Binge drinking: Burden of liver disease and beyond

The consumption of alcoholic beverages is harmful to human health. In recent years, consumption patterns of alcoholic beverages have changed in our society, and binge drinking has generalized. It is considered to be a socio-sanitary problem with few known consequences in terms of individual and third-party social impacts (in the form of violence or traffic accidents) and its organic impact (affects the liver and other organs and systems, such as the nervous and cardiovascular systems) and represents an important financial burden due to its increasing economic impact. This review provides a global approach to binge drinking and emphasizes its epidemiological character, the effect of this type of consumption and the possible management of a problem with an increasing tendency in our society.     

Alcohol use contexts (social settings,drinking games/specials,and locations) as predictors of high-intensity drinking on a given day among U.S. young adults

Background

This study examined whether variability in young adult drinking social settings, drinking games/drink price specials, and locations differentiated daily high-intensity drinking (HID) likelihood; whether contexts varied by legal drinking age and college status (attending a 4-year college full-time); and whether legal drinking age and college status moderated drinking context/intensity associations.

Methods

Participants (n = 818 people, 46.3% female) were part of the Young Adult Daily Life Study in 2019 to 2022. They were originally selected because they were past 30-day drinkers from the 2018 U.S. national probability Monitoring the Future 12th grade sample and because they reported one or more days of alcohol use during 14-day data collection bursts across the following 4 years (n = 5080 drinking days). Weighted multilevel modeling was used to estimate drinking context/intensity associations. Drinking intensity was defined as moderate (females 1 to 3, males 1 to 4 drinks), binge (4 to 7, 5 to 9 drinks), or HID (8+, 10+ drinks). Models controlled for other within-person (weekend, historical time period) and between-person (sex and race/ethnicity) covariates.

Results

Contexts differentiating HID and binge drinking days included drinking with large groups, strangers, pregaming, drinking games, and more drinking locations. Legal drinking age was associated with lower odds of free drinks but greater odds of drinking at bars/restaurants. College status was associated with lower odds of drinking alone or free drinks, but greater odds of drinking with friends, large groups, pregaming, drinking games, discounted price drinks, and at bars/restaurants, parties, and more drinking locations. Legal drinking age and college status moderated some context-intensity associations.

Conclusions

Social settings, pregaming, drinking games, and drinking at more locations were associated with increased risk of HID on a given day. Legal drinking age and college status were associated with specific drinking contexts and moderated some context/intensity associations. Incorporating the contexts associated with HID into interventions may help to reduce HID and related consequences in young adults.     

The importance of drinking frequency in evaluating individuals' drinking patterns: implications for the development of national drinking guidelines

Aims   This paper examines the relationship between frequency of drinking, usual daily consumption and frequency of binge drinking, taking into consideration possible age and gender differences.
Participants and design   Subjects were 10 466 current drinkers (5743 women and 4723 men) aged between 18 and 76 years, who participated in the GENACIS Canada (GENder Alcohol and Culture: an International Study) study.
Setting   Canada.
Measurements   The independent variable was the annual drinking frequency. The dependent variables were the usual daily quantity consumed, annual, monthly and weekly frequency of binge drinking (five drinks or more on one occasion).
Findings   Logistic regressions show (i) that those who drink less than once a week are less likely than weekly drinkers to take more than two drinks when they do drink; (ii) that the usual daily quantity consumed by weekly drinkers is not related to their frequency of drinking; but that (iii) the risk and frequency of binge drinking increase with the frequency of drinking.
Conclusions   Given that risk and frequency of binge drinking among Canadians increases with their frequency of drinking, any public recommendation to drink moderately should be made with great caution.     

Drinking patterns, dependency and life-time drinking history in alcohol-related liver disease

Aims   To examine the hypothesis that increases in UK liver deaths are a result of episodic or binge drinking as opposed to regular harmful drinking.
Design   A prospective survey of consecutive in-patients and out-patients.
Setting   The liver unit of a teaching hospital in the South of England.
Participants   A total of 234 consecutive in-patients and out-patients between October 2007 and March 2008.
Measurements   Face-to-face interviews, Alcohol Use Disorders Identification Test, 7-day drinking diary, Severity of Alcohol Dependence Questionnaire, Lifetime Drinking History and liver assessment.
Findings   Of the 234 subjects, 106 had alcohol as a major contributing factor (alcoholic liver disease: ALD), 80 of whom had evidence of cirrhosis or progressive fibrosis. Of these subjects, 57 (71%) drank on a daily basis; only 10 subjects (13%) drank on fewer than 4 days of the week—of these, five had stopped drinking recently and four had cut down. In ALD patients two life-time drinking patterns accounted for 82% of subjects, increasing from youth (51%), and a variable drinking pattern (31%). ALD patients had significantly more drinking days and units/drinking day than non-ALD patients from the age of 20 years onwards.
Conclusions   Increases in UK liver deaths are a result of daily or near-daily heavy drinking, not episodic or binge drinking, and this regular drinking pattern is often discernable at an early age.     

The relationship between drinking games and intentions to continue drinking,intentions to drive after drinking,and adverse consequences: Results of a field study

Background: Drinking games have become a nearly universal aspect of excessive drinking on university campuses with 50–62% of college students reporting playing drinking games in the past month. Participation in drinking games has been correlated with numerous negative consequences and increased consumption of alcohol. Objectives: The present study addresses the influence of drinking games on three drinking-related outcomes: problems experienced the night of the drinking event, the intent to keep drinking, and the intent to drive after drinking. Methods: The data collected for the present study were part of a study testing environmental influences of drinking behaviors of young adults. A total of 226 randomly selected parties (representing 1725 partygoers) were selected for study inclusion. Three multilevel logistic regression models tested the relationship between drinking games and the three drinking-related outcomes. Results: Participants who reported playing drinking games were 1.58 times more likely to report continued drinking intentions than participants who did not play drinking games. If drinking games were observed at a party, participants were 2.38 times more likely to plan to drive while intoxicated. Additionally, participants who reported playing drinking games were 1.59 times more likely to report experiencing a drinking-related problem than participants who did not play drinking games. Conclusion: Drinking games have consequences beyond increasing the level of intoxication; they contribute to problematic behavior at individual and environmental levels. Preventing drinking games is warranted.     

Pharmacotherapy for Addictions: Partnering with Contingency Management

ABSTRACT

Background: Problem drinking in college places students at an increased risk for a wealth of negative consequences including alcohol use disorders. Most research has shown that greater emotion regulation difficulties are related to increased problem drinking, and studies generally assume that drinking is motivated by efforts to cope with or enhance affective experiences. However, there is a lack of research specifically testing this assumption. Objectives: The current study sought to examine the mediating potential of drinking motives, specifically coping and enhancement, on the relationship between emotion regulation and problem drinking. Method: College participants (N = 200) completed an online survey, consisting of a battery of measures assessing alcohol use behaviors and related variables. Results: Coping drinking motives fully mediated the emotion regulation/problem drinking relationship, and enhancement motives partially mediated this relationship. Exploratory analyses indicated that all four drinking motives (i.e. coping, enhancement, social, and conformity) simultaneously mediated the relationship between emotion regulation and quantity/frequency of alcohol use. However, only coping and enhancement significantly mediated the relationship between emotion regulation and alcohol-related consequences (e.g. alcohol dependence symptoms, alcohol-related injuries). Conclusion: The current results offer direction for potentially modifying brief alcohol interventions in efforts to reduce students’ engagement in problem drinking behaviors. For example, interventions might incorporate information on the risks of using alcohol as a means of emotion regulation and offer alternative emotion regulation strategies.     

Types of drinkers and drinking settings: an application of a mathematical model

Aims US college drinking data and a simple population model of alcohol consumption are used to explore the impact of social and contextual parameters on the distribution of light, moderate and heavy drinkers. Light drinkers become moderate drinkers under social influence, moderate drinkers may change environments and become heavy drinkers. We estimate the drinking reproduction number, R_d, the average number of individual transitions from light to moderate drinking that result from the introduction of a moderate drinker in a population of light drinkers. Design and Settings Ways of assessing and ranking progression of drinking risks and data‐driven definitions of high‐ and low‐risk drinking environments are introduced. Uncertainty and sensitivity analyses, via a novel statistical approach, are conducted to assess R_d variability and to analyze the role of context on drinking dynamics. Findings Our estimates show R_d well above the critical value of 1. R_d estimates correlate positively with the proportion of time spent by moderate drinkers in high‐risk drinking environments. R_d is most sensitive to variations in local social mixing contact rates within low‐risk environments. The parameterized model with college data suggests that high residence times of moderate drinkers in low‐risk environments maintain heavy drinking. Conclusions With regard to alcohol consumption in US college students, drinking places, the connectivity (traffic) between drinking venues and the strength of socialization in local environments are important determinants in transitions between light, moderate and heavy drinking as well as in long‐term prediction of the drinking dynamics.     

South of the border: a legal haven for underage drinking

Aims The research describes the characteristics and motivations of youthful San Diego County residents who patronize the bars and nightclubs in Tijuana, Mexico. Design Two random‐digit‐dial surveys of San Diego County residents—one group aged 18–20 years and one aged 21–30 years—was conducted during a 2‐year period. Those who reported having visited the bars in Tijuana in the last year were compared with those who had not. Setting All respondents were residents of San Diego County, California, USA. Participants The study comprised 2200 youths between 18 and 30 years of age. Measurements The interview protocol included questions covering demographic characteristics, drinking and drug‐use history, experience with Tijuana bars, and ratings of bar features in San Diego and Tijuana. Findings About half of the 18–20‐year‐olds and a third of the 21–30‐year‐olds reported visiting bars in Tijuana at least once in the past 12 months. Race, age, gender, heavy drinking and drug‐use history were significantly associated with visits to Tijuana bars. The price of alcohol and the perceived freedom to get drunk in Tijuana bars were considered attractive features leading to cross‐border drinking. Conclusions The features of the alcohol service in Mexican bars that attract youthful drinkers (low cost and liberal availability of alcohol, lack of formal controls, and presence of heavy drinkers) are similar to those present in other drinking locales that lead to drunkenness. Thus, a better understanding of the characteristics and motivations of the US youths patronizing bars in Tijuana can lead to improved interventions to reduce heavy, risky drinking.     

Drinking patterns, drinking contexts and alcohol-related aggression among late adolescent and young adult drinkers

AIMS: The main objectives of this study were to determine: (1) the relative roles of heavy episodic drinking (HED), drinking frequency and drinking volume in explaining alcohol-related aggression and (2) whether drinking context variables (i.e. usual drinking locations, typical drinking companions and extent of peer drinking) confound or modify the relationship between HED and alcohol-related aggression or whether they predict alcohol-related aggression independently. DESIGN: A secondary analysis of the US National Longitudinal Survey of Youth was conducted. Alcohol-related aggression (denoted fights after drinking) was measured based on self-reports of arguments or fights that occurred during or after drinking in the previous 12 months. PARTICIPANTS: A composite sample of drinkers, ages 17-21, from the 1994, 1996 and 1998 Young Adult surveys (n = 738) was used. FINDINGS: Frequency of drinking and drinking volume largely confounded the association between HED and fights after drinking. Usually drinking in public locations away from home versus private locations was found to be significantly associated with a greater likelihood of fights after drinking among females. Among males, usual drinking location modified the relationship between drinking frequency and alcohol-related aggression, with the greatest risk of aggression for males who drank frequently and usually drank in public locations away from home. CONCLUSIONS: Programs designed to reduce drinking frequency in this population and to increase the safety of drinking locations in public places away from home may prove to be beneficial in reducing alcohol-related aggression.     

Drinking pattern and mortality in middle-aged men and women

Aims To address the prospective association between alcohol drinking pattern and all‐cause mortality. Design Population‐based cohort study conducted between 1993 and 2003. Setting Denmark. Participants A total of 26 909 men and 29 626 women aged 55–65 years. Measurements We obtained risk estimates for all‐cause mortality for different levels of quantity and frequency of alcohol intake adjusted for life‐style factors, including diet. Findings During follow‐up, 1528 men and 915 women died. For the same average consumption of alcohol, a non‐frequent intake implied a higher risk of death than a frequent one. Conclusions Drinking pattern and not just the total amount of alcohol consumed is important for the association between alcohol intake and mortality. These results suggest that future public guidelines concerning sensible alcohol drinking should include messages about drinking pattern together with quantity of alcohol.     

Trajectories of Drinking Urges During Individual- and Couple-Based Cognitive-Behavioral Treatment for Alcohol Use Disorders

Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. This study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males (N = 80 with 4,401 daily recordings) and females ( N = 101 with 8,011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.