Extreme Drinking Research Articles

Drinking contexts, coping motive, simultaneous cannabis use, and high-intensity drinking among adults in the United States

Abstract Aims High-intensity drinking (HID), extreme drinking considerably above the level of heavy episodic drinking (HED), is associated with long-term health and social consequences. There is limited understanding of HID beyond young adulthood. This study aims to identify concurrent risk factors for HID, comparing age differences among all adults. Methods Multinomial logistic and linear regression modeling was performed using a nationally-representative sample of adults (analytic n = 7956) from the 2015 and 2020 National Alcohol Surveys. The outcomes were any HID of 8–11 drinks and 12+ drinks for men, and 8+ drinks for women, and corresponding frequencies. Concurrent risk factors included coping motive, sensation seeking, simultaneous use of alcohol and cannabis (SAC), and drinking at a bar or party. Analyses were stratified by age (18–29 vs. older) and sex. Results For younger men, sensation-seeking was significantly associated with HID (vs. no HED) at both levels and frequency of HID 8–11 drinks, while drinking to cope was only significant for 12+ drinks. For older men, drinking to cope was a consistent predictor for both HID level and its frequency, but sensation-seeking was not significant. Both coping and sensation-seeking were significantly associated with any HID for all women, while coping was significant for HID frequency for younger women. Frequent drinking at bars and parties were associated with greater odds of HID for all adults. With HED as referent, similar patterns of (though fewer significant) associations were observed. Conclusions Younger and older adults share similar risk factors for HID, with coping more consistent for older men.

'I just drink to feel abnormal for some time': Reconfiguring heavy drinking and intoxication as pleasurable.

The sociocultural norms moderating alcohol consumption in Nigeria were more permissive for men than women in the traditional era. Alcohol use among young people was taboo, and intoxication among men who occupy drinking spaces was punished. In contemporary Nigeria, heavy drinking and the 'culture of intoxication' are reified features of some young people's leisure lives. Drawing on the intersections of pleasure and intoxication, this study explores the interplay between deliberate heavy drinking and the positioning of intoxication experiences as pleasurable. We conducted 53 semi-structured interviews and 3 focus groups (N=26) with 18-24-year-old youths in Benin City, Southern Nigeria. Participants deliberately pursued heavy drinking and intoxication to experience 'altered bodily effects', to know the feelings of intoxication, and to master extreme drinking levels. Other explanations given for 'determined drunkenness' included fun and excitement. Participants sought pleasurable experiences of drinking through repeated deliberate drunkenness or by taking large quantities of spirits. 'Loss of control' experiences were described as fun and exciting, and participants laughed when friends showed them videos of their 'passing out' experiences. Gendered alcohol 'providing' rituals in peer networks that facilitated intoxication and loss of consciousness were used to enact friendships. Providing drinks for friends and consuming large quantities conferred a higher status on the buyer and drinker, respectively. Friendship networks performed double-edged roles by instigating heavy drinking and providing care for inebriated members. The emerging drinking culture in Nigeria suggests that the cultural prohibitionist approach to young people's drinking should be reconsidered. Policymakers should implement public health interventions that promote low-risk drinking practices to mitigate the risks of heavy drinking and intoxication.

Binges, Brains, Birthdays, and BACs.

All of us have encountered attention-grabbing headlines such as "You may be boozing your brain cells away," but many of us don't accept thatclaim in stark, literal terms. Similarly, evidence in rodents that single, high oral doses of ethanol can be significantly neurotoxic, are often dismissed as "well rats are not people." It may be time to change our minds. Hua et al. (2020) now show us for the first time, in a highly original and well-conceived experiment, persuasive evidence for persisting structural brain alterations consequent on a single extreme drinking episode.

Prospective Study Examining the Effects of Extreme Drinking on Brain Structure in Emerging Adults.

Emerging adulthood is a critical neurodevelopment period in which extreme drinking has a potentially pronounced neurotoxic effect. Therefore, extreme drinking, even a single episode, could be particularly harmful to the developing brain's structure. Relatedly, heavy alcohol use in emerging adults has been associated with structural brain damage, especially in the corpus callosum. However, it is unclear whether and how much a single extreme drinking episode would affect brain morphometry. For the first time in the literature, the current study prospectively examined the impact of an extreme drinking episode (i.e., twenty-first birthday celebration) on the brain morphometry of emerging adults immediately following their birthday celebration (n=50) and approximately 5weeks post-birthday celebration (n=29). We found evidence that a single extreme drinking episode was associated with structural changes immediately post-birthday celebration. Specifically, higher twenty-first birthday estimated blood-alcohol concentration was associated with decreased volume of the posterior and central corpus callosum immediately post-birthday celebration. This extreme drinking episode was not associated with further structural changes, or recovery, 5weeks post-twenty-first birthday celebration. Overall, results suggest that a single episode of heavy drinking in emerging adulthood may be associated with immediate structural changes of the corpus callosum. Thus, emerging adulthood, which is characterized by high rates of extreme drinking, could be a critical period for targeted prevention and intervention.

Evidence for a Direct Harmful Effect of Alcohol on Myocardial Health: A Large Cross-Sectional Study of Consumption Patterns and Cardiovascular Disease Risk Biomarkers From Northwest Russia, 2015 to 2017.

BackgroundAlcohol drinking is an increasingly recognized risk factor for cardiovascular disease. However, there are few studies of the impact of harmful and hazardous drinking on biomarkers of myocardial health. We conducted a study in Russia to investigate the impact of heavy drinking on biomarkers of cardiac damage and inflammation.Methods and ResultsThe Know Your Heart study recruited a random sample of 2479 participants from the population of northwest Russia (general population) plus 278 patients (narcology clinic subsample) with alcohol problems. The general population sample was categorized into harmful drinkers, hazardous drinkers, nonproblem drinkers, and nondrinkers, according to self‐reported level of alcohol consumption, whereas the narcology clinic sample was treated as the separate group in the analysis. Measurements were made of the following: (1) high‐sensitivity cardiac troponin T, (2) NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), and (3) hsCRP (high‐sensitivity C‐reactive protein). The narcology clinic subsample had the most extreme drinking pattern and the highest levels of all 3 biomarkers relative to nonproblem drinkers in the general population: high‐sensitivity cardiac troponin T was elevated by 10.3% (95% CI, 3.7%–17.4%), NT‐proBNP by 46.7% (95% CI, 26.8%–69.8%), and hsCRP by 69.2% (95% CI, 43%–100%). In the general population sample, NT‐proBNP was 31.5% (95% CI, 3.4%–67.2%) higher among harmful drinkers compared with nonproblem drinkers. Overall, NT‐proBNP and hsCRP increased with increasing intensity of alcohol exposure (test of trend P<0.001).ConclusionsThese results support the hypothesis that heavy alcohol drinking has an adverse effect on cardiac structure and function that may not be driven by atherosclerosis.

Close Friends’ Drinking and Personal Income as Mediators of Extreme Drinking: A Prospective Investigation

This study examined longitudinal associations between college attendance, residence on- or off-campus, and work status during the first 2 years after high school with extreme binge drinking at 4 years after high school and tested peer drinking and personal income at 3 years after high school as mediators. Data were drawn from Waves 4-7 of the NEXT Generation Health Study (n = 2,081). Multinomial logistic regressions and mediation analyses were conducted. Extreme binge drinking was measured using the largest number of drinks on a single day in the past year. Univariate analyses indicated that attending university, living on campus, and working more than 30 hours at any point during the first 2 years after high school were associated with increased risk of drinking two to three times above the binge drinking threshold (relative risk ratios [RRR] ranged from 1.79 to 5.70). In multivariate analyses, dropping out of university was associated with drinking two times above the binge drinking threshold (RRR = 4.88), whereas living on campus (RRR = 4.54) and working more than 30 hours (RRR = 5.26) were associated with increased risk of drinking three times above the binge drinking threshold. Close friends' drinking and personal income were significant mediators. Living on campus and working more than 30 hours per week during the first 2 years after high school increased risk for drinking three times above the binge drinking threshold at 4 years after high school.

A Causal Model of Binge Drinking Among University Students in Northern Thailand.

Binge drinking, an extreme drinking pattern and the most common form of hazardous alcohol consumption among university students, has remained a public health concern with physical, psychological, academic, and social problems. Tracking multiple factors is needed to find ways to deal with such hazardous drinking patterns and their adverse consequences. In Thailand, the particular factors leading to binge drinking patterns among university students are still not recognized. Four hundred thirteen university students in Northern Thailand self-administered a Web-based survey about the causal factors. The survey was based on a hypothesized model from the Social Ecological Model and from empirical studies. There were four factors that were hypothesized to directly increase binge drinking behavior: attitudes toward drinking, peer influence, physical environments of drinking, and alcohol advertisements. However, there were another four factors that were hypothesized to directly decrease binge drinking behavior: drinking refusal self-efficacy, university alcohol regulations, alcohol public policies, and knowledge. Through testing of the hypothesized model by Structural Equation Modeling, the causal model of binge drinking among Thai university students revealed "binge drinking refusal self-efficacy" (β = -.22, p < .001) and "peer influence" (β = -.14, p < .05) as significant negative factors and "physical environments" (β = .18, p < .001) as a positive predictor regarding binge drinking. The study shows how healthcare providers may be able to lessen binge drinking by designing effective prevention programs centering on an intrapersonal factor (binge drinking refusal self-efficacy), an interpersonal factor (peer influence), and a community factor (physical environments).

A rare cause of acute hyponatremia: Psychogenic polydipsia

Psychogenic polydipsia is a psychiatric condition characterized by excessive drinking of water. In studies conducted regarding psychogenic or primary polydipsia, it’s been reported in patients with psychiatric disorders. Excessive drinking of water can lead to excessive fluid loading and electrolyte imbalance. We aimed to present a patient case with psychotic disorder who developed hyponatremia due to extreme water drinking and applied to emergency service with loss of consciousness. Thirty-four-year-old male, secondary school graduate, single, living with his family was applied to emergency room clinically unconscious. In physical examination general situation was bad, glasgow coma scale score point was 8. Minimal brain edema was detected in cranial computed tomography (CT). In laboratory tests Na: 109 mmol / L (136-145 mmol / L). The patient who was diagnosed with schizophrenia used drugs he could not remember its name. For the past 3 years, the patient has been using amylsulpride 1200 mg / day, valproic acid + sodium valproate 1000 mg / day and clozapine 600 mg / day. The patient was treated in emergency room with 150 ml 3% hypertonic infusion twice in 20 minutes to increase the Na concentration in the first hour by 5 mmol / L and to relieve symptoms. Hyponatremia patients may apply to emergency room with nonspecific symptoms such as nausea and vomiting at the onset and consciousness changes that may progress to coma. Psychogenic polydipsia-associated hyponatremia should be considered in patients with similar clinical findings and psychiatric history admitted to the emergency room.

Comparisons of alcohol consumption by timeline follow back vs.smartphone-based daily interviews

This study compared alcohol consumption data collected through daily interviews on a smartphone with data collected via the timeline follow back (TLFB) during a 6-week pilot study of a smartphone-based alcohol intervention system. The focus of the study was to assess for discrepancies between the two measurement methodologies on commonly utilized alcohol outcome variables. Twenty-five participants, aged between 22 and 45 years and were drinking heavily at study incipience, completed a 6-week alcohol intervention delivered by a smartphone application that monitored drinking through a daily interview. Participants also completed a TLFB of their alcohol consumption during the intervention period. Difference scores were calculated by subtracting the average weekly outcome variables derived from the smartphone daily interview from the average weekly outcome variables derived from the TLFB which yielded six discrepancy scores for each of the 25 participants and resulted in 150 observations. Hierarchical linear modeling indicated that the TLFB and smartphone daily interview methods did not produce significant discrepancies over the 6-week interval when examining percent of heavy drinking days and percent of days abstinent. However, discrepancies on drinks per drinking day increased substantially over time, suggesting that it is susceptible to recall bias when assessed by the TLFB. Results also indicated that participants under-reported their drinking on the TLFB compared to the daily smartphone-based assessment. Results indicate that outside of assessing for extreme drinking (binge or no drinking), the TLFB should be used cautiously and that smartphone apps represent a promising method for accurately assessing alcohol consumption over time.

Unravelling the alcohol harm paradox: a population-based study of social gradients across very heavy drinking thresholds

BackgroundThere is consistent evidence that individuals in higher socioeconomic status groups are more likely to report exceeding recommended drinking limits, but those in lower socioeconomic status groups experience more alcohol-related harm. This has been called the ‘alcohol harm paradox’. Such studies typically use standard cut-offs to define heavy drinking, which are exceeded by a large proportion of adults. Our study pools data from six years (2008–2013) of the population-based Health Survey for England to test whether the socioeconomic distribution of more extreme levels of drinking could help explain the paradox.MethodsThe study included 51,498 adults from a representative sample of the adult population of England for a cross-sectional analysis of associations between socioeconomic status and self-reported drinking. Heavy weekly drinking was measured at four thresholds, ranging from 112 g+/168 g + (alcohol for women/men, or 14/21 UK standard units) to 680 g+/880 g + (or 85/110 UK standard units) per week. Heavy episodic drinking was also measured at four thresholds, from 48 g+/64 g + (or 6/8 UK standard units) to 192 g+/256 g + (or 24/32 UK standard units) in one day. Socioeconomic status indicators were equivalised household income, education, occupation and neighbourhood deprivation.ResultsLower socioeconomic status was associated with lower likelihoods of exceeding recommended limits for weekly and episodic drinking, and higher likelihoods of exceeding more extreme thresholds. For example, participants in routine or manual occupations had 0.65 (95 % CI 0.57–0.74) times the odds of exceeding the recommended weekly limit compared to those in ‘higher managerial’ occupations, and 2.15 (95 % CI 1.06–4.36) times the odds of exceeding the highest threshold. Similarly, participants in the lowest income quintile had 0.60 (95 % CI 0.52–0.69) times the odds of exceeding the recommended weekly limit when compared to the highest quintile, and 2.30 (95 % CI 1.28–4.13) times the odds of exceeding the highest threshold.ConclusionsLow socioeconomic status groups are more likely to drink at extreme levels, which may partially explain the alcohol harm paradox. Policies that address alcohol-related health inequalities need to consider extreme drinking levels in some sub-groups that may be associated with multiple markers of deprivation. This will require a more disaggregated understanding of drinking practices.

Do drinking motives distinguish extreme drinking college students from their peers?

ObjectiveThe literature highlights the need to move beyond the traditional heavy episodic (“binge”) drinking criteria when trying to identify at-risk college drinkers. Thus, recent attention has focused on more extreme levels of drinking. This study examines whether drinking motives can distinguish college student extreme drinkers from lighter drinkers. MethodWe used data from 3518 college student current drinkers (63.4% women) who participated in eight different studies at five different college campuses across the United States; a subsample of these students was followed up at 6months post-baseline. At baseline and follow-up, drinkers were divided into three groups: nonbinge drinkers (<4 drinks for women and 5 for men on their maximum drinking occasion), binge drinkers (4–7 drinks for women; 5–9 for men), and extreme drinkers (8+ for women and 10+ for men). ResultsAt baseline, extreme drinkers, compared to nonbinge and binge drinkers, reported greater social, enhancement, and coping motives, as well as greater quantity and frequency of drinking per week and more alcohol-related problems. Those who were not extreme drinkers at baseline and later became extreme drinkers at follow-up reported significantly greater increases in social and enhancement motives, compared to those who remained nonextreme drinkers. Those who were extreme drinkers at baseline and reduced their drinking 6months later, compared to those who remained extreme drinkers, reported greater reductions in enhancement and coping motives. ConclusionsFocusing on drinking motives might be an efficacious target for preventive intervention programs to reduce extreme drinking among college students.

The Mechanisms of Alcohol Control.

A substantial economics literature documents that tighter alcohol controls reduce alcohol-related harms, but far less is known about mechanisms. We use the universe of Canadian mortality records to document that Canada's Minimum Legal Drinking Age (MLDA) significantly reduces mortality rates of young men but has much smaller effects on women. Using drinking data that are far more detailed than in prior work, we document that the MLDA substantially reduces 'extreme' drinking among men but not women. Our results suggest that alcohol control efforts targeting young adults should focus on reducing extreme drinking behavior.

Death and the Alcoholic: Public discourses of alcoholism in Anne Brontë’s The Tenant of Wildfell Hall

This article examines Anne Brontë’s dialogue with advanced thinking about drunkenness in The Tenant of Wildfell Hall (1848) by comparing the novel’s approach to extreme drinking with the advice of moral and medical theorists, and with contemporary temperance fiction. It addresses the novelist’s approaches to key questions about alcohol addiction: what are its causes; what are its symptoms; how should the urge to drink be understood; what constitutes successful treatment? It argues that the death of Arthur Huntingdon, who embodies Anne’s brother Branwell’s affliction, manifests her feelings of hopelessness and resulting frustration with the positive pictures of treatment and recovery presented by modern medicine and temperance fiction.

Death and the Alcoholic: Public discourses of alcoholism in Anne Brontë’s The Tenant of Wildfell Hall

This article examines Anne Brontë’s dialogue with advanced thinking about drunkenness in The Tenant of Wildfell Hall (1848) by comparing the novel’s approach to extreme drinking with the advice of moral and medical theorists, and with contemporary temperance fiction. It addresses the novelist’s approaches to key questions about alcohol addiction: what are its causes; what are its symptoms; how should the urge to drink be understood; what constitutes successful treatment? It argues that the death of Arthur Huntingdon, who embodies Anne’s brother Branwell’s affliction, manifests her feelings of hopelessness and resulting frustration with the positive pictures of treatment and recovery presented by modern medicine and temperance fiction.

Prepartying, drinking games, and extreme drinking among college students: A daily-level investigation

IntroductionDaily data collected over 14 consecutive days were used to examine whether extreme drinking was more likely on days college students reported prepartying (i.e., drinking before going out) or playing drinking games in a multi-ethnic sample of college seniors (analysis subsample: N=399; 57% women; M age=21.48years, SD=.40). MethodsMultilevel modeling with drinking occasions at Level 1 (1265 drinking days) nested within persons at Level 2 (399 drinkers) was used to predict four extreme drinking behavior outcomes at the daily level: consuming at least 8/10 (women/men) drinks, reaching an estimated blood alcohol concentration (eBAC) of .16% or greater, drinking enough to stumble, and drinking enough to pass out. ResultsPrepartying only (29% of drinking days) was more common than playing drinking games only (10%) or engaging in both behaviors on the same day (13%). Odds of extreme drinking were greater among students who frequently engaged in prepartying (ORs: 1.86–2.58) and drinking games (ORs: 1.95–4.16), except prepartying frequency did not predict drinking enough to pass out. On days students prepartied (ORs: 1.58–2.02) and on days they played drinking games (ORs: 1.68–1.78), odds of extreme drinking were elevated, except drinking games did not predict eBAC of .16% or greater. ConclusionsExtreme drinking is attributable to both person-level characteristics (e.g., preparty frequency) and specific drinking behaviors on a given day. Prepartying and drinking games confer elevated risk of extreme drinking and are important targets in alcohol interventions for college seniors.

Drinking games and contextual factors of 21st birthday drinking

Background: 21st birthday celebrations are among the highest risks for alcohol use throughout emerging adulthood and celebrants often experience a range of alcohol-related consequences. Objectives: The present research considered what happens when drinking games are paired with an already high-risk event (i.e., 21st birthday celebrations) and how drinking games compare with other contextual factors on 21st birthdays. Methods: Approximately four days after turning 21, 1124 college students (55% women) completed an online survey assessing alcohol use and related consequences experienced during their birthday celebrations. Participants were also asked whether drinking games and other contextual factors were associated with their celebrations. Results: Overall, 18% of participants reported playing drinking games during their 21st birthday celebrations. These individuals reported consuming more alcohol, had higher estimated BACs, and experienced more negative consequences than those who did not play drinking games. The association between playing drinking games and alcohol use and negative consequences was stronger for men. The effect of drinking games on negative consequences was mediated through elevated BAC levels. Receiving bar specials, having drinks purchased, playing drinking games, and loud music were uniquely and significantly associated with all alcohol outcomes. Conclusion: Together, these results suggest that drinking games are part of a larger context of risk contributing to extreme drinking on 21st birthdays. Furthermore, these results will help to facilitate interventions that are more individually tailored to target specific contextual risks, behaviors, and events.

Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities.

Easily detectable predictors of nonadherence to long-term drug treatment are lacking. We investigated the association between lifestyle factors and nonadherence to statin therapy among patients with and without cardiovascular comorbidities. We included 9285 participants from the Finnish Public Sector Study who began statin therapy after completing the survey. We linked their survey data with data in national health registers. We used prescription dispensing data to determine participants' nonadherence to statin therapy during the first year of treatment (defined as < 80% of days covered by filled prescriptions). We used logistic regression to estimate the association of several lifestyle factors with nonadherence, after adjusting for sex, age and year of statin initiation. Of the participants without cardiovascular comorbidities (n = 6458), 3171 (49.1%) were nonadherent with their statin therapy. Obesity (adjusted odds ratio [OR] 0.86, 95% confidence interval [CI] 0.74-0.99), overweight (adjusted OR 0.88, 95% CI 0.79-0.98) and former smoking (adjusted OR 0.82, 95% CI 0.74-0.92) predicted a reduced risk of nonadherence in this group after adjustment for sex, age and year of statin initiation. Of the participants with cardiovascular comorbidities (n = 2827), 1155 (40.9%) were nonadherent. In this group, high alcohol consumption (adjusted OR 1.55, 95% CI 1.12-2.15), extreme drinking occasions (adjusted OR 1.48, 95% CI 1.11-1.97) and a cluster of 3-4 lifestyle risks (adjusted OR 1.61, 95% CI 1.15-2.27) predicted increased odds of nonadherence after adjustment for sex, age and year of statin initiation. People with cardiovascular comorbidities who had risky drinking behaviours or a cluster of lifestyle risks were at increased risk of nonadherence. Among individuals without cardiovascular comorbidities, information on lifestyle factors was unhelpful in identifying those at increased risk of nonadherence; that overweight, obesity and former smoking were predictors of better adherence in this group provides insight into mechanisms of adherence to preventive medication that deserve further study.

The Mechanisms of Alcohol Control

A substantial economics literature documents that tighter alcohol controls reduce alcohol related harms, but far less is known about mechanisms. We use the universe of Canadian mortality records to document that Canada's Minimum Legal Drinking Age (MLDA) significantly reduces mortality rates of young men but has much smaller effects on women. Using drinking data that are far more detailed than in prior work, we document that the MLDA substantially reduces 'extreme' drinking among men but not women. Our results suggest that alcohol control efforts targeting young adults should focus on reducing extreme drinking behavior.

Alcohol consumption in midlife and cognitive performance assessed 13 years later in the SU.VI.MAX 2 cohort.

BackgroundAssociations between alcohol consumption and cognitive function are discordant and data focusing on midlife exposure are scarce.ObjectiveTo estimate the association between midlife alcohol consumption and cognitive performance assessed 13 y later while accounting for comorbidities and diet.Methods3,088 French middle-aged adults included in the SU.VI.MAX (1994) study with available neuropsychological evaluation 13 y later. Data on alcohol consumption were obtained from repeated 24h dietary records collected in 1994–1996. Cognitive performance was assessed in 2007–2009 via a battery of 6 neuropsychological tests. A composite score was built as the mean of the standardized individual test scores (mean = 50, SD = 10). ANCOVA were performed to estimate mean differences in cognitive performance and 95% confidence intervals (CI).ResultsIn women, abstainers displayed lower cognitive scores than did low-to-moderate alcohol drinkers (1 to 2 drinks/day) (mean difference = −1.77; 95% CI: −3.29, −0.25). In men, heavy drinkers (>3 drinks/day) had higher cognitive scores than did low-to-moderate (1 to 3 drinks/day) (mean difference = 1.05; 95% CI: 0.10, 1.99). However, a lower composite cognitive score was detected in male drinkers consuming ≥90 g/d (≈8 drinks/d). A higher proportion of alcohol intake from beer was also associated with lower cognitive scores. These associations remained significant after adjustment for diet, comorbidities and sociodemographic factors.ConclusionIn men, heavy but not extreme drinking was associated with higher global cognitive scores. Given the known harmful effects of alcohol even in low doses regarding risk of cancer, the study does not provide a basis for modifying current public health messages.Trial RegistrationClinicalTrials.gov NCT00272428

A randomized controlled trial of event-specific prevention strategies for reducing problematic drinking associated with 21st birthday celebrations.

While research has documented heavy drinking practices and associated negative consequences of college students turning 21, few studies have examined prevention efforts aimed at reducing high-risk drinking during 21st birthday celebrations. The present study evaluated the comparative efficacy of a general prevention effort (i.e., Brief Alcohol Screening and Intervention for College Students, or BASICS) and event-specific prevention in reducing 21st birthday drinking and related negative consequences. Furthermore, this study evaluated inclusion of peers in interventions and mode of intervention delivery (i.e., in-person vs. via the Web). Participants included 599 college students (46% male): men who intended to consume at least 5 drinks and women who intended to consume at least 4 drinks on their 21st birthday. After completing a screening/baseline assessment approximately 1 week before turning 21, participants were randomly assigned to 1 of 6 conditions: 21st birthday in-person BASICS, 21st birthday web BASICS, 21st birthday in-person BASICS plus friend intervention, 21st birthday web BASICS plus friend intervention, BASICS, or an attention control. A follow-up assessment was completed approximately 1 week after students' birthdays. Results indicated a significant intervention effect for BASICS in reducing blood alcohol content reached and number of negative consequences experienced. All 3 in-person interventions reduced negative consequences experienced. Results for the web-based interventions varied by drinking outcome and whether a friend was included. Overall, results provide support for both general intervention and ESP approaches across modalities for reducing extreme drinking and negative consequences associated with turning 21. These results suggest there are several promising options for campuses seeking to reduce both use and negative consequences associated with 21st birthday celebrations.