Binge Drinking in America

And the numbers are… fuzzy.

Public health officials in the UK have been wringing their hands for some time now over perceived rates of binge drinking among the populace. In a 2010 survey of 27,000 Europeans by the official polling agency of the EU, binge drinking in the UK—defined as five or more drinks in one, er, binge—clocked in at a rate of 34%, compared to an EU average of 29%. Predictably, the highest rate of UK binge drinking was found in people between the ages of 15 and 24. This still lagged well behind the Irish (44%) and the Romanians (39%). Scant comfort, perhaps, given the historical role drinking has played in those two cultures, but still, clearly, the British and the rest of the UK are above-average drinkers.

Or are they? And what about the U.S. How do we rank? For comparative purposes, we can use the “Vital Signs” survey in the United States from 2010, performed by the Centers for Disease Control and Prevention, and published in CDC’s Morbidity and Mortality Weekly Report, results of which are pictured above. Using almost the same criteria for binge drinking—five drinks at a sitting for men, four drinks for women—the study concludes that the “overall prevalence of binge drinking was 17.1%. Among binge drinkers, the frequency of binge drinking was 4.4 episodes per month, and the intensity was 7.9 drinks on occasion.”

By the CDC’s definition, the heaviest binge drinking in America takes place in the Midwest, parts of New England, D.C., and Alaska. Survey respondents with an income in excess of $75,000 were the most serious bingers (20.2%), but those making under $25,000 binged more often and had more drinks per binge than other groups, the report says. And binge drinking is about twice as prevalent among men. Binge drinking, the survey concludes, is reported by one of every six U.S. adults.

Even so, it appears that the U.S. does not have the same level of binge drinking as the UK. However, astute readers have no doubt noticed that actual binge drinkers in the U.S. were consuming almost 8 drinks per bout, well above the official mark of four or five drinks at one time. The problem is that there is no internationally agreed upon definition of binge drinking. A 2010 fact sheet from the UK’s Institute of Alcohol Studies (IAS) maintains that “drinking surveys normally define binge drinkers as men consuming at least eight, and women at least six standard units of alcohol in a single day, that is, double the maximum recommended ‘safe limit’ for men and women respectively.”

But referring to binge drinking as “high intake of alcohol in a single drinking occasion” is misleading, says IAS. The problem is biological: “Because of individual variations in, for example, body weight and alcohol tolerance, as well as factors such as speed of consumption, there is not a simple, consistent correlation between the number of units consumed, their resulting blood alcohol level and the subjective effects on the drinker.”

Furthermore, the report charges that “researchers have criticized the term ‘binge drinking’ as unclear, politically charged and therefore, unhelpful in that many (young) people do not identify themselves as binge drinkers because, despite exceeding the number of drinks officially used to define bingeing, they drink at a slow enough pace to avoid getting seriously drunk.”

There you have it. As currently defined and measured, binge drinking is a relatively useless metric for assessing a population’s alcohol habits. “The different definitions employed need to be taken into account in understanding surveys of drinking behavior and calculations of how many binge drinkers there are in the population,” as the UK report wisely puts it. Take the above chart with a few grains of salt.

Photo Credit: CDC

Last Call: Book Review

Lessons of Prohibition as timely as ever.

It gained serious momentum with the creation of the Anti-Saloon League, the most powerful pressure group in American history. It took down the 5th largest industry in the nation. Financed heavily by teetotaler John D. Rockefeller, it lasted 14 years, and it is mind boggling to contemplate the parallels with the current drug war.

On January 16, 1920, with the official passage of the 18th Amendment banning the manufacture, sale, or transport of alcoholic beverages, America carved out only the second explicit limitation on the activities of its citizens in the Republic’s history. As Daniel Okrent writes in his definitive history, Last Call: The Rise and Fall of Prohibition, “you couldn’t own slaves, and you couldn’t buy alcohol.”

Americans in the late 1800s drank a lot of alcohol. “Multiply the amount American’s drink today by three,” says Okrent. Taxes on whiskey and beer helped pay for the War of 1812 and the Civil War. By the end of the 19th Century, consumption of distilled spirits, particularly whiskey, had been partially replaced by…. beer! It was German immigrant brewers who cornered the market for “liquid bread,” as beer was sometimes known. (Italians who migrated to California sparked Napa Valley’s wine industry.)

Who had the power to take on the brewers and distillers of America in a fight to the finish over alcohol? According to Okrent, the answer was: white Anglo-Saxon protestant women.  And not just the well-publicized “hatchetation” of Carrie Nation and the Women’s Christian Temperance Union. In fact, the women’s suffrage movement and the drive for prohibition were inextricably linked. The fact of alcohol in family life was one of the reasons women wanted “the right to own property, and to shield their families’ financial security from the profligacy of drunken husbands.” As famed alcoholic Jack London observed, “the moment women get the vote in any community, the first thing they proceed to do is close the saloons.” At least, so London hoped—he thought perhaps prohibition might save his life.

Lamentably, women were joined by racists and nativists in the fight against alcohol and its alleged grip on “the infidel foreign population of our country.” On the Iron Range of northern Minnesota, “congressional investigators counted 256 saloons in fifteen mining towns, their owners representing eighteen distinct immigrant nationalities.” After the United States entered World War I, the Anti-Saloon League stoked anti-German feeling as part of the Prohibition strategy.  It was “native-born Protestants against everybody else,” Okrent writes. Demonizing foreigners was and is a useful strategy in any prohibition campaign.

In California, vintners exploited the so-called fruit juice clause in the Volstead Act, the enabling legislation for the 18th amendment. During the California Grape Rush of 1920, “Grapes are so valuable this year that they are being stolen, a Napa Valley newspaper lamented. The fruit juice clause was intended to allow farmer’s wives to “conserve their fruit” by fermenting the apple crop into hard cider.

A second useful loophole for grape growers was an exemption in the Volstead Act, allowing wine use for “sacramental purposes” during Catholic and Jewish ceremonies. A “dry” Methodist dentist promptly responded with a Protestant version: Welch’s Grape Juice.

The third major exception covered the legal distribution of alcoholic beverages “for medicinal purposes”—the only exemption for hard liquor. Clearly, alcohol in its many forms was a necessary part of practicing medicine. But “beverage alcohol” was a different story. Nonetheless, doctors wrote prescriptions for alcohol on government-issued prescription forms, and, despite initial opposition, the American Medical Association (AMA) eventually discovered 27 different medical conditions, ranging from diabetes to old age, which might benefit from the alcohol treatment, arguing that any interference with the medicinal use of liquor would be “a serious interference with the practice of medicine.”

It made for a strange set of bootlegging bedfellows: Rabbis, priests, farmer’s wives, doctors—and Al Capone. Meanwhile, alcohol poured over the border from Canada, came to the coast in ships from the Bahamas, and was offloaded in Seattle from smugglers on land and sea. As one prominent “wet” complained, Prohibition had become “an attempt to enthrone hypocrisy as the dominant force in this country.”

Prohibition even had its own version of “3 Strikes” legislation, called the Jones Law, which imposed up to a five-year sentence for first violations. Lansing, Michigan, passed an ordinance calling for mandatory life in prison for a fourth violation. One effect of such harsh laws was to force out small-time bootleggers, clearing the field for the major operators, like the Bronfman family and its Seagram’s brand of whiskey in Canada.

In the end, as the saying went, “Prohibition was better than no liquor at all.” Yet overall consumption of alcohol did decline, particularly during the early years.  Things began to change by the late 1920s, though, as the drys pushed “the limits of law’s ability to defeat appetite.” Part of the problem, Okrent believes, was simple: “Drys didn’t understand drinkers, in scores of different ways.”

“By one accounting, U.S. attorneys across the country spent, at minimum, 44 percent of their time and resources on Prohibition prosecutions—if that was the word for the pallid efforts they were able to sustain on such limited resources,” Okrent writes, again with application to the present state of affairs. In Alabama, prohibition prosecutions accounted for 90 percent of the federal court’s workload. And all this at a time when the federal government had lost more than $440 million in liquor tax revenues, much of which ended up in the pockets of foreign-born criminals.  By 1926, bootleg liquor sales were estimated at $3.6 billion nationally, “almost precisely the same as the entire federal budget that year.”

Not a pretty picture. “The business pays very well,” as attorney Clarence Darrow put it, “but it is outside the law and they can’t got to court.” As a result, Darrow said, “they naturally shoot.”

The head of the DuPont family suggested that liquor tax revenues “would be increased sufficiently to warrant the abolition of the income tax and corporation tax,” similar to today’s argument that, by ending drug prohibition, California and other states can balance their precarious budgets.

By the late 1920s, it was said, the only groups who continued to favor Prohibition were evangelical Christians and bootleggers.  In 1929, following the Crash and the beginning of the Great Depression, with banks folding and unemployment soaring, “any remaining ability to enforce Prohibition evaporated.” The Repeal movement promised that with the end of Prohibition, the Depression “will fade away like the mists before the noonday sun.” That didn’t happen. But in the first post-repeal year, the government took in more than $250 million in liquor taxes, representing about 9 percent of total federal revenue.

Photo Credit: http://www.druglibrary.org/