To any personal friends reading this, know that I don’t usually do this, but a few years ago I counted how many drinks you all had at a birthday party – and you’re all dangerous binge drinkers! Well, I don’t think that’s a fair representation of my friends’ drinking, but that’s how the government would classify them.
Just a few days before that party I had read a release from the government about binge/risk drinking statistics. It mentioned the criteria, which was 5 or more drinks on a single occasion for men, 4 or more for women. I thought it sounded a little absurd. I grew up seeing many people who didn’t seem to have drinking problems polish off far more than this many drinks at my family’s annual 4th of July picnic. Were my memories correct? Could people drink this much and not have it be a dark and ominous event?
When I walked into that big party space in New York, it hit me that I should keep tabs on everyone’s drinking. These were well-to-do folks, most had gone to college with my boyfriend at NYU. They had master’s degrees in various fields, they were professionals in several fields. They were 20 and 30something year olds who seem to hold it together and take care of themselves in a city where it’s notoriously tough to make it – New York. And yet, almost without fail, they all had a number of drinks that would qualify them as binge drinkers.
No fights broke out. Nobody injured themselves. There weren’t any cases of alcohol poisoning. Over about a 3 hour period, people just seemed to have fun. These people seemed to have their lives together. I see many of them multiple times a year, and their lives don’t appear to be falling apart.
What’s so bad about about their behavior on that day that it needs to be given an ugly label like “binge drinking?” To this day, I don’t know. Yet this concern about binge drinking persists. The Surgeon General just released a new report on substance use that raises the specter of binge drinking yet again. Jacob Sullum (who you should be following, for his great analysis on drug news over at Reason.com) discusses it in a recent article:
Murthy’s [the Surgeon General] report eschews the term substance abuse, explaining that the phrase “is increasingly avoided by professionals because it can be shaming.” Instead the report talks about “substance misuse,” which “is now the preferred term.” But substance misuse is just as judgmental, vague, and arbitrary as substance abuse. In fact, Murthy cannot quite decide what it means. On page 5 of the introduction, he says misuse occurs when people use drugs “in a manner that causes harm to the user or those around them.” But elsewhere (including the very next page), the report uses a much broader definition. “Although misuse is not a diagnostic term,” Murthy says, “it generally suggests use in a manner that could cause harm to the user or those around them.” Could cause harm? That definition is wide enough to cover all drug use.
Murthy does seem to think drug use is problematic even when it causes no problems. As an example of drug misuse, Murthy repeatedly cites a 2015 survey in which 25 percent of the respondents, representing 66.7 million Americans, reported that they had engaged in “binge drinking” during the previous month. “By definition,” Murthy says, “those episodes have the potential for producing harm to the user and/or to those around them, through increases in motor vehicle crashes, violence, and alcohol poisonings.” But the government’s definition of a binge—five or more drinks “on an occasion” for a man, four or more for a woman—encompasses patterns of consumption that do not harm anything except the sensibilities of public health officials. If a man at a dinner party drinks a cocktail before the meal, a few glasses of wine during it, and a little bourbon afterward, he is drinking too much, according to Murthy, even if he takes a cab home. By that standard, at least 44 percent of past-month drinkers are misusing alcohol.
Murthy also counts all consumption of federally proscribed drugs as misuse, no matter the context or consequences. As far as he is concerned, all 36 million Americans who consumed cannabis last year misused it, even if they lived in states where the drug is legal for medical or recreational purposes (which is now most states).
As you can see, our leaders are ready to pathologize basic partying. I bristle at this. Drugs and alcohol offer a cheap thrill. Why is that so bad? Riding a roller coaster is a cheap thrill; eating a sweet dessert offers a cheap thrill; surfing, skiing, and other sports offer a cheap thrill; sex offers a cheap thrill. What’s so bad about any of these things? What’s so bad about getting a cheap thrill? I don’t know, because life is full of such things. They offer the kind of fun that makes the icing on top of the cake of life. They are enriching in their own way.
Categorizing all drug use as misuse, and very normal drinking levels of “binge use” doesn’t help anyone. It can only increase hysteria. It can only raise doubts and fears in those who once had problems (a night of partying is recast as a risky binge or a relapse). I know of many former extremely heavy heroin users who now regularly smoke pot. Isn’t it great to stop using heroin and switch to pot? Your risk of overdose goes to zero in this case. Yet you’d still be considered to have a problem – to be a substance misuser.
These labels are just as useless with alcohol, and they infect the research. The US government released two similar epidemiological studies on alcoholism 10 years apart – NLAES in the 90s and NESARC in the 2000s. There were 3 categories of current drinking levels in NLAES: Drinking with Abuse or Dependence, Abstinent, or Drinking Without Abuse or Dependence. Presented in this way, the results were shocking to what most people believe about alcoholics. 50% were in the “Drinking Without Abuse or Dependence” category. That is, 50% of former alcoholics became moderate drinkers.
In the later study, NESARC, the data was nearly identical, but presented differently. There were 5 categories instead of 3. The moderate drinking outcomes seemed to be split into two categories, “Low Risk Drinkers”, and the more ominous “Asymptomatic Risk Drinkers.” The criteria for “Asymptomatic Risk Drinkers” was, as I wrote in my analysis of NESARC:
“Asymptomatic Risk Drinkers” are those who didn’t have any symptoms of abuse or dependence, but drank at these levels: for men- drank more than 14 drinks per week on average or had 5 or more drinks in one day at least once in the past year. For women – drank more than 7 drinks per week on average or had 4 or more drinks on a single day in the past year. Notice that you don’t even have to drink every day or drink the 7 or 14 drinks per week, you can be considered an asymptomatic risk drinker in this study if you have one day of somewhat heavy drinking. So – pop open five beers over the course of a 4th of July picnic, or finish off a bottle of champagne on New Year’s Eve, and bingo, you’re an asymptomatic risk drinker.
My assumption on why these additional categories were added to a nearly identical study, is that it doesn’t make the data look so clear cut upon first read as the 3 simple categories in NLAES. When you have a Stanton Peele out there constantly citing the NLAES data to say that moderation is just as probable as abstinence, it hurts the cause of the treatment industry and the bureaucrats who thrive on regulating the treatment of an “incurable disease.” When you rhetorically change the outcomes by lopping off some part of that group and recharacterizing their positive change as something more ominous such as “asymptomatic risk drinking” it widens the group of who you can claim needs help. But in fact they need no help. Both “asymptomatic risk drinking,” and “binge drinking” are usually normal, harmless, life enriching activities. Let’s stop pathologizing partying.