Heavy Episodic Consumption of Alcohol
Data from several national surveys indicate that about four in five college students drink and that about half of college student drinkers engage in heavy episodic consumption. Recent concerns have, therefore, often focused on the practice of binge drinking, typically defined as consuming five or more drinks in a row for men, and four or more drinks in a row for women. A shorthand description of this type of heavy episodic drinking is the "5/4 definition." Approximately two of five college students—more than 40 percent—have engaged in binge drinking at least once during the past 2 weeks, according to this definition. It should be noted, however, that colleges vary widely in their binge drinking rates—from 1 percent to more than 70 percent—and a study on one campus may not apply to others (Wechsler et al., 1994, 1998, 2000b).
The U.S. Surgeon General and the U.S. Department of Health and Human Services (USDHHS) have identified binge drinking among college students as a major public health problem. In "Healthy People 2010," which sets U.S. public health goals through the year 2010, the Federal government has singled out binge drinking among college students for a specific, targeted reduction (e.g., from 39 percent to 20 percent) by the year 2010. "Healthy People 2010" notes that: "Binge drinking is a national problem, especially among males and young adults." The report also observes that: "The perception that alcohol use is socially acceptable correlates with the fact that more than 80 percent of American youth consume alcohol before their 21st birthday, whereas the lack of social acceptance of other drugs correlates with comparatively lower rates of use. Similarly, widespread societal expectations that young persons will engage in binge drinking may encourage this highly dangerous form of alcohol consumption" (USDHHS, 2000).
There is evidence that more extreme forms of drinking by college students are escalating. In one study, frequent binge drinkers (defined as three times or more in the past 2 weeks) grew from 20 percent to 23 percent between 1993 and 1999. The number of students who reported three or more incidents of intoxication in the past month also increased (Wechsler et al., 2000b). It should be noted, however, that the number of college students who do not drink is also growing. In the same study, the percentage of abstainers increased from 15 to 19 percent.
Understanding Alcohol Consumption
The term alcohol consumption encompasses two ideas important in characterizing an individual's drinking behavior: frequency (how often a person drinks) and quantity (how much a person drinks). Frequency of consumption refers to the number of days or, sometimes, occasions that an individual has consumed alcoholic beverages during a specified interval (e.g., week, month, and year). Quantity of consumption refers to the amount ingested on a given drinking occasion.
Most typically, consumption is assessed using "standard drinks"—in the United States, these are 5 ounces of wine, 12 ounces of beer, or 1.25 ounces of distilled spirits. Because individuals do not drink the same amount at every drinking occasion, some surveys attempt to assess the frequency with which a person drinks various amounts of alcohol (e.g., one to two drinks, three to four drinks, five to six drinks) over a specified period of time. Although cumbersome, this approach probably provides a fairly accurate assessment of total volume consumed and of variability in drinking pattern.
For many purposes, however, identifying "light" or "moderate" consumption is not the issue, "heavy" consumption is. For that reason, it is common to assess heavy consumption on the basis of the frequency of consuming a number of drinks meeting or exceeding a certain threshold. When describing college drinking, heavy drinking occasions are often referred to as "binges." Based on the influential work of Henry Wechsler and colleagues—who define binge as five or more drinks in a row for men and four or more drinks for women—the prevalence of binge drinking has become a key measure in estimating the extent of alcohol problems on college campuses.
Historically, binge drinking has referred to an extended period of heavy drinking (for example, a "bender" that lasts 3 days or more) that is seen in some alcoholic patients. Some clinicians believe that using the term binge to refer to a less severe phenomenon blurs this important distinction. However, Dr. Wechsler has observed that the term binge is now commonly associated with eating and shopping and that its application to alcohol use is consistent with the term's generally accepted meaning.
Other researchers have voiced concern because the specific time period over which the five or four drinks are consumed is not specified nor is the body mass of an individual drinker. For example, after 5 drinks consumed over a fixed time span, a man of 240 pounds would have a lower blood alcohol level than a man of 140 pounds. Nor would a male or female of the same body weight achieve the same blood alcohol level following equal consumption because of gender-related differences in physiology. Dr. Wechsler believes that the phrase "in a row" implies a relatively short time frame. He also shows that individuals who consume alcohol at these levels increase their likelihood of experiencing a range of negative consequences.
Whether terms such as heavy drinking, binge drinking, or drinking to intoxication are used to describe students' behavior, it is clear that consumption of large quantities of alcohol on a single drinking occasion is important in assessing alcohol involvement. Also key in evaluating alcohol consumption are the consequences of that consumption which can include academic, personal, social, legal, and medical problems as well as dependent symptoms such as tolerance, withdrawal, and loss of control.
Reprinted with the permission of the National Institute on Alcohol Abuse and Alcoholism.
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