26 January 2007

Binge drinking vs. alcoholism

A statewide New Mexico survey suggests that most Americans who drink too much may not, in fact, be full-blown alcoholics but rather binge drinkers.

While the poll revealed that 16.5% of that state's residents are excessive drinkers, only 1.8% of the men and women interviewed met the official definition for alcohol dependence. In turn, most of these excessive drinkers were found to be engaged in "binge drinking" - defined as imbibing five or more drinks at one sitting.

"Short-term episodic drinking - not alcoholism - is the predominant alcohol-related problem," said study co-author Jim Roeber, an alcohol epidemiologist with the New Mexico Department of Health in Santa Fe.

Reporting in the February issue of Alcoholism: Clinical & Experimental Research, the authors referenced 2001 figures from the U.S. Centers for Disease Control and Prevention (CDC) outlining the tragic impact of serious alcohol abuse. In that year, an estimated 75 000 Americans lost their lives due to excessive alcohol use, the researchers said.

According to the CDC, men who consume an average of more than two drinks per day are considered "heavy drinkers." For women, that line is drawn at more than one drink per day.

Dangers of excessive alcohol use
Both the study authors and the CDC pointed out that excessive alcohol use is associated with the development of many serious health problems, including liver cirrhosis, pancreatitis, various cancers, high blood pressure, as well as elevating risk for depression and suicide.

Alcohol abuse also promotes a variety of dangerous behaviours, such as driving or operating machinery while impaired. To gauge the nature of the problem in New Mexico, Roeber and his colleagues analysed a 2002 telephone survey conducted by the New Mexico Department of Health with CDC assistance.

Focusing on drinking behaviour in the month prior to the interview, the researchers asked almost 4 800 state residents over the age of 18 to recall how often they had engaged in binge drinking, heavy drinking, and/or alcohol-impaired driving. Alcohol dependence was also assessed.

People identified as "dependent" were defined as having experienced three or more problems associated with alcoholism over the past year: a build-up of tolerance to alcohol; withdrawal symptoms when deprived; a persistent desire to drink; drinking more than initially intended; devoting undue time to drinking; eschewing other social and job-related activities for drinking; developing alcohol-related psychological problems; or being unable to stop drinking.

Alcoholism demographics
Drunk-driving was defined as driving at least once when having "perhaps too much to drink" over the prior 30 days. Roeber and his team found that while 55% of those interviewed were current drinkers, fewer than 2% were actually alcoholics. Alcoholism was more prevalent among young males, the college educated, and non-whites.

This was in stark contrast to the nearly 17% of those interviewed who engaged in excessive drinking, among whom binge drinking was far and away the most common problem - evident among nearly 88% of this group.

The researchers found that while just two percent of all those interviewed had driven drunk, nearly 12% of excessive drinkers and just over 17% of alcoholics had done so in the past month. Nevertheless, the researchers concluded that despite having one of the highest alcoholism rates in the United States, the bulk of New Mexico's alcohol problem was a function of excessive drinking and not, in fact, alcoholism.

Roeber hopes the New Mexico finding will lead to a national shift in public health policy. That policy now directs approximately $4 billion toward alcoholism treatment, while only $1 billion goes toward alcohol abuse prevention.

Ways to intervene
"There's a whole range of different ways to intervene to try and prevent episodic drinking, which is very different from taking a person who's alcohol dependent and getting them through treatment," he said. Increasing the price of alcohol, improving enforcement of minimum age drinking laws, and bolstering excessive drinking monitoring in bar environments are some of the specific ways to curtail excessive drinking, Roeber said.

Deborah Dawson, an epidemiologist at the National Institute on Alcohol Abuse and Alcoholism in Washington, D.C., agreed with that stance. "Our own studies show a very similar picture on a national level, so I would say the New Mexico findings are a representative pattern of the U.S. as a whole," Dawson noted. "So, we need to allocate money ideally for both prevention and treatment and not put it all in one pot or the other."

Dr Timothy Naimi, a New Mexican public health physician who works as part of the CDC's Alcohol Team, also agreed. "Do we prevent heart attacks by standing in the ER and waiting for people to roll in with chest pain?" he asked. "No. We treat high blood pressure and cholesterol with the idea of preventing it. It's folly not to do the same with alcohol use. Otherwise, we're a day late and a dollar short."

Naimi said the study was an important wake-up call for drinkers and medical professionals alike.

An important wake-up call
"A typical defense for someone who might drink in a risky way -- when a loved one or a physician asks them about their drinking - is to say 'I'm not an alcoholic,' " Naimi noted. "And the point is that while that may be true, that doesn't mean that those people who are drinking too much are not at risk for alcohol-related problems."

"So, we need to recognise that the risks from excessive drinking begin way before people reach the stage of alcoholism," Naimi added. "Because while not all excessive drinkers will become alcoholics, it is one, among many, bad possible outcomes that stem from excessive drinking. And, of course, alcoholics don't just roll out of bed that way. All were once, in fact, excessive drinkers in a milder form." -(HealthDayNews, January 2007)

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