in Australia. Evidence as to the effectiveness of these types of campaigns is mixed.
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. An effective strategy of intervention for adolescents whose binge drinking leads to admission to hospital, for example, for alcohol poisoning or injury, involves brief interventions at the hospital in counseling sessions conducted by trained staff. Evaluation of personal pattern of drinking and associated risks and an emphasis on personal responsibility is recommended during the intervention; discussing and informing and educating the adolescent of possible negative short and long-term consequences of drinking is also recommended. The setting of goals and rules to achieve those goals should be conducted during intervention with problem binge drinking adolescents. Encouraging recreational and adventurous training activities such as climbing or driving can be used 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. For more severe cases, an intervention involving parents, guardians, or a psychotherapist is recommended.
Motivational enhancement therapy also shows promise as a treatment.
There is some evidence that interventions by employers such as, health and lifestyle checks, psychosocial skills training and peer referral, can reduce the level of binge drinking.
Due to the risks to adolescents of cognitive impairments and possible irreversible brain damage associated with binge drinking, urgent action has been recommended.
Binge drinking is more common in males, particularly in young adulthood:
One in six US adults binge drinks, with 25% doing so at least weekly. ... Binge drinking is most common among younger adults aged 18–34. Binge drinking is nearly twice as common among men than among women.
College students have been found to be more likely to binge drink than their same age peers who were not enrolled in college. Overall, 44% of the students (50% of the men and 39% of the women) binged: "The strongest predictors of college binge drinking were residence in a fraternity or sorority, adoption of a party-centered life-style, and engagement in other risky behaviors." In the US, this effect has caused serious problems with the country's legal drinking age. Given the harmful consequences of binge drinking, especially on younger adults, college campuses are concerned about how best to address this problem and seeking effective intervention strategies.
Among older adults, there are significant racial/ethnic differences in prevalence rates of binge drinking: One study found the presence of binge drinking was most common among non-Hispanic Whites (11.9%), followed by Latinos (10.8%), American Indian/Alaska Natives (9.8%), Blacks (8.0%), and Asians (4.2%). Binge drinking has also been found to be a common pattern among Native Americans of all ages.
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ReferencesISBN links support NWE through referral fees
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