Excessive and extreme drinking patterns, including binge drinking, are a serious public health concern in many countries around the world, and are associated with a range of negative social and health outcomes. There are multiple terms and definitions used to describe this drinking patternâ€”and differing degrees of societal acceptance or tolerance in various cultures.
Despite these variations, binge drinking remains a distinct phenomenon and issue which can be addressed by initiatives designed to prevent hazardous drinking patterns in the first place, as well as to reduce their potential harm where they do occur. Since heavy drinking patterns can be particularly harmful for young people, it is imperative that prevention and harm reduction efforts address the social dynamics and other factors at play for young people who are at risk. In addition, it is our position that education and prevention efforts are more effective approaches than taxation measures, which (as noted in this report) have not resulted in reduced levels of binge drinking.
BASED ON THESE FINDINGS AND OBSERVATIONS, BROWN-FORMAN SUPPORTS AND ENCOURAGES
Education and prevention Ongoing and continually updated education and prevention initiatives supported by the private sector, public agencies, and private-public partnerships.
Such initiatives should reinforce the significant negative health and social consequences of binge drinking, and should include social marketing campaigns (such as Irelandâ€™s â€œHad Enoughâ€ campaign, developed to discourage excessive drinking and reinforce its negative impact on the individual and society).
Screening and brief intervention of high risk drinkers Targeted measures to identify binge drinkers and intervene to address the problem are proven to be effective. These can take the form of well-developed question and intervention techniques by medical practitioners (doctors, nurses, physician assistants), counselors, or others in a position of influence.
Through continued self-regulation, a strong commitment by all beverage alcohol companies that they will not, under any circumstances, encourage excessive drinking, or use marketing or advertising which condones excessive drinking or intoxication
Shared commitment It is important to emphasize and embrace the great value of family, school, and community involvement in all education, prevention, and intervention initiatives.
In alignment with our Global Actions commitments to helping reduce harmful drinking, we commit to work with retailers with whom we have commercial relationships to join us in launching a responsible retailing initiative. We will focus on measures to prevent under-age drinking and training retail staff in how to identify, prevent and manage intoxicated drinkers.
Excessive and hazardous drinking patterns, including binge drinking, are dangerous and potentially life-threatening, and are of great concern to public health authorities, families, and communities around the world.
Binge drinking is associated with a number of serious social and health-related outcomes. The harmful consequences associated with binge drinking include an increased risk for traffic accidents, injuries, and violence, a greater risk for certain cardiovascular conditions1.Â Binge drinking has also been identified as a factor contributing to increased mortality rates2.
In addition, binge drinking is associated with negative outcomes which can be particularly dangerous for young people, in part due to the physiological, emotional, and other developmental changes which occur during adolescence. There is evidence that binge drinking by young people can have lasting harmful consequences, including a greater risk for the development of alcohol dependence3.Â Moreover, because youth are generally more likely than adults to engage in risky behaviorsâ€”even if they are not drinkingâ€”the likelihood of youth engaging in risky or dangerous behaviors understandably heightens if they engage in heavy drinking episodes4,Â 5.
There are also cultural distinctions with regard to binge drinking and varying levels of acceptance in different countries and societies. While many cultures do not generally condone either binge drinking or drunkenness, there â€œare also cultures in which binge drinking is a normative drinking pattern and drunkenness the usual outcomeâ€ 6.Footnotes Less
- 1. International Center for Alcohol Policies, Blue Book, Module 6. See: http://icap.org/PolicyTools/ICAPBlueBook/BlueBookModules/6BingeDrinking/tabid/167/Default.aspx
- 2. Centers for Disease Control and Prevention. (2004). Alcohol-attributable deaths and years of potential life lost: United States, 2001. Morbidity and Mortality Weekly Report, 53, 866â€“870.
- 3. Hingson, R., & Kenkel, D. (2004). Social, health, and economic consequences of underage drinking. In National Research Council and Institute of Medicine, Reducing underage drinking: A collective responsibility, background papers. [CD-ROM]. Washington, DC: National Academies Press.
- 4. Fromme, K., Katz, E., & D'Amico, E. (1997). Effects of alcohol intoxication on the perceived consequences of risk taking. Experimental and Clinical Psychopharmacology, 5, 14â€“23.
- 5. Binge Drinking and Europe, Institute on Alcohol Studies, July 2007. See: http://www.ias.org.uk/resources/papers/europe/index.html.
- 6. International Center for Alcohol Policies, Blue Book, Module 6. See: http://icap.org/PolicyTools/ICAPBlueBook/BlueBookModules/6BingeDrinking/tabid/167/Default.aspx
The precise definition of â€œbinge drinkingâ€ has been the topic of some debate. The terms â€œheavy episodic drinkingâ€ and â€œextreme drinkingâ€ are alternative terms sometimes used to describe the same dangerous drinking pattern, which has specific characteristics that distinguish it from chronic abuse or alcohol dependency.
Some definitions of binge drinking specifically reference gender, weight, the number of drinks, and/or Blood Alcohol Concentration (BAC). For example, the National Institute on Alcohol and Alcoholism in the United States defines binge drinking as â€œa pattern of drinking alcohol that brings blood alcohol concentration to 0.08 gram percent or above,â€ adding that, â€œfor the typical adult, this pattern corresponds to consuming five or more drinks (male), or four or more drinks (female), in about two hoursâ€1. Alternatively, in a report on binge drinking in Europe recently commissioned by the European Commission, the working definition applied was consumption of 60g of alcohol (for men, roughly six drinks) or 40g of alcohol (for women, roughly four drinks) in a period of about two hours2.
In addition, in the 2007 survey (and follow up in 2011) which served as the basis for its Europe-wide reports on alcohol and youth, the European School Survey Project on Alcohol and Drugs (ESPAD) defines â€œheavy episodic drinkingâ€ as five or more drinks on a single occasion3.
For the purposes of The Issues Forum, the term binge drinking will be understood to mean an episodic pattern of heavy, excessive drinking to the point of rapid intoxication, typically involving the consumption of numerous drinks in a relatively short time frame. Contrasted with light or moderate drinking, which studies around the world have correlated with certain health benefits, binge drinking negates such benefits and often leads to negative consequences for the drinker or those around him or her.Footnotes Less
- 1. National Institute on Alcohol and Alcoholism Newsletter, Winter 2004, Number 3, page 3. See: http://www.niaaa.nih.gov/.
- 2. Alcohol in Europe A Public Health Perspective, Institute on Alcohol Studies. See: http://www.ias.org.uk/What-we-do/Publication-archive/The-Globe/Issue-2-2006/Alcohol-in-Europe-A-Public-Health-Perspective.aspx
- 3. The European School Survey Project on Alcohol and Other Drugs (ESPAD). (2011). See: http://www.espad.org/en/Reports--Documents/ESPAD-Reports/
FINDINGS ON BINGE DRINKING
Binge drinking has been a subject of great public health concern internationally, as well as the focus of numerous research studies and media stories worldwide. Although a great deal of attention has centered on hazardous and tragic binge drinking incidents onÂ United StatesÂ college campuses and by drinkers in the United Kingdom, this phenomenon is not limited to the U.S. or U.K. There are also questions as to what degree binge drinking is on the rise compared to historical patterns of consumption.
In the 2007 report Binge Drinking and Europe, more than one in six (18 percent) of European Union (EU) 15- to 16-year olds reported binge drinking (defined as five or more 50 g drinks on a single occasion). Approximately 80 million Europeans age 15 and older reported binge drinking at least once a week in 2006, a proportion that increased from 2003 statistics. The report found the highest levels of both binge drinking and drunkenness in the United Kingdom, Ireland, Slovenia, and Latviaâ€” contrasted with much lower levels of binge drinking and drunkenness found in France, Italy, Lithuania, Poland, and Romania1.
In the United States, research shows that although adolescents drink less frequently than adults, when they do drink, they drink more heavily than adults. According to the U.S. Department of Health and Human Servicesâ€”which defines a binge drinker as a person who drank five or more drinks on the same occasion on at least one day in the past 30 daysâ€”as of 2000, almost seven million people aged 12 to 20 were binge drinkers2.
It is also important to note that binge drinking is not a phenomenon confined to underage and young adult drinkers. Although college students may be thought to be prototypical binge drinkers, there is research which shows that 70 percent of binge drinking episodes involve adults 25-years old or older3.
Source: 2012 SAHMSA National Survey on Drug Use and Health
In Europe, while 24 percent of those surveyed between the ages of 15 and 24 reported binge drinking at least once a week in 2006, binge drinking was also common amongst those age 55 and older, with 18 percent reporting that they are binging at least once a week4.
CULTURE AND BINGE DRINKING
Researchers have identified cultural views as playing â€œan important role in defining drinking patterns and attitudes, including those related to the acceptability of binge drinkingâ€5.
For example, the traditional Mediterranean culture does not typically accept or tolerate binge drinking or drunkenness6. On the other hand, studies have also recognized that in some eastern and northern European cultures, binge drinking is a common drinking pattern, and is especially more accepted among men than women7, 8. Researchers have identified certain cultural practices which accept or tolerate binge drinking in the context of â€œmale bondingâ€ or a rite of passage, despite the potential negative outcomesâ€”among other places, in Japan and among Pacific Islanders9, 10. In addition, there are cultures where binge drinking is generally not accepted, yet can be a part of certain celebrations and/or religious ceremonies11,Â 12.
ADDITIONAL RESEARCH INSIGHTS
In an effort to shed light on the phenomenon of binge drinking, culture, and young people, the International Alliance for Responsible Drinking (IARD) conducted a series of focus groups in 2008 with young adults of legal drinking age in Brazil, China, Italy, Nigeria, Russia, South Africa, and Scotland.Â Using the phrase â€œextreme drinkingâ€ as an alternative term to describe a drinking pattern which involves heavy drinking and rapid intoxication as well as risk-taking and unrestrained behaviors, focus group facilitators gained anecdotal insight about the nature of this drinking pattern, and young people who engage in it13.
The focus group results revealed key cultural distinctions:
â€¦the Nigerian, Russian, Scottish, and South African groups all had respondents who felt that people at times consumed alcohol with the expressed intention of becoming intoxicated. Interesting contrasts were provided by the Italian, Brazilian, and Chinese samples. In Italy, drunkenness was perceived to be an undesirable outcome of a drinking occasion; and in both Italy and Brazil, the main reason for going out and drinking was to meet friends, which was not merely an excuse for drinking. Meanwhile, in China, complex rules governed when it was appropriate for a young person to exhibit intoxication (normally a shameful behavior), including within a business setting14.
In addition, the findings identified certain cross-cultural similarities among the young people surveyedâ€”chief among them, that most binge or â€œextremeâ€ drinking occasions were intentionally excessive, yet also that a so-called â€œsuccessfulâ€ drinking occasion, in their minds, involved being able to socialize without experiencing problems (in terms of health, safety, etc.) as a result.Footnotes Less
- 1. Binge Drinking and Europe, Institute on Alcohol Studies, July 2007. See: http://www.ias.org.uk/resources/papers/europe/index.html.
- 2. The Surgeon Generalâ€™s Call to Action To Prevent and Reduce Underage Drinking. See: http://www.surgeongeneral.gov/topics/underagedrinking/.
- 3. Naimi TS, Brewer RD, Mokdad A, Clark D, Serdula MK, Marks JS. Binge drinking among US adults. JAMA 2003;289(1):70â€“75.
- 4. Binge Drinking and Europe, Institute on Alcohol Studies, July 2007. See: http://www.ias.org.uk/resources/papers/europe/index.html.
- 5. International Center for Alcohol Policies, Blue Book, Module 6. See: http://icap.org/PolicyTools/ICAPBlueBook/BlueBookModules/6BingeDrinking/tabid/167/Default.aspx
- 6. Schmid, H. H., Ter Bogt, T. T., Godeau, E. E., Hublet, A. A., Dias, S. F. S. F., & Fotiou, A. A. (2003). Drunkenness among young people: A cross-national comparison. Journal of Studies on Alcohol, 64, 650â€“661.
- 7. Gmel, G., Rehm, J., & Kuntsche, E. (2003). Binge-trinken in Europa: Definitionen, epidemiologie und folgen [Binge drinking in Europe: Definitions, epidemiology, and consequences]. SUCHT: Zeitschrift fÃ¼r Wissenschaft und Praxis, 49, 105â€“116.
- 8. Grant, M. (1998). Alcohol and emerging markets: Patterns, problems and responses. Philadelphia: Brunner/Mazel.
- 9. Heath, D. B. (2000). Drinking occasions: Comparative perspectives on alcohol and culture. Philadelphia: Brunner/Mazel.
- 10. Higuchi, S., Suzuki, K., Matsushita, S., & Osaki, Y. (2004, October). Young peopleâ€™s drinking behavior in Japan. Paper presented at the Symposium 40, â€œYoung Peopleâ€™s Drinking: International Perspective,â€ XVIII World Congress of the World Association for Social Psychiatry, Kobe, Japan.
- 11. Trenk, M. (2001). Religious uses of alcohol among the Woodland Indians of North America. Anthropos, 96, 73â€“86.
- 12. Schnell, S. (1997). Sanctity and sanction in communal ritual: A reconsideration of Shinto festival processions. Ethnology, 36, 1â€“12.
- 13. Swimming with Crocodiles: The Culture of Extreme Drinking, International Center for Alcohol Policies. See: http://icap.org/Publication/ICAPBookSeries/SwimmingwithCrocodiles/tabid/272/Default.aspx.
- 14. Swimming with Crocodiles, Chapter 5. Editorâ€™s Note: The title is derived from comments offered by a South African focus group participant: â€œWhen I get drunk, I want to go swimmingâ€¦ This is a stupid thing to do because there are crocodiles and hippos in the river, but you feel like you are invincible when you are drunk, so you do it. I do it.â€ (Chapter 5).
Research in countries around the world continues to confirm the significant role of culture in drinking patterns, including binge drinking. Hence cultural views are a key consideration in terms of policy approaches. In societies where the cultural perspective accepts or tolerates binge drinking patterns under certain circumstances, cultural norms and variations should be taken into account and acknowledged in prevention and education initiatives.
For instance, the â€œHad Enoughâ€ campaign in Ireland is a hard-hitting nationwide advertising initiative credited with beginning to shift cultural norms and peoplesâ€™ general attitudes about drinking to intoxication. The campaign highlights the unacceptable impact of drunken behavior on a range of innocent parties, including nurses, people walking alone, taxi drivers, shop workers and neighbors of a noisy house partyâ€”all of whom turn to the camera in advertising spots to say that theyâ€™ve â€œhad enoughâ€1.
THE ROLES OF RETAILERS AND SERVERS
In various countries, the roles of retailers (and retail advertisers) have been called into question with regard to binge drinking. For example, in 2008, the United Kingdomâ€™s Home Secretary announced a new mandatory code of practice intended to target irresponsible retail practices, banning offers such as â€œAll You Can Drink for 10â€ (10 pounds)2. In addition, retailers have been criticized for so-called â€œloss leaderâ€ promotions which make certain alcohol products available at or below retailer cost. Such promotions have been criticized as â€œfuelling binge drinkingâ€3. Mandatory training for those seeking to sell or serve alcohol has also been a part of recent efforts in Europe to curb binge drinking and its negative consequences4.
RESPONSIBLE MARKETING AND AD PLACEMENTS
There are well-established industry codes for responsible marketing worldwideâ€”codes which comprehensively address the importance of marketing and advertising practices which target only consumers of legal drinking age. These codes include the Distilled Spirits Council of the United States (DISCUS) Code of Responsible Practices for Beverage Alcohol Advertising and Marketing and similar codes of responsibility established by The Beer Institute and The Wine Institute, the European Spirits Association (CEPS), the European Forum for Responsible Drinking (EFRD) Common Standards on Commercial Communications, the Distilled Spirits Industry Council of Australia (DSICA), the Brewers Association of Japan and the Japan Spirits & Liquors Makers Association, and the Portman Group in the United Kingdom.
Two key elements of such codes are industry standards for ad content as well as ad placement. In the U.S., ad content standards address binge drinking primarily through prohibiting content that portrays rapid or excessive consumption or a state of intoxication. For example, the DISCUS code states:
Beverage alcohol advertising and marketing materials should not depict situations where beverage alcohol is being consumed excessively or in an irresponsible manner. These materials should not portray persons in a state of intoxication or in any way suggest that intoxication is socially acceptable conduct, and they should not promote the intoxicating effects of beverage alcohol consumption5.
(For more on self-regulation, see The Issues Forum entry on Self-Regulation.)
As binge drinking becomes more prevalent in many countries, there is increasing evidenceâ€”and concernâ€”that young people view this drinking pattern as an intentional or desirable goal of the occasions when they drink6. Such expectations, as well as peer dynamics, may increase the likelihood of the risky and dangerous behaviors most often associated with binge drinking.
EDUCATION AND TARGETED PREVENTION INITIATIVES
Of particular concern are instances where youth who engage in binge drinking are also underage. A range of programs have been developed and customized for various youth audiences, taking into account that external influences such as parents, other family members, peers, and educators contribute to young peoplesâ€™ choices about whether or not they decide to drink â€“ and if so how they do so7. For example, The Foundation for Advancing Alcohol Responsibility (Responsibility.org) has developed Alcohol 101 Plusâ€”an interactive, online program designed to help college students in the U.S. make responsible decisions about alcohol8. Also, in the U.K., part of theÂ Alcohol Harm Reduction Strategy for England includes measures such as stronger alcohol education in schools and law enforcement targeting of pubs and shops suspected of selling beverage alcohol to underage youth. In Spain, an education program in schools which focuses on 12- to 16-year olds and their parents has been showing positive results, according to the Fundacion Alcohol y Sociedad. Between 2002 and 2006, the age at which teenagers report having their first drink increased from 13.9 to 14.5, and the percentage of underage drinkers decreased from 60.1 percent to 50.3 percent9.
CERTAIN RISK FACTORS AND TARGETED INTERVENTIONS
For some young people as well as adults, binge drinking may in part be the result of risk factors such as sexual abuse, mental illness, or other serious emotional or health considerations10, 11.Â A number of customized interventions have proven to be successful in influencing the decisions that young people make about alcohol. For example, the talkaboutalcohol.com website developed by a private-public partnership and the European Forum for Responsible Drinking (EFRD) offers information and parent-teen activities aimed at reducing alcohol-related harm amongst underage drinkers12. Early identification of problem drinking, followed by brief interventions aimed at modifying behavior can help minimize harm among individuals who may be particularly susceptible to engaging in harmful drinking patterns. Such programs range from social norms marketing (aimed at correcting peer misperceptions) to server training programs and life skills programs in schools and communities13.
THE STRONG INFLUENCE OF FAMILY AND FRIENDS
The majority of youth surveyed report that they get the alcohol they drink from family and friendsâ€”from their parents, their friends’ parents, older siblings or family members or older friends, with or without permission.Â Education and prevention programs such as Responsibility.orgâ€™s Ready or Not initiative stem from research results such as 97 percent of young people claiming they believe they have enough information to make the right decisions about drinkingâ€”yet half of the sixth through 12th graders surveyed reported drinking alcohol within the past month14, and increasing percentages of youth between the ages of 12 and 20 reporting binge drinking incidents as they approach age 21 (See Tables 1 and 2 in the research section).
One proposed policy approach to binge drinking is higher taxation of beverage alcohol. However, research shows that heavier drinkers are least affected by changes in price through taxation15. In addition, an International Alliance for Responsible Drinking (IARD) review of taxation rates and harmful drinking patterns shows no correlation between taxation rates and heavy episodic drinking patterns, and that â€œdespite high rates of taxation, harmful drinking patterns and adverse outcomes persist in many countriesâ€16.
As illustrated in Table 3, Iceland, Finland, and Germany have high rates of heavy episodic drinking. Taxation rates in Iceland and Finland are high, yet relatively low in Germany, â€œsuggesting that heavy episodic drinking occurs independently of levels of taxation.â€ Conversely, rates of heavy episodic drinking are significantly lower in Italy, Slovakia, and Spain, countries with some of the lowest excise taxes in Europe.
TABLE 3: PREVALENCE OF WEEKLY HEAVY EPISODIC DRINKING AMONG DRINKERS IN THE PAST 12 MONTHS BY SEX, WHO REGION, AND THE WORLD
*Of the adults who say they drink, percentage of adults who report heavy, episodic drinking. Reported by IARD, citing the World Health Organization (WHO), 201117.Footnotes Less
- 1. The campaign is sponsored by MEAS (Mature Enjoyment of Alcohol in Society Limited). See: www.meas.ie/page.php?intPageID=454.
- 2. See: http://www.homeoffice.gov.uk/about-us/news/crackdown-irresponsible-drinking.
- 3. See: http://www.telegraph.co.uk/news/uknews/1540396/Supermarkets-fuelling-binge-drinking.html.
- 4. Betsy Thom and Mariana Bayley (2007) Multi-component programmes: an approach to prevention and reduction of alcohol-related harm, York, Joesph Rowntree Foundation. See: http://www.jrf.org.uk/sites/files/jrf/1976-prevention-alcohol-harm.pdf
- 5. See: www.discus.org.
- 6. Binge Drinking and Europe, Institute on Alcohol Studies, July 2007. See: http://www.ias.org.uk/resources/papers/europe/index.html. See also: Hibell, B., Andersson, B., AhlstrÃ¶m, S., Balakireva, O., Bjarnason, T., Kokkevi, A., et al. (2004). The ESPAD Report 2003: Alcohol and other drug use among students in 35 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN).
- 7. Houghton & Roche, 2001.
- 8. See: http://www.centurycouncil.org.
- 9. See: http://www.alcoholysociedad.org/
- 10. Champion, H. L., Foley, K. L., DuRant, R. H., Hensberry, R., Altman, D., & Wolfson, M. (2004). Adolescent sexual victimization, use of alcohol and other substances, and other health risk behaviors. Journal of Adolescent Health, 35, 321â€“328.
- 11. Simons, J. S., Christopher, M. S., & McLaury, A. E. (2004). Personal strivings, binge drinking, and alcohol-related problems. Addictive Behaviors, 29, 773â€“779.
- 12. See: www.talkaboutalcohol.com. In addition, a number of program examples are included in the annual EFRD/CEPS brochure which can be viewed at www.efrd.org.
- 13. For a complete listing of targeted intervention examples worldwide, see: International Center for Alcohol Policies, Blue Book, Module 11. See: http://icap.org/PolicyTools/ICAPBlueBook/BlueBookModules/11YoungPeopleandAlcohol/tabid/172/Default.aspx
- 14. See: World Health Organization (WHO). (2011). Global status report: Alcohol and Health. See: http://www.who.int/substance_abuse/publications/global_alcohol_report/en/index.html.
- 15. Manning, W., Blumberg, L., & Moulton, L. (1995). The demand for alcohol: The differential response to price. Journal of Health Economics, 14, 123â€“148.
- 16. Taxation of Beverage Alcohol, International Center for Alcohol Policies. See: http://www.icap.org/PolicyTools/ICAPIssuesBriefings/tabid/243/Default.aspx.
- 17. World Health Organization (WHO). (2011). Global status report on alcohol and health. See: http://www.who.int/substance_abuse/publications/global_alcohol_report/en/index.html See also: International Center for Alcohol Policies (ICAP). (2009). Taxation of beverage alcohol. ICAP Issues Briefings at http://www.icap.org/PolicyTools/ICAPIssuesBriefings/tabid/243/Default.aspx.