The Truth Should Be Self-Evident--Not All "Bingers" are Created Equal

Binge drinking. We all have heard the term used incessantly in the media, who usually claim it is getting worse. Our kids are out of control, they say, and we need to get tougher. Except, of course, when the issue of the 21 drinking age comes up--then it has gone way down, and the raising of the drinking age in the 1980s gets all (or nearly all) the credit.  Predictable to say the least.

So which is it? It depends on your definition of "binge" drinking. The term originally meant a multi-day, very heavy drinking session in which the drinker neglects usual responsibilities and behaves recklessly--also known as a bender. Fortunately, very few people do this, both now and back in the day. But in 1994, Henry Wechsler of the Harvard University School of Public Health redefined the term to mean anytime someone drinks 5 or more drinks in the same evening, later modified to be 4 or more for a woman. This "5/4 definition" is the one most commonly used nowadays, with the gender-neutral 5+ definition a close second since the latter has been tracked by national surveys since 1975. And yes, it (defined this way) has gone down since its peak in 1979 for everyone except college students and non-college females. But that downward trend began several years before a significant number of states raised their drinking ages to 21, and also occurred in states that stayed 21 throughout.

But is it really an accurate index of harmful drinking? That question appears to have been answered fairly in a new study. Using self-reported alcohol-related injuries (major or minor) in the past 6 months as the dependent variable, researchers examined the effect of the number of drinks per drinking day, and the frequency of occasions having that number of drinks in the past month, among college students. This clearly makes more sense than lumping them all together, or looking only at total volume or frequency. Results were that risks increase rapidly after consuming 8+ drinks (males) or 5+ (females), on at least four days per month. Effects were further magnified among those who scored high on sensation-seeking. It was also found that the 5/4 definiton loses much of its predictive power when days of 8/5+ are removed from the equation. And remember, none of these models account for speed or context of drinking, or even distinguish drunk driving, and students often undercount their drinks as well (due in part to the ubiquitous "red party cups" and the popularity of hard liquor).  But one benefit to this study is that body weight was controlled for, since the effect of a specific number of drinks varies widely across individuals.

Another recent study found that a 7/6+ cutoff was far more predictive of alcohol-related problems (relative to non-bingers) than a 5/4+ one.  Those who met the 5/4+ cutoff but not the 7/6+ one averaged 5.4 drinks per occasion, while those who met the 7/6+ cutoff averaged a whopping 9.1 drinks.  In terms of negative consequences, those males who typically drank 5-6 drinks (and 4-5 for females) generally did not fare significantly worse than the nonbingers, but the heavier 7/6+ group clearly did.

Clearly, the 5/4 definition is an arbitrary convention with little to no scientific basis. Kind of like, well, the 21 drinking age. An ideal definition would take into account context, speed, and BAC, set at rational thresholds. However, a quick, context-neutral, numerical definition is needed for survey purposes. While for the vast majority of the college-age population a 5/4+ threshold is a good negative test for acutely dangerous drinking, a 10/8+ threshold is a better sufficient test for the same, and intermediate between the two is an 8/6+ threshold.  Thus, we at 21 Debunked propose two thresholds: 8/6+ drinks and 10/8+ drinks. It's probably best to jettison the word "binge" entirely--call the first threshold "heavy episodic drinking" or "high risk drinking," and the second one "extreme drinking." Unfortunately, these have not been measured very well over time, so to answer the first question, we don't know for sure.

But if we are to go with anecdotal data and statistical proxies for extreme drinking, we can probably safely that say such drinking has been on the rise, at least for college students. For example, another study found that between 1998 to 2005, there was a significant increase in alcohol-related nontraffic deaths among students, driven by a near tripling of alcohol poisoning deaths. (The actual statistics were simply those for 18-24 year olds multiplied by 30%, so this actually includes many non-students as well) That being said, we should note that the majority of college drinkers still drink responsibly, whether legally or illegally, and only a small minority drinks to these ludicrously high levels. However, the latter appears to be where the real problems lie, and where our efforts are best concentrated.  But we still keep on barking up the wrong tree time and again.

It's also worth noting that in the first study mentioned, participants from 3 out of the 4 American universities surveyed had higher rates of alcohol-related injury than those from the one Canadian university, though the difference was not statistically significant.  It is quite plausible that the 21 drinking age, by forcing drinking underground, exacerbates such problems. (Canada's drinking age is 18 or 19, depending on the province)

We at Twenty-One Debunked do not endorse any kind of drinking, underage or otherwise, and we do not mean to imply that drinking below a specific threshold is safe for everyone. To our knowledge, no such absolute threshold exists. But we do think that we need to get our priorities straight as a society when it comes to drinking.  America's young people--our future--deserve nothing less.