HMN 2024: Extreme Drinking on Holidays and Special Occasions

Alcohol is the most-used substance in the United States: 84% of people 18-plus report ever using alcohol. High-intensity drinking means consuming eight or more drinks over a few hours for women and 10 or more for men. It is a major problem. Alcohol use disorder (AUD) is a chronic disease with significant medical, social, and psychological implications. AUD afflicts more than 29 million individuals, causing over 140,000 deaths annually in the United States. It contributes to 200,000-plus hospitalizations annually and 7.4% of emergency room visits. About 29.5 million people 12 and over have AUD in the United States; however, only 7.6% receive treatment.

Singer Amy Winehouse reportedly struggled with mental illness and addiction. She died in 2011 of alcohol poisoning; an inquest found her blood alcohol level was 0.416. (A BAL of .08 means a person is legally drunk.) Her extreme levels appeared to indicate high-intensity consumption, life-threatening because it’s associated with loss of consciousness and suppression of vital life functions. Winehouse’s song “Rehab,” about her refusal to enter rehab, was released in 2006 as a single from her album Back to Black. It was the bestselling album of 2007 in the United Kingdom, selling 1.85 million copies over the year, and Time magazine named “Rehab” the Best Song of 2007.

Winehouse went to rehab more than once, but months and years reportedly passed between her attempts at sober living.

Levels of Alcohol Consumption

Binge drinking refers to consuming four or more drinks for women over a few hours and five or more for men. However, many people regularly consume much higher amounts. High-intensity drinkers consume double or even triple binge drinking amounts.

Having eight to 10 drinks in a short period can produce a blood alcohol concentration (BAC) of over 0.2%. In contrast, a typical binge (four to five drinks) may result in a BAC of around 0.08%. George Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), said high-intensity drinking “significantly increases risk of injuries, overdose and deaths.” Koob also said a higher number of drinks per occasion is associated with a greater likelihood of alcohol use disorder (AUD).

High-Intensity Blackouts

High-intensity drinkers are more likely than others to report blackouts, landing them in the hospital. Blackouts are periods of memory loss/amnesia. The person walks and talks but may not create memories. Blacking out is different from passing out, which means falling asleep from excessive drinking or drinking oneself unconscious.

The severity of amnesia distinguishes blackouts. The most common form involves spotty memories, with islands of memories separated by missing memories. This is a fragmentary blackout, grayout, or brownout. With this blackout, later focusing on islands of memories often helps cue recall for some missing pieces. In contrast, amnesia spanning hours or more is an “en bloc” blackout. With this severe blackout, memories were never formed, and no amount of digging will uncover them. They don’t exist.

Alcohol produces blackouts by shutting down circuits involving the hippocampus, a brain area playing a central role in places a person went to or things they did while intoxicated.

High-intensity drinking may lead to impulsively bad decision-making, physical assaults, accidents, and relationship problems. Character James Bond in the 2006 movie Casino Royale consumed 20 drinks before a high-speed car chase, leaving Bond in the hospital for two weeks. That’s high-intensity drinking.

Special Occasions and Drinking

Alcohol consumption spikes during holidays, particularly New Year’s Eve and Christmas. Research shows adults consume about twice as much alcohol during holidays as the rest of the year. Social/family gatherings, along with stress/sadness tied to the holidays, contribute to increased drinking. A study of 1,124 college students found students consumed more alcohol and reached higher BACs on their 21st birthdays, New Year’s Eve, and the Fourth of July. The National Highway Traffic Safety Administration (NHTSA) reports that alcohol-related fatalities are 116% higher on New Year’s Eve than on other nights.

College spring break is a highly anticipated time for some college students to drink excessively. Studies find college students who travel with friends dramatically increase alcohol use, facing more alcohol-related consequences. In contrast, those who stay home or vacation with parents tend to drink moderately or not at all.

Sporting Events

Sporting events are often associated with heavy drinking. One study found men drink more on Super Bowl Sunday than on a typical Saturday. Lisa Merlo and colleagues found high rates of heavy drinking among 466 tailgaters before football games at two large universities. Her work also links binge/high-intensity drinking associated with sporting events with game-day violence and arrests. In general, studies find athletes and sports fans are more likely than nonathletes and non–sports fans to engage in binge/high-intensity drinking.

Consequences of High-Intensity Drinking

High-intensity drinking may result in multiple adverse consequences, such as alcohol-related injuries, alcohol poisoning, risky sexual behavior, emergency room visits, blackouts, and long-term harm to academic or occupational status. Students who binge drank three or more times in a two-week period were twice as likely to experience alcohol-induced memory losses (27% vs. 54%), not use protection during sex (10% vs. 20%), and become injured (11% vs. 27%).

Medical/Psychiatric Problems Associated With HID

Acute effects of HID may include alcohol poisoning, severe dehydration, electrolyte imbalances, or hypoglycemia. People with HID also experience an increased risk of accidents, injuries, or fatalities. Chronic health risks include liver damage (acute alcoholic hepatitis or progression toward cirrhosis), cardiovascular risks (arrhythmias, cardiomyopathy), and neurological effects (acute alcohol-related brain damage, blackouts). HID is strongly predictive of AUD and may accelerate the progression from social drinking to dependence.

Psychiatric consequences of HID include increased risks for depression and anxiety, particularly after binges. There is also a strong association with suicidal ideation/attempts, especially during intoxication or withdrawal. Executive functioning deficits during HID episodes can lead to poor decision-making.

Naltrexone in Binge/High-Intensity Drinking

Naltrexone has been shown to reduce binge drinking episodes, which may include HID patterns. While not explicitly labeled for HID, the medication’s ability to modulate the brain’s reward system may help diminish extreme drinking. Much research focuses on AUD broadly, but studies and clinical observations suggest naltrexone may be particularly beneficial for HID.

Genetics also plays a role. Among patients with the OPRM1 A118G polymorphism, naltrexone works well for individuals whose drinking is motivated by euphoria/reward. This may be relevant for some HID patients.

Conclusions

High-intensity drinking is relatively common among teens and young adults. HID is associated with Christmas, New Year’s Eve, spring break, bachelor parties, and sporting events.

NIAAA has highlighted HID as distinct from binge drinking, with elevated alcohol-related harms like injuries, overdoses, AUD, depression, and chronic health issues.

Naltrexone is promising for high-intensity drinkers, although success depends on drinking triggers, genetic profiles, and motivation for treatment. However, large-scale clinical trials focusing exclusively on naltrexone for HID patients remain limited.

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