Binge Drinking: Current Diagnostic and Therapeutic Issues
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The concept of binge drinking (BD) refers to patterns of heavy episodic alcohol consumption, with BD primarily occurring among adolescents and young adults. Several official definitions of BD have been proposed, in particular by the World Health Organization, the National Institute on Alcoholism and Alcohol Abuse, and the Substance Abuse and Mental Health Services Administration. Nevertheless, none of these definitions address the psychosocial and medical consequences of the type of alcohol use seen in BD. In practice, BD can thus correspond to either hazardous or harmful use of alcohol (HUA), while the episodic nature of heavy drinking in BD means that it does not meet the criteria for ‘alcohol dependence’. This diagnostic differentiation is important because it determines which type of intervention is recommended. Psychosocial, rather than pharmacological, interventions are recommended as first-line treatment for adults with HUA, while pharmacological treatment is recommended for alcohol dependence; however, HUA appears to be associated with much poorer outcomes in adolescents, which could thus warrant early use of pharmacotherapy in this patient group. For HUA, and especially in adolescents, there is currently a severe lack of data regarding the efficacy and safety of the different drugs that have been approved for adults with alcohol dependence. Various guidelines propose the use of drugs for some types of BD but that use remains off-label and empirical, which raises important safety and ethical concerns. Future research on BD should systematically assess the criteria for HUA to better differentiate its subtypes with actual consequences and better address the heterogeneity of BD in terms of both clinical profiles and outcomes. Regarding pharmacotherapy, some national guidelines have recommended nalmefene for ‘mild’ dependence or second-line treatment for HUA, but such recommendations are not supported by evidence. Only naltrexone has been investigated in HUA but not in adolescents. More clinical trials should be conducted among adolescents with BD and HUA criteria to determine the most appropriate use of drugs in this particularly vulnerable population of subjects.
KeywordsAlcohol Dependence Aripiprazole Naltrexone Baclofen Binge Drinking
Compliance with Ethical Standards
The work of Benjamin Rolland on BD is supported by a research grant from the Fondation Actions-Addictions (http://actions-addictions.org), an independent French foundation supporting evidenced-based actions against addictive disorders.
Conflicts of interest
Benjamin Rolland has provided expert testimony for Ethypharm and Indivior, and has received lecture fees from Ethypharm, Lundbeck, Indivior, Bouchara-Recordati, Gilead, AstraZeneca, Bristol-Myers-Squibb, Otsuka, and Servier. Mickaël Naassila has received lecture or expert fees from Merck-Serono, Lundbeck, and Bouchara-Recordati. Both authors received grants from the Fondation Actions-Addictions.
- 1.World Health Organization. Global status report on alcohol and health, 2014. Available at: http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf. Accessed 15 Dec 2016.
- 2.Substance Abuse and Mental Health Services Administration. Binge drinking: terminology and patterns of use. Available at: http://www.samhsa.gov/capt/tools-learning-resources/binge-drinking-terminology-patterns. Accessed 15 Dec 2016.
- 3.National Institute on Alcohol Abuse and Alcoholism (NIAAA). Drinking Levels defined. Available at: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking. Accessed 15 Dec 2016.
- 14.World Health Organization (WHO). Hazardous use. Available at: http://www.who.int/substance_abuse/terminology/definition3/en/. Accessed 15 Dec 2016.
- 15.World Health Organization (WHO). Harmful use. Available at: http://www.who.int/substance_abuse/terminology/definition2/en/. Accessed 15 Dec 2016.
- 16.World Health Organization (WHO). Syndrome of dependence. Available at: http://www.who.int/substance_abuse/terminology/definition1/en/. Accessed 15 Dec 2016.
- 18.National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (NICE). 1-guidance: guidance and guidelines. Available at: https://www.nice.org.uk/guidance/cg115/chapter/1-Guidance#interventions-for-alcohol-misuse. Accessed 15 Dec 2016.
- 19.Australian Government Department of Health. Australian guidelines to reduce health risks from drinking alcohol, 2009. Available at: https://www.nhmrc.gov.au/guidelines-publications/ds10. Accessed 15 Dec 2016.
- 20.Batra A, Müller CA, Mann K, Heinz A. Alcohol dependence and harmful use of alcohol. Dtsch Ärzteblatt Int. 2016;113:301–10.Google Scholar
- 21.Société Française d’Alcoologie (2015) Alcohol misuse: screening, diagnosis, and treatment. Available at: http://www.sfalcoologie.asso.fr/download/SFA-GPR-AlcoholMisuse.pdf?PHPSESSID=4ef2ff748d337dbee7e43533a238cb6d. Accessed 15 Dec 2016.
- 24.Hasin D, Hatzenbuehler ML, Keyes K, Ogburn E. Substance use disorders. Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and International Classification of Diseases, tenth edition (ICD-10). Addiction. 2006;101(Suppl):59–75.Google Scholar
- 35.O’Malley SS, Corbin WR, Leeman RF, DeMartini KS, Fucito LM, Ikomi J, et al. Reduction of alcohol drinking in young adults by naltrexone: a double-blind, placebo-controlled, randomized clinical trial of efficacy and safety. J Clin Psychiatry. 2015;76(2):e207–13.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.European Medicines Agency. Opinion of the Paediatric Committee on the granting of a product-specific waiver for nalmefene, 2010. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/PIP_decision/WC500101154.pdf. Accessed 15 Dec 2016.