Editorial Journal of Addictions Nursing & Volume 28 & Number 1, 1Y3 & Copyright B 2017 International Nurses Society on Addictions Women and Binge Drinking Christine Vourakis, PhD, RN, FIAAN, FAAN INTRODUCTION Celebrations are another excuse for bingeing. A study of Consuming large quantities of alcohol via the ritual of ‘‘tak- 21st birthday celebrations found that downing a significant ing/doing shots’’ of liquor and/or gulping beer in one number of shots of liquor in a single episode is an acceptable drinking episode is not a new phenomenon. What is new, is way for many youths to mark the passage to adulthood. One the more recent, at least in the last two decades, heightened finding was that 68% of participants reported drinking more widespread popularity of these activities often in the form of than intended. Peers in attendance were instrumental cheer- ‘‘drinking games’’ among both young men and women. This leaders and half the sample of 150 participants was female. binge drinking (consuming four or more drinks for women (Brister, Wetherill & Fromme, 2010). Drinking games and five or more for men in one episode or within two hours and alcohol fueled ‘‘rites-of-passage’’ celebrations are com- [NIAAA, 2004]) is most common among millennials (18Y34 monplace among significant numbers of millennials. years olds as of 2015 and currently, the largest living U.S. gen- eration [Fry, 2016, April 25]). Hanging out at the bar and SCOPE OF PROBLEM AND HARMFUL trading shots with men (Kindy & Keating, 2016). is potentially CONSEQUENCES causing irrevocable harm for women. Drinking large amounts of alcohol in a short period of time Partying college students are known to engage in drinking becomes normalized for many millennial drinkers who even- games such as ‘‘Beer Bong.’’ This game frequently played at tually find that slowly sipping drinks no longer appeals to fraternity parties’ entails consuming large quantities of beer them. So while popular and seemingly natural, bingeing is dan- via a funnel attached to a tube which is inserted into the gerous to the health and welfare of these adults, especially mouth. With the use of gravity, the funnel allows two or more women. A report from the Center for Disease Control (CDC) beers to be rapidly administered. In riskier situations a thin stated, ‘‘Excessive alcohol use accounted for an estimated average plastic hose may be inserted into the esophagus (often causes of 23,000 deaths and 633,000 years of potential life lost (YPLL) discomfort and many cannot tolerate this) so beer can literally among women and girls in the United States (U.S.) each year be poured into the recipient’s stomach. during 2001-2005. Binge drinking accounted for more than half Another game, ‘‘Beer Pong’’ is more generally known and of these deaths and YPLL (2013).’’ has several variations. One common variation is played with One study of over 14,000 participants during 2003 and each of two teams placing approximately 10 plastic cups on a 2004 found that binge drinkers consumed an average of flat surface such as a pool table. Participants attempt to toss or 8 drinks (beer, wine or liquor-containing drinks) per bounce ping pong balls into the opposing team’s cups. Team drinking episode. Men in the study consumed an average members each swallow designated cups (often two) of beer of 8.3 drinks and women 7.0 per episode. Participants aged every time the other team lands a ping pong ball in one of 18Y34 years consumed more drinks than those over 34 years. their cups. Large quantities of beer are consumed in both of This serious behavior is compounded by the fact that binge these games. drinking is often characterized by ‘‘slamming’’ down (gulping drinks) shots of liquor or beer in rapid succession dangerously Editor-in-Chief, Journal of Addictions Nursing, and Professor Emeritus. raising blood alcohol levels. (Naimi, Nelson & Brewer, 2010). The Editor, Christine Vourakis, confirms that there are no conflicts of in- Using U.S. data, the number of adult women binge drink- terest. The Editor alone is responsible for the writing and content of the article. ing increased from 2009 (10%) to 2011 (12%) however the The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article. average number of bingeing episodes decreased from 3.1 to Correspondence related to content to: Christine Vourakis, PhD, RN, 2timesintheprevious30days(Kanny,Liu,&Brewer, FIAAN, FAAN, Editor-in-Chief, Journal of Addictions Nursing Health 2011; Kanny, Liu, Brewer & Lu, 2013). Intensity of binge Learning, Research & Practice, Wolters Kluwer, Two Commerce Square drinking remains highest among 24Y34 (30%) and 35Y44 2001 Market Street, Philadelphia, PA 19103 E-mail: [email protected] (29.7%) year old adults with women consuming 5.7 drinks DOI: 10.1097/JAN.0000000000000161 per episode (Kanny, Liu, Brewer & Lu, 2013). Journal of Addictions Nursing www.journalofaddictionsnursing.com 1 Copyright © 2017 International Nurses Society on Addictions. Unauthorized reproduction of this article is prohibited. There are indications that both men and women with Sisters. Pop culture iconic actresses such as Melissa McCarthy, higher incomes and education have a higher prevalence of Sandra Bullock, Amy Schumer, Tina Fey and Amy Poehler are binge drinking. Interestingly though, people with lower in- influential among women and this is not lost on advertisers comes and education who binge drink, binge drink more for the alcohol industry. frequently and more heavily during each episode. Overall, The evidence to associate a direct influence of advertising the average number of binge drinking episodes for binge on the drinking practices of the population has been difficult drinkers is similar across racial/ethnic groups reported for both to demonstrate even though one industry spokesman, as noted sexes, based on male and female drinking patterns, however in the Washington Post, bragged that sales of a boxed beer the average largest number of drinks (8.4), consumed by binge called ‘‘Bandit’’ rose by 22% after Amy Schumer was drinkers (both men and women) was reported by American displayed drinking from a carton of Bandit during the movie Indians and Alaskan Natives (Kanny, Liu, & Brewer, 2011). Trainwreck (Kindy and Keating, 2016). It is more likely that ‘‘Although men are more likely to drink alcohol and drink the industry capitalizes on social trends it observes among the in larger amounts, gender differences in body structure and population and gears their advertising to maximize the benefits chemistry cause women to absorb more alcohol, and take of these trends. longer to break it down and remove it from their bodies Alcohol bingeing is not easily tackled hence is part of the (i.e., to metabolize it). In other words, upon drinking equal reason it has persisted and become increasingly popular. It is amounts, women have higher alcohol levels in their blood common knowledge that peer groups exert considerable in- than men, and the immediate effects of alcohol occur more fluence on members lives. Youth and millennials wanting to quickly and last longer in women than men. These differences fit in and be part of a group are likely to willingly adopt the also make it more likely that drinking will cause long-term attitude, style and behavior of their friends. Parents, guardians, health problems in women than men (CDC, 2016).’’ Binge counselors, teachers, peers and other concerned citizens need drinking therefore is a risk factor for many health and social to work together to change the excessive drinking socio- problems among women and girls, including, brain damag- cultural environment through education, peer counselor train- ing effects such as shrinkage and memory loss, heart muscle ing, leadership training and by engaging youth and young damage, alcohol-related liver disease, unplanned and alcohol- adults in alternative activities that encourage them to have a exposed pregnancy, physical assault, sexually transmitted dis- sense of responsibility within their communities. Treating eases and breast cancer (CDC, 2013; CDC, 2016, March). young adults with respect and giving them opportunities to Despite some evidence of a decrease in binge drinking ep- behave as responsible citizens will likely enhance their self- isodes for women from 2009-2011, as noted, the frequency esteem and self-efficacy. and intensity remains harmful and of serious concern (CDC, Peers who encourage bingeing need to be educated to do 2016 - March). As a result of these drinking practices, we tend the opposite and to encourage their peer celebrators to tone to see a telescoping of the harmful effects of alcohol in these down their consumption. Advertisers need to be reined in by women after drinking fewer than or the same number of years regulation coupled, if necessary, by public boycotting of their as men. products. Regulation can include higher excise taxes on sales Amazingly, policy makers and other seem indifferent to to discourage youth purchase. Prevention needs to start early the fact that the telescoped harm that excessive alcohol use or at least in high school. Some anecdotal data indicates causes to women’s bodies has been well known for at least that even some high school freshman and sophomores are four decades, since the public messages to women are often attending parties and participating in drinking games. This limited to those who are pregnant or planning pregnancy. behavior, as a result, is likely to continue in college and/or While focus on pregnancy is important, since 3.1% of pregnant into adulthood. women report binge drinking (CDC, 2015), the emphasis The CDC recommends a broad public health approach needs to be broadened to help women in general under- using evidence-based interventions. They recommend the stand the damage that extreme alcohol consumption does to Guide to Community Preventive Services (available at their bodies.