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Cleaning Up the Language of Consumption: Burying the “Binge”

I became interested in the way people talk about their drinking during my years as a trauma clinical nurse specialist. It always seemed to me that, in spite of what my skeptical colleagues said, patients were accurate about their self-reported drinking if I approached them in the right way. In particular, patients who were problem drinkers (as compared to dependents) had little agenda about their drinking except to provide health assessment data to concerned practitioners. After several years as an injury scientist, our research on self-reported alcohol consumption supported this clinical “gut feeling” about the validity of self-report. Non-dependent drinkers reported their general trends of drinking accurately when the assessment was embedded in a clinical interview (Sommers, Dyehouse, Howe, Volz, & Manharth, 2000). While as a scientist I gained insight into the way people talked about their drinking, I then became concerned about the way clinicians and scientists talk about alcohol consumption, and in particular the use of the term, “binge.” I attribute the seeds of this concern to a scholarly dialogue that occurred with my friend and colleague, Professor Carol Boyd of the University of Michigan. “Binge” drinking (5 or more standard drinks1 on one occasion, or 5+ drinking) is problematic behavior with respect to injury. Interestingly enough, the highest risk for injury among those 30 and younger who consume 5+ drinks appears to be for those who drink at this level only a few times each year (Cherpitel, Tam, Midanik, Caetano, & Greenfield, 1995). This finding suggests that larger amounts of alcohol consumed less frequently by those with a shorter history of drinking may be the most risky pattern for injury. “Binge” drinking, particularly infrequent “binge” drinking, seems to place young adults at risk for injury. But is the term “binge” really the best way to talk about heavy, episodic drinking? Some scientists and clinicians have been moving away from the term “binge” to refer to 5+ drinking because “binge” may imply heavy drinking over a prolonged period of several days (Gill, 2002). While the term “heavy, episodic drinking” is becoming more accepted (Carey, 2001; Dawson, 1998a; 1998b), Murgraff, Parrott, and Bennett (1999) recommended the use of the term “risky single occasion drinking” (RSOD), and Measham (1996) referred to “heavy sessional drinking.” Many of these definitions differ across gender, with “heavy, episodic drinking” defined as drinking five or more drinks for men (5+) and four or more drinks for women (4+) on the same occasion (SAMHSA, 2001). Lange and Voas (2001) raised further questions about the term “binge:” “It is, we feel, a mistake to use the term binge drinking on the basis of its value in predicting problems. Inherent in the concept of binge drinking is recognition that such drinking produces high blood alcohol concentrations (BACs)” (p. 331). These scientists found that young Americans walking into Tijuana, Mexico to drink on the weekends had a mean number of 6.2 drinks for men and 4.1 drinks for women. In many states,