According to a new report published online on September 16 in the journal JAMA Pediatrics, extreme binge drinking is a major healthcare problem in the US. Researchers affiliated with the National Institute on Alcohol Abuse and Alcoholism (NIAAA; Bethesda, Maryland) note than nearly 1 in 10 US high school seniors have engaged in recent binge drinking.
The NIAA defines binge drinking as the amount of alcohol leading to a blood alcohol level of 0.08%, which, for most adults, would be reached by consuming five drinks for men or four drinks for women during a two-hour period. For younger drinkers, this increases short- and long-term risk of blackouts, homicides, car crashes, sexual assaults, altered brain development, and other harmful outcomes.
The report was based on classroom questionnaires given to more than 16,000 high school seniors; a question on extreme binge drinking was added in 2005. It found that Caucasians and males were the most likely to engage in all levels of binge drinking. Students with more educated parents had higher rates of binge drinking than other teens; however, they had lower rates of extreme binge drinking.
The study authors note that in the early 1980s, before all states adopted age 21 years as the minimum legal drinking age, the percentage of high school seniors who consumed five or more drinks on occasion during the last two weeks exceeded 40%. In contrast, from 2005 through 2011, 20.2% of seniors consumed five or more drinks at a single setting in the last two weeks between 2005 and 2011. However, high school seniors varied regarding how much they exceeded the binge threshold. On occasion, 10.5% consumed 10 to 14 drinks, and 5.6% consumed 15 drinks or more. Between 2005 and 2011, the percent of students who peaked at five to nine drinks and 10 to 14 drinks per occasion declined but not the percentage of students peaking at 15 or more drinks.
The researchers note that their findings might help explain why some consequences of underage drinking, such as hospitalizations for overdoses, are on the rise, despite general declines in binge drinking.
Binge drinking entails the consumption of a large amount of alcohol over a short period of time: rapidly ingesting five or more drinks in quick sequence. It is often done in groups and can result in coma and death. The amount of alcohol in the body is usually measured as the blood alcohol content (BAC). It is expressed as the percentage of alcohol per liter of blood. Alcohol consumption is also measured by the number of drinks. Examples of one alcoholic drink are: beer (12 ounces); wine (5 ounces); and 80 proof liquor (1.5 ounces).
Peer pressure is a major factor in binge drinking. Teens and young adults who have never drank alcohol, or who have only consumed an occasional alcoholic beverage, not uncommonly succumb to peer pressure in a party environment and engage in binge drinking. Party attendees are sometime encouraged to partake of a beer bong to facilitate binge drinking. A beer bong is a funnel attached to a hose. The drinker lies on his or her back and one or more bottles of beer are funneled into the drinker’s mouth. Words of encouragement are shouted during the experience. Drinking games at parties contribute to binge drinking. The games require “chugging” beer if an error is made (i.e., following a cue from another player). Obviously, as more alcohol is consumed, the errors increase and inhibitions decrease.
Significant evidence exists that genetic factors are involved in alcoholism. The interaction of genes and environmental factors that influence alcohol dependence is a complex scientific topic. For most people with alcohol dependence, many factors are involved. Since 1989, the U.S. Government-funded Collaborative Study on the Genetics of Alcoholism (COGA) has been tracking alcoholism in families. To date, COGA researchers have interviewed more than 14,000 people and sampled the DNA of 262 families. They have found evidence for the existence of several alcohol-related genes; COGA researchers are increasingly convinced that different types of alcoholics are representative of a number of genetic variations.
- Rate of drinking: More rapid consumption of a given amount of alcohol increases the risk of alcohol poisoning. One to two hours are required to metabolize one drink.
- Sex: Young males from age 18 through 25 are the most likely group to engage in binge drinking; thus, they are at the highest risk for alcohol poisoning. However, young women also engage in binge drinking and are more susceptible to alcohol poisoning because they produce less of an enzyme that slows the release of alcohol from the stomach than men.
- Age: Teenagers and college students are more likely to engage in binge drinking; however, the majority of deaths from binge drinking occur in individuals 35 to 54. This age group often does not metabolize alcohol as readily as younger individuals and are more likely to have an underlying health problem that increases the risk.
- Body mass: A heavier individual can drink more alcohol than a lighter one to register the same BAC. For example, a 240 pound man who drinks two cocktails will have the same BAC as a 120 pound woman who consumes one cocktail.
- Overall health: Individuals with kidney disease, liver disease, heart disease, or other health problems may metabolize alcohol more slowly. Diabetics who binge drink might experience a dangerous drop in blood sugar.
- Food consumption: A full stomach slows the absorption of alcohol; thus drinking on an empty stomach increases the risk.
- Drug use: Prescription and over-the-counter drugs might increase the risk of alcohol poisoning. Ingestion of illegal substances, such as cocaine, methamphetamine, heroin, and marijuana, increase the risk.
Alcohol poisoning symptoms include:
- Confusion, stupor, or unconsciousness
- Respiratory depression (slow breathing rate).
- Irregular breathing.
- Slow heart rate.
- Low blood pressure.
- Low body temperature (hypothermia).
- Pale or blue skin.
- Irregular breathing (a gap of more than 10 seconds between breaths)
- Blue-tinged skin or pale skin
Screening and Diagnosis:
The blood alcohol content (BAC) is a definitive test for alcohol poisoning. Individuals with alcohol poising often have a BAC of 0.35% to 0.5%). By way of comparison, the level for driving under the influence (DUI) is 0.08% in all states in the U.S. Other blood tests include complete blood count (CBC), glucose, urea, arterial pH, and electrolytes.
Treatment and Therapy:
Acute treatment consists of supportive measures until the body metabolizes the alcohol. This includes:
- Insertion of an airway (endotracheal tube) to prevent vomiting and aspiration of stomach contents into the lungs.
- Close monitoring of vital signs (temperature, heart rate and blood pressure).
- Medication to increase blood pressure and heart rate if indicated.
- Respiratory support if indicated.
- Maintenance of body temperature (blankets or warming devices).
- Intravenous fluids to prevent dehydration. Glucose should be added if the patient is hypoglycemic (low blood sugar). Thiamine is often added to reduce the risk of a seizure.
- Hemodialysis (blood cleansing) might be needed for dangerously high BACs (more than 0.4%). It is also necessary if methanol or isopropyl alcohol has been ingested.
Follow-up Treatment and Therapy
Follow-up treatment for binge drinking requires the aid of a healthcare professional skilled in alcohol abuse treatment. A treatment plan should be formulated, which includes behavior-modification techniques, counseling, goal-setting, and use of self-help manuals or Internet resources. Counseling on an individual or a group basis is an essential treatment component. Group therapy is particularly valuable because it allows interaction with other alcohol abusers. It increases the awareness that one’s problems are not unique. Therapy may include the presence of a spouse or other family members. Family support is a significant component of the recovery process. Binge drinking may be a component of other mental health disorders. For these individuals, psychological counseling or psychotherapy may be recommended. Treatment for depression or anxiety may also be a part of follow-up. Beyond counseling and medication, other modalities may be helpful. For example, in September 2010, UCLA researchers released the results of a clinical trial on a unique new therapy that applies electrical stimulation to a major nerve emanating from the brain. The technique, trigeminal nerve stimulation (TNS) achieved an average of a 70% reduction in depression over an eight-week study period.
Long-term pharmaceutical treatment may be used. Oral medications are available for treatment including disulferam, acamprostate, and naltrexone. Disulferam (antabuse®), which is taken by mouth, produces unpleasant physical reactions such as flushing, headaches, nausea, vomiting and headaches. Disulferam does not reduce the craving for alcohol; however, acamprosate (Campral®) may reduce alcohol craving. Naltrexone (ReVia®) also may reduce the urge to drink; furthermore, it blocks the pleasant sensations associated with the consumption of alcohol. A problem with oral medications is that if one desires to return to drinking, he or she can simply stop taking the medication.
Aftercare programs and support groups are essential for the recovering alcoholic to avoid (or manage) relapses and deal with the necessary lifestyle changes to maintain sobriety. Regular attendance at a support group such as Alcoholics Anonymous (AA) is often a component of follow-up care.
Although death can occur from binge drinking, most fatalities are secondary to automobile accidents while driving under the influence. Women who binge drink are vulnerable to sexual assault while either intoxicated or in an alcohol-induced stupor. The sexual assault can result in an unwanted pregnancy or acquiring a sexually transmitted disease (STD). Repeated episodes of binge drinking can result in permanent damage to one’s health. Brain and liver damage is not uncommon in repetitive binge drinkers. Binge drinking while a young adult not uncommonly progresses to alcoholism.
The best prevention is educating at-risk individuals regarding the dangers of binge drinking. Unfortunately, the highest risk population is young males who have a sense of invincibility and disregard advice from any source. Peer pressure is probably the best deterrent; it is also a factor that can encourage binge drinking. Children with a good parental relationship are less likely to drink to excess.