What is binge drinking?

Causes

Ethanol (C2H5OH) is the psychoactive (mind-altering) component of alcoholic beverages, namely beer, wine, and hard liquor. Since antiquity, ethanol has been produced by the fermentation of sugar.

Alcohol is a flammable and colorless liquid and is readily available on the marketplace. Although the sale of alcoholic beverages in the United States and many other developed nations is generally restricted to adults over the age of twenty-one years, minors can often obtain the product through a third party, sometimes even their parents, without difficulty.

Peer pressure is a major factor in binge drinking. Teenagers and young adults who have never consumed alcohol, or who have consumed only an occasional alcoholic beverage, may succumb to peer pressure in a party environment and engage in binge drinking through drinking games. Party attendees are sometimes encouraged to partake in drinking with a beer “bong,” which facilitates binge drinking. (A beer bong is a funnel attached to a hose. The drinker lies on his or her back, and one or more bottles of beer are funneled into his or her mouth.)

Significant evidence exists that genetic factors are involved in the development of alcoholism. The interaction of genes and environment is complex and, for most people with alcohol dependence, many factors are involved. Since 1989, the US government-funded Collaborative Study on the Genetics of Alcoholism (COGA) has been tracking alcoholism in families. COGA researchers have interviewed more than fourteen thousand people and sampled the DNA (deoxyribonucleic acid) of hundreds of families. Researchers have found evidence for the existence of several alcohol-related genes. COGA researchers are increasingly convinced that certain types of alcoholics are representative of specific genetic variations.

Risk Factors

The following factors increase one’s risk of binge drinking:

Rate of drinking. Rapid consumption of a given amount of alcohol increases the risk of alcohol poisoning. One to two hours are required to metabolize one drink.

Gender. Young men from age eighteen through twenty-five years are the most likely group to engage in binge drinking; thus, they are at the highest risk for alcohol poisoning. However, young women also engage in binge drinking and are more susceptible to alcohol poisoning because women produce less of an enzyme that slows the release of alcohol from the stomach than men.

Age. Teenagers and college-age youth are more likely to engage in binge drinking; however, the majority of deaths from binge drinking occur in persons age thirty-five to fifty-four years. The persons in this age group often do not metabolize alcohol as readily as younger persons and are more likely to have underlying health problems that increase the risk.

Body mass. A heavier person can drink more alcohol than a lighter person and still register the same blood alcohol content (BAC). For example, a 240-pound man who drinks two cocktails will have the same BAC as a 120-pound woman who consumes one cocktail.

Overall health. Persons with kidney, liver, or heart disease, or with other health problems, may metabolize alcohol more slowly. Persons with diabetes who binge drink might experience a dangerous drop in blood sugar level.

Food consumption. A full stomach slows the absorption of alcohol; thus, drinking on an empty stomach increases the risk.

Drug use. Prescription and over-the-counter drugs might increase the risk of alcohol poisoning. Ingestion of illegal substances, such as cocaine, methamphetamine, heroin, and marijuana, also increase the risk.

Symptoms

Symptoms of alcohol poisoning include respiratory depression (slow breathing rate); confusion, stupor, or unconsciousness; slow heart rate; low blood pressure; low body temperature (hypothermia); vomiting; seizures; irregular breathing (a gap of more than ten seconds between breaths); and blue-tinged skin or pale skin.

Screening and Diagnosis

The BAC test is a definitive measure of alcohol in the blood and, hence, of blood poisoning. Persons with alcohol poisoning often have a BAC of 0.35 to 0.5 percent. By comparison, the BAC level that marks driving under the influence is 0.08 percent in all US states. Other screening tests include complete blood count and other tests that check levels of glucose, urea, arterial pH, and electrolytes in the blood.

Treatment and Therapy

Acute treatment consists of supportive measures until the body metabolizes the alcohol; acute treatment includes insertion of an airway (endotracheal tube) to prevent vomiting and aspiration of stomach contents into the lungs; close monitoring of vital signs (temperature, heart rate, and blood pressure); oxygen administration; medication to increase blood pressure and heart rate, if needed; respiratory support, if needed; and maintenance of body temperature (blankets or warming devices). Acute treatment also includes the administration of intravenous fluids to prevent dehydration (glucose should be added if the person is hypoglycemic, and thiamine is often added to reduce the risk of a seizure). Further treatment includes hemodialysis (blood cleansing), which might be needed for dangerously high BAC levels (more than 0.4 percent). Hemodialysis also is necessary if methanol or isopropyl alcohol has been ingested.

Follow-up treatment for binge drinking requires the aid of a health care professional skilled in alcohol abuse treatment. A treatment plan includes behavior-modification techniques, counseling, goal setting, and use of self-help manuals or online resources. Counseling on an individual or group basis is an essential treatment component. Group therapy, which is particularly valuable because it allows interaction with others who abuse alcohol, helps a person become aware that his or her problems are not unique. Family support is a significant component of the recovery process, so therapy may include a spouse or other family member.

Binge drinking may be a component of other mental health disorders. Counseling or psychotherapy may be recommended. Treatment for depression or anxiety also may be a part of follow-up care. Beyond counseling and medication, other modalities may be helpful. For example, in September 2010, researchers at the University of California, Los Angeles released the results of a clinical trial on a unique therapy that applies electrical stimulation to a major nerve that emanates from the brain. The technique, trigeminal nerve stimulation, reduced participants’ depression an average of 70 percent in an eight-week period.

Care also may include long-term pharmaceutical treatment, including the oral medications disulfiram, acamprosate, and naltrexone. Disulfiram (Antabuse), which is taken orally, produces unpleasant physical reactions to alcohol ingestion; these reactions include flushing, headaches, nausea, and vomiting. Disulfiram, however, does not reduce the craving for alcohol. One drug that can reduce craving is acamprosate (Campral). Another drug, naltrexone
(ReVia), may reduce the urge to drink, and it blocks the pleasant sensations associated with alcohol consumption. Oral medications are not foolproof, however; if a person wants to return to drinking, he or she can simply stop taking the medication.

To avoid (or manage) relapses and to help deal with the necessary lifestyle changes to maintain sobriety, aftercare programs and support groups are essential for the recovering alcoholic. Regular attendance at a support group, such as Alcoholics Anonymous, is often a component of follow-up care.

Although death can occur from binge drinking, most alcohol-related fatalities occur in automobile accidents caused by driving under the influence. Also, women who binge drink are vulnerable to sexual assault while in an alcohol-induced stupor. Repeated episodes of binge drinking can result in permanent physical injury and in reduced quality of health. Brain and liver damage is common in repetitive binge drinkers. A young adult who binge drinks often progresses to alcoholism in adulthood.

Prevention

The best way to prevent binge drinking is to educate persons who partake in at-risk behaviors. The highest risk for binge drinking occurs among young men, who often have a sense of invincibility and who often disregard advice from any source. Peer pressure is probably the best deterrent; it also is a factor that can encourage binge drinking. Finally, children with a good parental relationship are less likely to drink to excess.

Bibliography

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