Elsevier

Drug and Alcohol Dependence

Volume 175, 1 June 2017, Pages 92-98
Drug and Alcohol Dependence

Full length article
Comparison between the WHO and NIAAA criteria for binge drinking on drinking features and alcohol-related aftermaths: Results from a cross-sectional study among eight emergency wards in France

https://doi.org/10.1016/j.drugalcdep.2017.01.034Get rights and content

Highlights

  • Compared to World Health Organization (WHO) binge drinkers, National Institute on Alcoholism and Alcohol Abuse (NIAAA) bingers were younger and were more likely males.

  • Drinking frequencies and average levels of drinking were greater among NIAAA bingers.

  • Features of alcohol-related aftermaths and psychiatric problems were more frequent.

  • An overall severity gradient was found between non-bingers, WHO bingers, and NIAAA bingers.

Abstract

Background

Binge drinking (BD) consists of heavy episodic alcohol use. Whereas the World Health Organization (WHO) defines BD as 60 g of alcohol or more per occasion, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) conceives BD as drinking 70 g (men) or 56 g (women) in less than two hours. We compared the subjects delineated by each definition.

Methods

Eight-center cross-sectional study among 11,695 subjects hospitalized in emergency wards. Participants completed the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), CAGE and Rapid Alcohol Problem Screen 4 (RAPS4-QF) questionnaires. The WHO criteria were investigated using the RAPS4-QF. Independent questions assessed the NIAAA criteria. The main medical admission motive was noted. The characteristics of subjects meeting respectively: 1) the exclusive WHO criteria (BD1); 2) the NIAAA criteria (BD2); and 3) no BD criteria (noBD) were compared using multinomial regression analyses. Binary age- and gender-adjusted regression analyses directly compared BD1 and BD2. Subjects with at least four drinking occasions per week were excluded from the analyses, to withdrawn regular heavy drinking.

Results

Compared to BD1, BD2 subjects were more frequently males (OR = 1.67 [1.39–2.0]), single (aOR = 1.64 [1.36–1.98]) and unemployed (aOR = 1.57 [1.27–1.90]). BD2 reported significantly more drinks per occasion, and higher heavy drinking frequencies. Previous alcohol-related remarks from family (aOR = 3.00 [2.53–3.56]), ever drinking on waking-up (aOR = 2.05 [1.37–2.72]), and admission for psychiatric motive (aOR = 2.27 [1.68–3.07]) were more frequent among BD2 subjects.

Conclusions

Compared to WHO criteria, NIAAA criteria for BD delineate subjects with more concerning drinking patterns and alcohol aftermaths.

Introduction

Binge drinking (BD) is defined by the World Health Organization (WHO) as heavy episodic alcohol use (World Health Organization, 2014). Though subjects with BD only occasionally meet the criteria for characterized alcohol use disorders, they are significantly more at risk to subsequently develop such disorders (Jefferis et al., 2005, McCarty et al., 2004), and they are also more exposed to a large array of immediate or further social or medical consequences, such as physical injuries, violence, risky or unwanted sexual activity, depression or suicide (Behnken et al., 2010, Schuler et al., 2015, Townshend et al., 2014, Wilkinson et al., 2016). Such consequences warrant scientific investigations into BD, with the objective to better understand its social, psychological and biological underlying mechanisms, and to develop relevant prevention and treatment health policies.

However, there has been an important debate in the scientific world about how BD should be exactly defined. The most commonly used definitions of BD are based on drinking thresholds. For example, the WHO has retained the cut-off of six WHO standard-drinks (i.e., 60 g of alcohol) or more per occasion to define heavy episodic drinking (World Health Organization, 2014). Alternatively, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) defines BD as “a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL, [which] typically occurs after 4 [American] drinks [i.e., 56 g of alcohol] for women and 5 [American] drinks [i.e., 70 g of alcohol] for men—in about 2 h” (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2016). The nuance is meaningful, as the NIAAA cut-offs comprise a minimum drinking speed. Introducing the notion of drinking rapidity into the BD definition more specifically targets a profile of subjects who are eager to drink and to become drunk.

It is thus likely that the two types of BD definitions, namely those based only on the number of drinks per occasion on the one hand, and those based on a drinking threshold plus a minimum drinking speed on the other, do not delineate the same types of profiles. In particular, it may by hypothesized that these two BD populations significantly differ in terms of drinking frequencies, usual drinking amounts, frequency of heavy drinking, and alcohol-related aftermaths. It is important to highlight and to correctly address these specific alcohol-related parameters, depending on which BD definition is used. Otherwise, unclear or even contradictory findings would lead to erroneous messages on BD to the lay public and policymakers. Despite this, no previous study has ever compared the populations defined according to these two conceptual approaches of BD.

In a large-sample cross-sectional study conducted in eight emergency wards of the Auvergne – Rhône-Alpes, France, we compared – between BD subjects defined according to the NIAAA criteria, and BD subjects defined exclusively according to the WHO criteria – some aspects of the drinking patterns, alcohol-related aftermaths, and main medical causes for admission to the hospital. The reporting of the study is performed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (von Elm et al., 2007) (see the Supplemental material 1).

Section snippets

Type of study

This was a cross-sectional study conducted among subjects recruited in the emergency wards of eight public hospitals in the Auvergne – Rhône-Alpes region, France, between 2012 and 2013. The total recruitment period was one month for each center, which led to 11,695 the final number of included subjects. For more details, the complete study protocol can be found elsewhere (De Chazeron et al., 2015).

Participants and data collected

Every subject aged 13 or more and hospitalized in the emergency ward was proposed to participate

Descriptive results and bivariable comparisons

In total, 11,695 subjects participated in the study. When matched with the total number of admissions during the study period, this corresponded to 49% of the total number of admissions. After eliminating multiple hospitalizations and subjects aged below 13 years, the final number of participants amounted to 72% of the eligible subjects.

After exclusion of the participants with a drinking frequency of four occasions per week or more (n = 2048), and those with insufficient collected material or

Discussion

The main objective of the study was to compare the socio-demographic and drinking characteristics of subjects with exclusive WHO criteria for BD (BD1 group), subjects with NIAAA + WHO criteria for BD (BD2 group), and subjects with no criteria for BD.

Regarding comparisons with the noBD group, our results are in line with the findings of previous studies performed, especially those conducted at emergency departments. BD was associated with younger age, increased rates of male subjects, and

Contributors

Georges Brousse and Ingrid de Chazeron designed the study protocol.

Georges Brousse was the grant holder.

Ingrid de Chazeron, Françoise Carpentier, Fares Moustafa; Alain Viallon, Xavier Jacob; Patrick Lesage, Julie Geneste, Delphine Ragonnet, Annick Genty, and Georges Brousse collected the data.

Benjamin Rolland and Mickaël Naassila analyzed the data.

Benjamin Rolland, Georges Brousse, Ingrid de Chazeron, and Mickaël Naassila wrote the first draft of the manuscript.

All authors have read and

Role of funding source

The study was funded by an inter-regional public grant (PHRC interregional Auvergne - Rhône-Alpes 2012). The funder had no role in the writing of the study protocol or in the conductance of the study.

Conflicts of interest

Benjamin Rolland received lecture or expert fees from Ethypharm, Lundbeck, Indivior, Bouchara-Recordati, Gilead, AstraZeneca, Bristol-Myers-Squibb, Otsuka, and Servier. Maurice Dematteis has received sponsorship to attend scientific meetings, speaker honoraria, and consultancy fees from Lundbeck, Ethypharm, Indivior, Merck-Serono, and Bouchara-Recordati. Mickael Naassila received lecture or expert fees from Merck-Serono, Lundbeck and Bouchara-Recordati. Georges Brousse has received sponsorship

Acknowledgements

The work provided by Benjamin Rolland on this study was supported by a research grant from the Fondation Actions-Addictions (http://actions-addictions.org), which is an independent French foundation supporting evidenced-based actions against addictive disorders.

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