INTRODUCTION
Consuming large quantities of alcohol via the ritual of "taking/doing shots" of liquor and/or gulping beer in one drinking episode is not a new phenomenon. What is new, is the more recent, at least in the last two decades, heightened widespread popularity of these activities often in the form of "drinking games" among both young men and women. This binge drinking (consuming four or more drinks for women and five or more for men in one episode or within two hours [NIAAA, 2004]) is most common among millennials (18-34 years olds as of 2015 and currently, the largest living U.S. generation [Fry, 2016, April 25]). Hanging out at the bar and trading shots with men (Kindy & Keating, 2016). is potentially causing irrevocable harm for women.
Partying college students are known to engage in drinking games such as "Beer Bong." This game frequently played at fraternity parties' entails consuming large quantities of beer via a funnel attached to a tube which is inserted into the mouth. With the use of gravity, the funnel allows two or more beers to be rapidly administered. In riskier situations a thin plastic hose may be inserted into the esophagus (often causes discomfort and many cannot tolerate this) so beer can literally be poured into the recipient's stomach.
Another game, "Beer Pong" is more generally known and has several variations. One common variation is played with each of two teams placing approximately 10 plastic cups on a flat surface such as a pool table. Participants attempt to toss or bounce ping pong balls into the opposing team's cups. Team members each swallow designated cups (often two) of beer every time the other team lands a ping pong ball in one of their cups. Large quantities of beer are consumed in both of these games.
Celebrations are another excuse for bingeing. A study of 21st birthday celebrations found that downing a significant number of shots of liquor in a single episode is an acceptable way for many youths to mark the passage to adulthood. One finding was that 68% of participants reported drinking more than intended. Peers in attendance were instrumental cheerleaders and half the sample of 150 participants was female. (Brister, Wetherill & Fromme, 2010). Drinking games and alcohol fueled "rites-of-passage" celebrations are commonplace among significant numbers of millennials.
SCOPE OF PROBLEM AND HARMFUL CONSEQUENCES
Drinking large amounts of alcohol in a short period of time becomes normalized for many millennial drinkers who eventually find that slowly sipping drinks no longer appeals to them. So while popular and seemingly natural, bingeing is dangerous to the health and welfare of these adults, especially women. A report from the Center for Disease Control (CDC) stated, "Excessive alcohol use accounted for an estimated average of 23,000 deaths and 633,000 years of potential life lost (YPLL) among women and girls in the United States (U.S.) each year during 2001-2005. Binge drinking accounted for more than half of these deaths and YPLL (2013)."
One study of over 14,000 participants during 2003 and 2004 found that binge drinkers consumed an average of 8 drinks (beer, wine or liquor-containing drinks) per drinking episode. Men in the study consumed an average of 8.3 drinks and women 7.0 per episode. Participants aged 18-34 years consumed more drinks than those over 34 years. This serious behavior is compounded by the fact that binge drinking is often characterized by "slamming" down (gulping drinks) shots of liquor or beer in rapid succession dangerously raising blood alcohol levels. (Naimi, Nelson & Brewer, 2010).
Using U.S. data, the number of adult women binge drinking increased from 2009 (10%) to 2011 (12%) however the average number of bingeing episodes decreased from 3.1 to 2 times in the previous 30 days (Kanny, Liu, & Brewer, 2011; Kanny, Liu, Brewer & Lu, 2013). Intensity of binge drinking remains highest among 24-34 (30%) and 35-44 (29.7%) year old adults with women consuming 5.7 drinks per episode (Kanny, Liu, Brewer & Lu, 2013).
There are indications that both men and women with higher incomes and education have a higher prevalence of binge drinking. Interestingly though, people with lower incomes and education who binge drink, binge drink more frequently and more heavily during each episode. Overall, the average number of binge drinking episodes for binge drinkers is similar across racial/ethnic groups reported for both sexes, based on male and female drinking patterns, however the average largest number of drinks (8.4), consumed by binge drinkers (both men and women) was reported by American Indians and Alaskan Natives (Kanny, Liu, & Brewer, 2011).
"Although men are more likely to drink alcohol and drink in larger amounts, gender differences in body structure and chemistry cause women to absorb more alcohol, and take longer to break it down and remove it from their bodies (i.e., to metabolize it). In other words, upon drinking equal amounts, women have higher alcohol levels in their blood than men, and the immediate effects of alcohol occur more quickly and last longer in women than men. These differences also make it more likely that drinking will cause long-term health problems in women than men (CDC, 2016)." Binge drinking therefore is a risk factor for many health and social problems among women and girls, including, brain damaging effects such as shrinkage and memory loss, heart muscle damage, alcohol-related liver disease, unplanned and alcohol-exposed pregnancy, physical assault, sexually transmitted diseases and breast cancer (CDC, 2013; CDC, 2016, March).
Despite some evidence of a decrease in binge drinking episodes for women from 2009-2011, as noted, the frequency and intensity remains harmful and of serious concern (CDC, 2016 - March). As a result of these drinking practices, we tend to see a telescoping of the harmful effects of alcohol in these women after drinking fewer than or the same number of years as men.
Amazingly, policy makers and other seem indifferent to the fact that the telescoped harm that excessive alcohol use causes to women's bodies has been well known for at least four decades, since the public messages to women are often limited to those who are pregnant or planning pregnancy. While focus on pregnancy is important, since 3.1% of pregnant women report binge drinking (CDC, 2015), the emphasis needs to be broadened to help women in general understand the damage that extreme alcohol consumption does to their bodies.
INTERVENTION
Although it is difficult to directly fault alcohol industry advertising for this intense style of drinking, they are certainly a contributor to the problem. The entire advertising industry is quite sophisticated at observing fads and amplifying those that support their economic agenda.
Promotion of excessive drinking is becoming a frequent thread on social media and in television and films. Downing multiple straight shots (often vodka, tequila or whiskey) of liquor or extreme beer consumption is highlighted and popularized in comedic movies such as The Heat, Trainwreck and Sisters. Pop culture iconic actresses such as Melissa McCarthy, Sandra Bullock, Amy Schumer, Tina Fey and Amy Poehler are influential among women and this is not lost on advertisers for the alcohol industry.
The evidence to associate a direct influence of advertising on the drinking practices of the population has been difficult to demonstrate even though one industry spokesman, as noted in the Washington Post, bragged that sales of a boxed beer called "Bandit" rose by 22% after Amy Schumer was displayed drinking from a carton of Bandit during the movie Trainwreck (Kindy and Keating, 2016). It is more likely that the industry capitalizes on social trends it observes among the population and gears their advertising to maximize the benefits of these trends.
Alcohol bingeing is not easily tackled hence is part of the reason it has persisted and become increasingly popular. It is common knowledge that peer groups exert considerable influence on members lives. Youth and millennials wanting to fit in and be part of a group are likely to willingly adopt the attitude, style and behavior of their friends. Parents, guardians, counselors, teachers, peers and other concerned citizens need to work together to change the excessive drinking socio-cultural environment through education, peer counselor training, leadership training and by engaging youth and young adults in alternative activities that encourage them to have a sense of responsibility within their communities. Treating young adults with respect and giving them opportunities to behave as responsible citizens will likely enhance their self-esteem and self-efficacy.
Peers who encourage bingeing need to be educated to do the opposite and to encourage their peer celebrators to tone down their consumption. Advertisers need to be reined in by regulation coupled, if necessary, by public boycotting of their products. Regulation can include higher excise taxes on sales to discourage youth purchase. Prevention needs to start early or at least in high school. Some anecdotal data indicates that even some high school freshman and sophomores are attending parties and participating in drinking games. This behavior, as a result, is likely to continue in college and/or into adulthood.
The CDC recommends a broad public health approach using evidence-based interventions. They recommend the Guide to Community Preventive Services (available at https://www.cdc.gov/epo/communityguide.htm) and the U.S. Preventive Services Task Force (https://www.uspreventiveservicestaskforce.org/) for intervention strategies "[horizontal ellipsis]to reduce the frequency and intensity and ultimately the prevalence of binge drinking among women and girls, and the harms related to it." (CDC, 2013; CDC, 2016).
The alarming and perilous practice, particularly among approximately12% of millennial women, of extreme drinking during a single episode needs the attention of policy makers, the local and national community, and all health care professionals. Women are a vital resource to a global world and we cannot afford to lose them, their talents and contributions for the challenging years ahead.
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