What’s worse than bingeing? This new middle-aged drinking habit worries docs

Christina Caron
The holidays offer an excuse to gather with loved ones, let loose and indulge: Plates loaded with comfort foods. Unapologetic napping. And, for some, plenty of alcohol. But heavy drinking is not limited to the Christmas and New Year season. Nor is it mainly the pastime of college students. Overall

binge drinking

rates are now equivalent among young adults and those in midlife. That’s because young people, especially young men, are bingeing less while middle-aged adults are throwing back more alcohol in a single session than they previously did.
We’ve long been warned about the risks of binge drinking, usually defined as having four or five drinks in a two-hour span. Now, researchers are increasingly focused on a more dangerous pattern of alcohol use that they call

high-intensity drinking

: consuming eight or more drinks in a row for women and 10 or more drinks in a row for men.
High-intensity drinking is even riskier than binge drinking, and it’s on the rise among certain segments of the population.

How does it differ from binge drinking?

The definition of binge drinking stems from the work of Henry Wechsler, a social psychologist at Harvard University who in 1993 tracked alcohol use among college students across the country. He found that young women who reported consuming at least four drinks in a night and men who consumed at least five experienced the most drinking-related problems.
But other researchers noticed that some of the worst consequences associated with binge drinking, such as blackouts and alcohol poisoning, tended to happen when people had much more than four or five drinks.

Over the years, experts have referred to heavier levels of binge drinking in different ways, including “extreme drinking” and the far less catchy “extreme ritualistic alcohol consumption”. In recent years, they settled on the term ‘high-intensity drinking’.

Who consumes 8 or 10 drinks in a row?

Heavy drinking has long been associated with youth, but trends are changing. Since 2005, the Monitoring the Future survey, which tracks the behaviour of American adolescents through adulthood, has asked people from ages 19 to 30 how often they have engaged in high-intensity drinking over the previous two weeks. The survey found that high-intensity drinking decreased to 8.5% of study subjects in 2023, from about 11% in 2013.
But “while the prevalence is coming down, it is still high,” particularly for those in their late 20s, said George F Koob, director of the National Institute on

Alcohol Abuse

and Alcoholism. Nearly one in eight people between ages 27 and 28 regularly consumes 10 or more drinks in a night, according to the latest data from 2023.
The National Alcohol Survey series, which collects data from the general population, defines high-intensity drinking as the consumption of at least 8 drinks in a row by anyone, male or female, over the previous 12 months. The survey’s latest analysis, which does not include data beyond 2020, also showed a decline in high-intensity drinking among young adults overall. But its frequency among men aged 30 and older and women aged 18 to 64 has increased, said Camillia Lui, a scientist at the Alcohol Research Group who crunched the data.

Heavier consequences

Experts who study the effects of alcohol said it was worth distinguishing between bingeing and high-intensity drinking because the latter comes with heavier consequences. Consuming eight or ten drinks in a short period of time can produce a blood alcohol concentration (BAC) of over 0.2%, “which significantly increases the risk of injuries, overdose and deaths,” Dr Koob said. For comparison, a regular binge (four or five drinks) typically results in a BAC of around 0.08%.
High-intensity drinkers are also more likely to experience a “full blackout”, with zero recall of what transpired, or to end up in the emergency room “grossly intoxicated and a danger to themselves and others,” said Keith Humphreys, an addiction expert and psychologist at Stanford University. When people drink that much, “the risk of harm goes up pretty dramatically,” he added.
In addition, a higher number of drinks per occasion is associated with a greater likelihood of developing alcohol use disorder, Dr Koob said. And “high-intensity drinking doesn’t just harm the drinker,” Dr Lui said. It can lead to physical assaults, drunk-driving accidents, property damage and relationship problems, she added.

Why are people drinking so much?

There are many reasons someone might abuse alcohol, from a genetic disposition to self-medicating. But when it comes to high-intensity drinking, studies have found that young people were largely motivated by the expectation that it would make them more social and help them have fun with friends. And that, for them, outweighed any potential negative consequences.
The US National Alcohol Survey has shown that middle-aged and older adults drink during social events too, but they also reported using drinking as a way to deal with stress, Dr Lui said. More research is needed to fully unpack why some age groups are gravitating toward this more extreme form of bingeing. Because while five drinks is risky, it’s not the same as 10, Dr Humphreys said.“The dose makes the poison,” he added. NYT NEWS SERVICE
Quote: High-intensity drinkers are more likely to experience a full blackout, with zero recall of what transpired, or end up in the ER grossly intoxicated and a danger to themselves and others. When people drink that much, the risk
of harm goes up dramatically
— Keith Humphreys, Addiction expert and psychologist, Stanford University