BETWEEN SYMBOLS AND TECHNICALITIES – A CONCEPT OF BINGE DRINKING

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Gmel et al. 1 approach a concept of binge drinking from a technical perspective. They indicate that risky single-occasion drinking (RSOD) or binge drinking measures may include or hide heavy volume drinking, which is very likely to overestimate the association between RSOD and chronic complications. In other words, they claim rightly that a certain proportion of those classified as bingers are also chronic high-volume drinkers. The latter is often not considered in numerous studies showing the detrimental effects of binge or risky single-occasion drinking. While discussing these major questions, the authors show numerous examples of conceptual confusion with regard to definition of a drink and various cut-off levels applied in different countries and/or in different studies, which is very likely to produce miscommunication within a research world and between research and the ‘real’ world. Taking their technical or positivistic approach, the authors do not discuss cultural and political shifts which are behind all technicalities: why the term ‘binge drinking’, which had been used for decades in the context of a disease concept of alcoholism describing several days of heavy drinking, often manifested by skid-row homeless alcoholics, has suddenly changed its meaning to describe drinking with the primary intention of becoming intoxicated by the heavy consumption of alcohol over a short period of time 2. This ‘modern’ definition shifts attention from older male alcoholics to young, often under-aged people, including teenage and young adult female drinkers. This redefinition also shifts the focus of control from individual deviants towards a deviant generation of young bingers. It offers an easy explanation of numerous problems emerging among youngsters: growing discontent, violence, including among young women, football hooliganism and so on 3. It satisfies cultural demand to explain the alienation of a substantial segment of the young generation in contemporary societies, in particular in individualized societies in the United Kingdom or the United States. It also underscores the moral supremacy of dominant classes and legitimizes postmodern capitalism, offering brilliant careers for a few smart individuals and permanent uncertainty for their less fortunate peers 4. Therefore, the new meaning of an old concept makes its career both in public health as much as in the popular media in English-speaking countries 5, 6; ‘Binge drinking is a national epidemic that plagues even our nation's most esteemed universities. Its consequences affect not only the social aspects of college life, but the cultural and legal aspects as well’7. Juggling with the meaning may have an impact on communication between the research world and society. Alarming headlines showing the high prevalence of binge drinking rarely offer an operational definition of binge drinking. A threshold of six drinks, or 60 g of alcohol, is not translated into culturally understood volumes, such as several rounds of beer or whisky or four large glasses of wine, which are prevalent and acceptable in most European cultures. In fact—as argued by the authors—this cut-off level rarely leads to a blood alcohol concentration (BAC) of 0.08%, which is still the legal BAC for drivers in several countries. The realization of this by the general public is very likely to reduce concern about binge drinking (or is less likely to increase concern of alcohol and driving). In fact, binge drinking is a common pattern among Europeans, the vast majority of whom binge at least once a year, and approximately 40% binge once a month. The recent Eurobarometer 8 confirms the results of its earlier edition of 2006 quoted by the authors showing that the annual prevalence of binge drinking is only slightly higher among 15–24-year-olds compared to older age groups, while bingeing several times a week among 15–24-year-olds was the least prevalent (8% versus 14% among those aged 55+ years). It can be attributed to the fact that many older binge drinkers are chronic high-volume drinkers. Conversely, it shows that major concern about young binge drinkers is not entirely justified by epidemiology and plays a role in symbolic debate. Therefore, the research world should reconsider using such imprecise concepts as binge drinking, which may confuse public debate. Instead, it should work on standardizing cut-off points for RSOD or define it in terms of BAC rather than number of drinks. Attempts at a conceptual level would not only ameliorate the quality of research, but hopefully contribute to the rationalization of public debate. Current post is funded through Institute of Psychiatry and Neurology, Warsaw, Poland.