Binge Drinking in US Runs Up Public Health Tab

Damian McNamara

March 19, 2018

Approximately 37 million adults in the United States engage in binge drinking once a week on average, consuming more than 17 billion alcoholic drinks annually, according to a study using Centers for Disease Control and Prevention (CDC) data.

Interestingly, older binge drinkers were found to consume more than young adults. Although more than half of binge drinkers in 2015 were 18 to 34 years old, people aged 35 years and older consumed more than half the total number of alcoholic drinks.

"This study shows that binge drinkers are consuming a huge number of drinks per year, greatly increasing their chances of harming themselves and others," study coauthor Robert Brewer, MD, MSPH, of the CDC's National Center for Chronic Disease Prevention and Health Promotion, said in a news release.


The study was published in the April issue of the American Journal of Preventive Medicine.

Major Public Health Burden

Unintentional injuries, interpersonal violence, suicide, alcohol poisoning, hypertension, heart disease, stroke, cancer, liver disease, and severe alcohol use disorder are risks associated with binge drinking, the investigators note.

Excessive alcohol use is also responsible for 1 in 10 deaths among adults of working age, or about 88,000 deaths in the United States each year. Binge drinking accounts for about half of this overall mortality. In addition, binge drinking is costly in a public health sense — it is associated with about three quarters of the total $249 billion in economic costs from excessive alcohol use.

The current results align with previous reports. For example, the finding that more than three quarters of the total number of drinks consumed during binges were consumed by people aged 25 years and is similar to findings from a study that reported that 70% of binge drinking episodes involve people aged 26 years and older (JAMA. 2003;289:70-5). Moreover, annually, about three quarters of deaths attributable to alcohol poisoning — typically caused by high-intensity binge drinking — occur in adults aged 35 to 64 years (MMWR Morb Mortal Wkly Rep. 2015;63:1238-42).

A New Measure of Binge Drinking

Most previous studies of binge drinking focused on prevalence. The researchers propose that their new measure, total binge drinks, might reveal important nuances regarding demographic and other factors related to public health.

"There are important disparities in binge drinking at the state and national levels based on sociodemographic characteristics (eg, race/ethnicity, education, and income) that are not well characterized by any single binge-drinking measure," they write.

The current findings stem from 408,800 survey responses from adults aged 18 years and older to the Behavioral Risk Factors Surveillance System (BRFSS) survey, which is a state-based, random telephone survey conducted year round in all 50 states and the District of Columbia.

Survey respondents reported the number of drinking days that they had engaged in during the previous 30 days; the average number of drinks consumed during days in which alcohol was consumed; the number of binge-drinking episodes; and the largest number of drinks consumed on any one occasion.

The researchers defined binge drinking as consuming four or more drinks on one occasion for women and consuming five or more drinks on one occasion for men. For women, heavy drinking was defined as consuming eight or more drinks per week; for men, it was defined as consuming 15 or more drinks per week.

Sex Differences

The approximate 1 in 6 adults who reported binge drinking engaged in an average of 53 binge-drinking episodes per year, for a total of 1.9 billion episodes annually. Respondents consumed on average seven alcoholic drinks during each binge episode.

Rates of binge drinking differed significantly among the sexes — 22% of men vs 12% of women reported binge drinking (P < .0001). In addition, binge drinking by men accounted for 72%, or 1.4 billion, of the total episodes in 2015.

As assessed by race and ethnicity, the prevalence of binge drinking was 19% among non-Hispanic whites and 18% among American Indians/Alaska Natives. These rates were significantly higher than for other race and ethnic groups (P < .001).

The prevalence of binge drinking was 14% among participants with less than a high school education, a rate significantly lower than the 19% among college graduates. However, when those with less education did binge drink, they consumed 1.7 times the annual number of binge drinks consumed by college graduates.

Similarly, the prevalence was lower for those with a household income less than $25,000 — 14%, compared to 22% of respondents with a household income of $75,000 or more (P < .0001). In contrast, those in the lower income bracket consumed less — an average of 74 binge drinks per adult, vs 87 binge drinks among those in the higher income group.

Not surprisingly, the prevalence of binge drinking was much higher in people who reported heavy drinking — 78%, compared to 25% for those who were not heavy drinkers (P < .0001). Heavy drinkers also reported an average of 106 binge drinking episodes per year and consuming an average of nine alcoholic drinks per episode.

The states with the highest annual number of binge drinks per binge drinker were Arkansas, Mississippi, Kentucky, and Hawaii. Binge drinkers in Washington, DC, New Jersey, New York, and Washington State consumed the lowest amounts.

Comprehensive Approach Needed

The researchers suggest a two-prong strategy to address binge drinking.

"The findings also show the importance of taking a comprehensive approach to prevent binge drinking, focusing on reducing both the number of times people binge drink and the amount they drink when they binge," Brewer said in the release.

Alcohol screening with a brief intervention in clinical settings can be an effective tactic to reduce excessive drinking, the researchers note. In a systematic review, screening and brief interventions offered via computer or cell phone were found to be effective in reducing the intensity of binge drinking (Am J Prev Med. 2016;51:801-11).

The study authors endorse interventions recommended by the Community Preventive Services Task Force. Among the recommendations are limiting the number of establishments where alcohol is served in a given geographic area; increasing taxes on alcohol; and holding commercial outlets more accountable when they provide alcohol to underaged drinkers.

In contrast, the researchers point out that 9 in 10 studies in the literature reveal that binge drinkers are not alcohol dependent. This suggests that providing access to alcohol dependence treatment might be ineffective as a strategy to curb binge drinking.

Drinking is self-reported in the BRFSS survey, a potential limitation of the study. Also, the underreporting of alcohol intake tends to increase among binge drinkers, especially with increasing intensity of binge drinking.

"Therefore, the prevalence, frequency, and intensity of binge drinking are likely to have been substantially underestimated in this study," they write.

"Monitoring total binge drinks consumed annually and total binge drinks per binge drinker could...provide a more sensitive and specific way to plan, implement, and evaluate community and clinical preventive strategies for reducing binge drinking and related harms," the investigators add.

The findings in the study are those of the authors and do not necessarily represent the position of the Centers for Disease Control and Prevention. The authors have disclosed no relevant financial relationships.

Am J Prev Med. 2018;54:486-96. Full text

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