Binge drinking

Binge drinking, in Italian “drinking to get drunk” or “alcohol binge,” refers to the consumption, on a single occasion and within a short period of time (2–3 hours), of very large amounts of alcohol—conventionally 5–6 or more glasses of alcoholic beverages, even of different types (considering that one glass corresponds to one standard Alcohol Unit, AU, equal to 12 grams of pure alcohol)—leading to intoxication, loss of control and, in some cases, alcohol poisoning and alcoholic coma.
More specifically, “episodic heavy drinking/binge drinking is defined as the consumption of 60 grams or more of pure alcohol on a single occasion, once a week or more often, over the past 12 months” (European Action Plan to Reduce the Harmful Use of Alcohol, 2012–2020).
The goal of those who engage in binge drinking is to get drunk in a short period of time.
This behavior, initially more common in Northern European countries, has spread significantly in Italy as well, particularly among young people, predominantly males.
It is now a widespread practice especially among young people aged 18–24, gradually decreasing with increasing age. Unfortunately, the phenomenon is also beginning to spread among very young adolescents (11–17 years), despite the legal ban on the sale and serving of alcoholic beverages to minors (Law No. 189 of November 8, 2012).
The ISTAT Multiscope Survey on Families “Aspects of Daily Life” (AVQ), conducted annually since 1993, collects extensive information on the lifestyles of the Italian population; since 2003, indicators on alcohol consumption quantities and binge drinking have been available. According to the latest ISTAT surveys on alcohol consumption in Italy (Report of the Minister of Health to Parliament pursuant to Law No. 125 of March 30, 2001, “Framework Law on Alcohol and Alcohol-Related Problems”), there has been a gradual change in Italians’ habits: on the one hand, a decrease in daily alcohol consumers, and on the other, an increase in occasional and out-of-meal drinking, especially among young people (18–24 years) and very young adolescents (11–17 years). For very young adolescents, even the consumption of a single alcoholic drink in a year is considered risky behavior. Among risky alcohol consumption behaviors in young people, binge drinking represents the most widespread and established habit. Data analysis shows that binge drinking affects 18.9% of men and 10.8% of women (2022 data). Among young people, the prevalence of binge drinking is high and represents the most common pattern of alcohol consumption.
The results of the 2022 survey of the HBSC (Health Behaviour in School-aged Children) surveillance system, which every four years analyzes lifestyles and risk behaviors among adolescents aged 11 to 17, confirm that binge drinking is increasing, with prevalence rising as age increases (3.7% and 6.9% respectively among 11-year-old girls and boys, and 55.7% and 60.3% respectively among 17-year-old girls and boys).
Among young people, this is mainly a social behavior: excessive drinking is used to conform to the group, to socialize more easily by feeling more relaxed and disinhibited.
Cultural level and the socio-economic status of the family environment, together with peer influence, play an important role in binge drinking, with higher prevalence among adolescents from higher socio-economic backgrounds. Parental drinking habits also appear to influence children’s behavior. Among young people, binge drinking is more frequent if one or both parents do not have moderate drinking habits.
Habitual binge drinking over time can develop into alcoholism.

HEALTH EFFECTS

Alcohol is one of the leading risk factors for disease, disability and premature death in Italy, in Europe and worldwide.
It has been widely demonstrated that both regular, continuous alcohol consumption and occasional excessive consumption (binge drinking) can cause strictly alcohol-related health problems, particularly alcoholic liver cirrhosis, as well as worsen pre-existing conditions and act as a contributing cause of other health problems, especially cardiovascular, gastroenterological and neuropsychiatric disorders.

Unlike food, which may take hours to be digested, alcohol is absorbed rapidly by the body but takes much longer to be eliminated. The more alcohol is consumed—especially over a short period of time—the greater the risk of alcohol poisoning. Consuming large quantities of alcohol (5–6 or more alcohol units) in a very short time span (binge drinking) is more dangerous than consuming the same amount over a longer period. In addition, cocktails (a mixture of different alcoholic beverages in a single drink), often preferred by binge drinkers, may contain more than one dose of alcohol and take even longer to be metabolized.
Most alcohol is metabolized by the liver. The rate at which the liver removes alcohol from the blood varies from person to person depending on sex, age and body weight, but an average of about half a standard drink per hour can be assumed; therefore, one drink may take 2–3 hours to be eliminated. For women, elimination times are doubled.

THE IMPACT ON HEALTH VARIES ACCORDING TO AGE AND GENDER DIFFERENCES

Young people, in particular, are an extremely vulnerable population group to the risks associated with alcohol consumption. Full development of the limbic system (emotions, reward, pleasure) and the prefrontal cortex (responsible for planning, rationality and logic) does not occur before the age of 25; therefore, the preceding period is one of high vulnerability. Alcohol consumed between the ages of 12 and 25 interferes with the development of brain synapses—that is, the connections between neurons—permanently altering normal brain development into adulthood. Moreover, under the age of 18 the body is not yet able to effectively metabolize alcohol; for this age group, consuming excessive amounts of alcohol in a short time has even more harmful effects than in adults, potentially leading to loss of consciousness, poisoning, coma and even death.

Women are more vulnerable to the negative effects of alcohol than men at equal levels of consumption, due to less efficient alcohol metabolism mechanisms; they are able to eliminate only half the amount of alcohol compared to men.

Young women (under 18 years) and older women (over 65 years) are even more vulnerable to the effects of alcoholic beverages due to a further reduction in alcohol metabolism capacity compared to adult women.

In any case, binge drinking is always considered a risky behavior, harmful to health regardless of age and gender.

Alcohol intoxication

Binge drinking is one of the main causes of alcohol intoxication: the more one drinks, especially in a short period of time, the greater the risk of alcohol poisoning.
Symptoms of alcohol intoxication are divided into two phases. The excitation phase includes:

•  alcoholic breath odor
•  flushed face and glossy eyes
•  increased heart rate (tachycardia) and breathing rate
•  loss of inhibitions and tendency to keep talking excessively (logorrhea)
•  psychomotor agitation
•  nausea and vomiting

Followed by a depressive phase with:

•  difficulty maintaining balance
•  difficulty articulating understandable speech
•  reduced body temperature (hypothermia)
•  respiratory paralysis and coma in the most severe cases

Numerous factors can increase the risk of alcohol intoxication, including:

•  low body weight
•  general health status
•  drinking on an empty stomach
•  combining alcohol with other drugs
•  alcohol content of the beverage consumed (as with cocktails)
•  individual tolerance level

“Night-out” or short-term risks

Drinking too much, too quickly on a single occasion can increase the risk of:

•  road traffic accidents, which may cause injuries of varying severity or death
•  fall-related injuries
•  alcohol intoxication
•  loss of self-control, which can lead to risky behaviors such as unprotected sex, resulting in:
  - increased risk of sexually transmitted infections
  - unintended pregnancies
•  violent behavior, including sexual assault
•  impaired judgment in assessing dangerous situations
•  suicide and homicide

Long-term risks

In addition to immediate risks, there are also medium- and long-term health risks. Excessive alcohol consumption can increase blood pressure (hypertension), cholesterol levels (hypercholesterolemia) and blood sugar levels (hyperglycemia), thereby increasing the risk of serious heart and brain disorders, such as myocardial infarction and stroke.

Risks during pregnancy

Binge drinking during pregnancy is the most important risk factor for fetal damage, particularly affecting sensory abilities and psychological development. In particular, binge drinking during pregnancy is associated with an increased risk of miscarriage or preterm birth, as well as fetal damage due to prenatal alcohol exposure—namely a set of physical, mental, behavioral and social abnormalities and disabilities of varying severity grouped under the term Fetal Alcohol Spectrum Disorders, of which fetal alcohol syndrome is the most severe. Alcohol should never be consumed during pregnancy.

Risks in very young people

Before the age of 15, the digestive system is not yet able to metabolize alcohol because the enzymatic system is not fully developed. Young people who begin binge drinking during adolescence have a higher risk of developing neurological and cardiovascular diseases.
Moreover, binge drinking increases the risk of developing pathological addictions and mental disorders in adulthood: among very young people, it increases the likelihood of becoming alcohol-dependent as adults.
The main consequences of alcohol consumption during adolescence include:

•  increased mortality: alcohol-related road accidents are the leading cause of death among adolescents; drownings, suicides and homicides have also been linked to alcohol consumption
•  early sexual activity: adolescents who drink tend to become sexually active earlier and have sex more often than those who do not drink; they are also more likely to engage in unprotected sex
•  school problems and dropout: adolescents who drink tend to have more difficulties than those who do not
•  alcoholism: individuals who start drinking during adolescence, especially those who engage in binge drinking, are more likely to develop alcohol dependence than those who start drinking in adulthood.