The American Psychiatric Association (APA) does not formally recognize a binge drinking disorder. Nonetheless, the criteria for binge drinking and heavy drinking are defined and explained by professional organizations, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) and APA.
- For females, binge drinking is defined as four or more alcoholic drinks on the same occasion; for males, it is five or more alcoholic drinks on the same occasion.
- The term same occasion is typically meant to represent a period of just a few hours.
- This level of consumption is estimated as the amount of alcohol it would take to raise a normal individual’s blood alcohol concentration (BAC) to 0.08 percent.
- Some individuals may actually require more or less alcohol to reach the estimated BAC.
- The notion of a single occasion or single timeframe is considered to consist of just a few hours.
- Heavy alcohol use is defined as binge drinking on five or more times during the same month.
Obviously, occasional binge drinking is not as problematic as heavy drinking.
Statistics on Binge Drinking
According to data released by SAMHSA in 2017:
- Estimates of individuals, ages 12-20, admitting to binge drinking within the month prior to the survey are:
- 6 million males in 2015; 2.3 million in 2016
- 4 million females in 2015; 2.3 million in 2016
- Estimates of individuals, ages 12-20, who reported heavy drinking within the month prior to the survey are:
- 707,000 males in 2015; 586,000 in 2016
- 554,000 females in 2015; 485,000 in 2016
- Estimates of college-age individuals (ages 18-25) who reported binge drinking behaviors are:
- 2 million males in 2015; 6.9 million in 2016
- 4 million females in 2015; 6.4 million in 2016
- Estimates of college-age individuals (ages 18-25) reporting heavy alcohol use are:
- 4 million males in 2015; 2 million in 2016
- 4 million females in 2015; 1.5 million in 2016
There is a bit of overlap in the figures from SAMHSA regarding age groups; however, the data indicates that there are significant numbers of individuals in these age levels who engage in binge drinking behavior and heavy alcohol use. In addition, males slightly outnumber females in this capacity. The vast majority of individuals within the college age groups who report binge drinking and heavy drinking behaviors have some level of college education (which can indicate they are still in college or have dropped out) or have graduated from college.
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Factors to Consider
There is no specified level of alcohol use that is required by APA for a diagnosis of an alcohol use disorder. The diagnostic criteria for an alcohol use disorder simply state that the person experiences significant impairment or distress as a result of use of alcohol and then demonstrates at least four symptoms over a 12-month period. The severity of the alcohol use disorder is dependent on the number of symptoms present.
SAMHSA suggests that the quantity of alcohol use that constitutes a low risk for the development of an alcohol use disorder in men consists of consuming 14 or fewer alcoholic beverages in a week (with no more than four alcoholic beverages consumed on a single occasion), whereas for women, low risk to develop an alcohol use disorder is confined to consuming seven or fewer alcoholic beverages per week with no more than three drinks on a single occasion. Both APA and SAMHSA have determined that a very small proportion of individuals who engage in drinking alcohol at this level or below develop alcohol use disorders (2-4 percent of individuals at this level of use go on to develop alcohol use disorders, an extremely low percentage).
By definition, heavy drinkers drink significantly more than this and certainly have an increased risk to develop alcohol use disorders. Binge drinking behaviors occurring in any capacity could be defined as alcohol abuse in individuals under the age of 21, because it is not legal for them to drink alcohol.
Binge Drinking and Alcohol Abuse
The relationship between binge drinking and the development of an alcohol use disorder is quite straightforward. If one understands the statistics, then it is clear that individuals who binge drink are at an increased risk to become heavy drinkers, and individuals who become heavy drinkers are at an extremely increased risk to develop alcohol use disorders. The particular type of alcohol consumed is not as important as the amount of alcohol regularly consumed.
The effects of binge drinking, particularly binge drinking that becomes classified as heavy drinking, indicate an increased risk for:
- Performance losses in school and at work
- Becoming involved in an accident
- Developing issues in personal relationships
- Developing legal problems as a result of alcohol
- Becoming isolated from others
- Getting involved in risky behaviors, such as having unprotected sex, experimenting with dangerous drugs, being the victim of a crime, performing criminal activities, etc.
- Effects on organ systems that can result in increased susceptibility to numerous health conditions and diseases
- Becoming diagnosed with some other form of mental illness, such as major depressive disorder, trauma- and stressor-related disorders, eating disorders, etc.
Signs of Binge Drinking
According to the book Binge Drinking, some of the signs that indicate that a person might be binge drinking include:
- Excessive use of alcohol on weekends or holidays: Binge drinking behavior and heavy drinking behavior often don’t occur on weekdays but on “special occasions,” which may include weekends and holidays. For many binge drinkers, this justifies their alcohol use, even if it is dysfunctional for them.
- Rationalization by the person of their need to drink excessively: No one needs to drink excessively. Heavy drinkers and binge drinkers often use the excuse that their drinking behavior is “normal for them.”
- Becoming defensive or ignoring the concerns of others: Binge drinkers and heavy drinkers often ignore or become very defensive when other people begin to question their use of alcohol. They may even become aggressive.
- Early signs of issues with controlling use of alcohol: Binge drinkers often begin drinking by stating that they are only going to have “a few” or “a couple of drinks,” which often turns into many more than just two or three drinks. Typically, for chronic binge drinkers and heavy drinkers, this is a rationalization to begin the bingeing session, not to limit it.
- Blackouts: These may occur in individuals who drink large amounts of alcohol on a single occasion. Although not one of the diagnostic criteria for an alcohol use disorder, many mental health professionals consider blackouts to be a sign of an impending serious issue with alcohol abuse.
- Slacking on personal responsibilities: Individuals may fail to fulfill important obligations after drinking, such as not attending school or work, ignoring important aspects of personal life, etc.
- Romanticizing and craving alcohol: Binge drinkers often romanticize their use of alcohol and frequently express cravings or needs to have a few drinks in order to deal with everyday issues.
The vast majority of people who begin to abuse or misuse alcohol in a manner that results in dysfunctional issues for them will not readily recognize these issues; instead, they will often focus on what they perceive as the positive benefits of their alcohol use. Even though the negative issues may clearly far outweigh any positive issues they can use to rationalize their behavior, they are unable to view the situation from this point of view. Individuals with these issues are typically on the way to developing an alcohol use disorder if they have not already developed one.
A formal alcohol use disorder can only be diagnosed by a trained and licensed mental health clinician. Recognizing binge drinking behavior or heavy alcohol use in someone is simply a matter of accurately understanding the quantity of alcohol they normally drink on a single occasion and how often they repeat this behavior.
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Helping the Person
Individuals who are able to maintain low-risk drinking behaviors, as outlined by SAMHSA, most likely do not need professional help. Individuals who binge drink beyond the specified level of safe drinking as mentioned above, or who are heavy alcohol users, need help. These individuals are most likely at a high risk for the development of an alcohol use disorder and may have already experience significant levels of dysfunction or distress associated with their use of alcohol. They are not able to view their situation objectively in most instances and may require specialized care.
One option is to perform an alcohol use disorder intervention. This is a formalized process that should include the assistance of an intervention specialist or mental health professional. In the long run, it is up to the person with the alcohol use issue to address their behavior unless they are mandated to do so by the legal system, their employer, or some other party that has the authority to force them into treatment.
Many individuals may believe that being forced into treatment for alcohol abuse will not be productive; however, according to the National Institute on Drug Abuse and numerous research studies, voluntary participation in a recovery program is not necessary. Overall success rates are similar for individuals who are forced into treatment and for those who volunteer to go into treatment. Eventually, no matter how the person entered treatment, many benefit from empirically validated treatment approaches.
For some individuals, fear is often a driving force that keeps them from getting help. Any person who believes they may need assistance in stopping their use of alcohol should contact a licensed mental health professional who specializes in the treatment of addictive behaviors. This meeting would be performed on a strictly confidential basis. In addition, individuals can readily attend social support groups, such as AA.