What We Talk About When We Talk About Binge Drinking: Towards an Integrated Conceptualization and Evaluation.

RATIONALE: Binge drinking (BD), characterized by recurring alternations between intense intoxication episodes and abstinence periods, is the most frequent alcohol consumption pattern in youth and is growing in prevalence among older adults. Many studies have underlined the specific harmful impact of this habit by showing impaired abilities in a wide range of cognitive functions among binge drinkers, as well as modifications of brain structure and function. AIMS: Several controversies and inconsistencies currently hamper the harmonious development of the field and the recognition of BD as a specific alcohol consumption pattern. The main concern is the absence of consensual BD conceptualization, leading to variability in experimental group selection and alcohol consumption evaluation. The present paper aims at overcoming this key issue through a two-step approach. METHODS AND CONCLUSIONS: First, a literature review allows proposing an integrated BD conceptualization, distinguishing it from other subclinical alcohol consumption patterns. Six specific characteristics of BD are identified, namely, (1) the presence of physiological symptoms related to BD episodes, (2) the presence of psychological symptoms related to BD episodes, (3) the ratio of BD episodes compared to all alcohol drinking occasions, (4) the frequency of BD episodes, (5) the consumption speed and (6) the alternation between BD episodes and soberness periods. Second, capitalizing on this conceptual clarification, we propose an evaluation protocol jointly measuring these six BD characteristics. Finally, several research perspectives are presented to refine the proposed conceptualization.

A feasibility study on identifying drinking-related contents in Facebook through mining heterogeneous data.

Binge drinking is a severe health problem faced by many US colleges and universities. College students often post drinking-related text and images on social media, portraying their alcohol use as socially desirable. In this project, we investigated the feasibility of mining the heterogeneous data (e.g. text, images, and videos) on Facebook to identify drinking-related contents. We manually annotated 4266 posts during 21 October 2011 and 3 November 2014 from "I'm Shmacked" group on Facebook, where 511 posts were drinking-related. Our machine learning models show that by combining heterogeneous data types, we were able to identify drinking-related posts with an F1-score of 0.81. Prediction models built on text data were more reliable compared to those built on image and video data for predicting drinking-related contents. As the first step of our efforts in this direction, this feasibility study showed promise toward unleashing the potential of mining social media to identify students who binge drink.

After how many drinks does someone experience acute consequences-determining thresholds for binge drinking based on two event-level studies.

BACKGROUND AND AIMS: The threshold of 4+/5+ drinks per occasion has been used for decades in alcohol research to distinguish between non-risky versus risky episodic drinking. However, no study has assessed the validity of this threshold using event-level data. This study aimed to determine the optimal thresholds for the detection of five acute alcohol-related consequences (hangover, blackout, risky sex, fights and injury) using data from two event-level studies. DESIGN: An event-level study to assess the ability to use the number of drinks consumed to discriminate between nights with and without consequences using the area under the receiver operating characteristic (AUROC) curve. Optimal thresholds were determined using the Youden Index based on sensitivity and specificity. Separate thresholds were estimated for gender and age groups (16-17 versus 18-25). SETTING: Lausanne and Zurich, Switzerland. PARTICIPANTS: Three hundred and sixty-nine participants aged 16-25 years. MEASUREMENTS: On 3554 weekend nights, participants reported total number of alcoholic drinks consumed the previous night and acute consequences (hangover, blackout, risky sex, fights and injury) FINDINGS: Hangover was the most frequently reported consequence and injury the least for both genders. Throughout age groups and studies, optimal thresholds for any consequence, and for hangover only, were equal to 4+/5+ (40+/50+ g alcohol) while those for blackouts, risky sex, fights and injuries were up to three drinks higher. Adolescents tended to experience consequences more often and at slightly lower drinking levels than did adults. For all consequences but injuries, the optimal thresholds were one to two drinks lower for women than for men. CONCLUSIONS: Event-level data collection techniques appear particularly suitable to estimate thresholds at which acute alcohol-related consequences occur. Binge drinking thresholds of 4+/5+ (women/men) drinks, equivalent to 40+/50+ g pure alcohol, predict the occurrence of consequences accurately in general but are too low to predict severe acute alcohol-related consequences.

Comparison between the WHO and NIAAA criteria for binge drinking on drinking features and alcohol-related aftermaths: Results from a cross-sectional study among eight emergency wards in France.

BACKGROUND: Binge drinking (BD) consists of heavy episodic alcohol use. Whereas the World Health Organization (WHO) defines BD as 60g of alcohol or more per occasion, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) conceives BD as drinking 70g (men) or 56g (women) in less than two hours. We compared the subjects delineated by each definition. METHODS: Eight-center cross-sectional study among 11,695 subjects hospitalized in emergency wards. Participants completed the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), CAGE and Rapid Alcohol Problem Screen 4 (RAPS4-QF) questionnaires. The WHO criteria were investigated using the RAPS4-QF. Independent questions assessed the NIAAA criteria. The main medical admission motive was noted. The characteristics of subjects meeting respectively: 1) the exclusive WHO criteria (BD1); 2) the NIAAA criteria (BD2); and 3) no BD criteria (noBD) were compared using multinomial regression analyses. Binary age- and gender-adjusted regression analyses directly compared BD1 and BD2. Subjects with at least four drinking occasions per week were excluded from the analyses, to withdrawn regular heavy drinking. RESULTS: Compared to BD1, BD2 subjects were more frequently males (OR=1.67 [1.39-2.0]), single (aOR=1.64 [1.36-1.98]) and unemployed (aOR=1.57 [1.27-1.90]). BD2 reported significantly more drinks per occasion, and higher heavy drinking frequencies. Previous alcohol-related remarks from family (aOR=3.00 [2.53-3.56]), ever drinking on waking-up (aOR=2.05 [1.37-2.72]), and admission for psychiatric motive (aOR=2.27 [1.68-3.07]) were more frequent among BD2 subjects. CONCLUSIONS: Compared to WHO criteria, NIAAA criteria for BD delineate subjects with more concerning drinking patterns and alcohol aftermaths.

Binge Drinking: Current Diagnostic and Therapeutic Issues.

The concept of binge drinking (BD) refers to patterns of heavy episodic alcohol consumption, with BD primarily occurring among adolescents and young adults. Several official definitions of BD have been proposed, in particular by the World Health Organization, the National Institute on Alcoholism and Alcohol Abuse, and the Substance Abuse and Mental Health Services Administration. Nevertheless, none of these definitions address the psychosocial and medical consequences of the type of alcohol use seen in BD. In practice, BD can thus correspond to either hazardous or harmful use of alcohol (HUA), while the episodic nature of heavy drinking in BD means that it does not meet the criteria for 'alcohol dependence'. This diagnostic differentiation is important because it determines which type of intervention is recommended. Psychosocial, rather than pharmacological, interventions are recommended as first-line treatment for adults with HUA, while pharmacological treatment is recommended for alcohol dependence; however, HUA appears to be associated with much poorer outcomes in adolescents, which could thus warrant early use of pharmacotherapy in this patient group. For HUA, and especially in adolescents, there is currently a severe lack of data regarding the efficacy and safety of the different drugs that have been approved for adults with alcohol dependence. Various guidelines propose the use of drugs for some types of BD but that use remains off-label and empirical, which raises important safety and ethical concerns. Future research on BD should systematically assess the criteria for HUA to better differentiate its subtypes with actual consequences and better address the heterogeneity of BD in terms of both clinical profiles and outcomes. Regarding pharmacotherapy, some national guidelines have recommended nalmefene for 'mild' dependence or second-line treatment for HUA, but such recommendations are not supported by evidence. Only naltrexone has been investigated in HUA but not in adolescents. More clinical trials should be conducted among adolescents with BD and HUA criteria to determine the most appropriate use of drugs in this particularly vulnerable population of subjects.

The search for an elusive cutoff remains: Problems of binary classification of heavy drinking as an endpoint for alcohol clinical trials.

BACKGROUND: To examine whether a clinically meaningful alcohol consumption cutoff can be created for clinical samples, we used receiver operator characteristic (ROC) curves to derive gender-specific consumption cutoffs that maximized sensitivity and specificity in the prediction of a wide range of negative consequences from drinking. METHODS: We conducted secondary data analyses using data from two large clinical trials targeting alcohol use disorders: Project MATCH (n=1726) and COMBINE (n=1383). RESULTS: In both studies, we found that the ideal cutoff for men and women that maximized sensitivity/specificity varied substantially both across different alcohol consumption variables and alcohol consequence outcomes. Further, the levels of sensitivity/specificity were poor across all consequences. CONCLUSIONS: These results fail to provide support for a clinically meaningful alcohol consumption cutoff and suggest that binary classification of levels of alcohol consumption is a poor proxy for maximizing sensitivity/specificity in the prediction of negative consequences from drinking. Future research examining consumption-consequence associations should take advantage of continuous measures of alcohol consumption and alternative approaches for assessing the link between levels of consumption and consequences (e.g., ecological momentary assessment). Clinical researchers should consider focusing more directly on the consequences they aim to reduce instead of relying on consumption as a proxy for more clinically meaningful outcomes.