ALCOHOL RESEARCH: C u r r e n t R e v i e w s

The Epidemiology of Binge

Drinking Among College-Age
Individuals in the United States
Heather Krieger, Chelsie M. Young, Amber M. Anthenien, and
Heather Krieger, M.A., is a Clayton Neighbors
graduate student; Chelsie M.
Young, Ph.D., is a post-doctoral Rates of alcohol consumption continue to be a concern, particularly for individuals
researcher; Amber M. Anthenien, who are college age. Drinking patterns have changed over time, with the frequency
M.S., is a graduate student; and of binge drinking (consuming four/five or more drinks for women/men) remaining
Clayton Neighbors, Ph.D., is a high (30% to 40%). Young adults in the college age range are developmentally and
socially at higher risk for drinking at binge levels. Changes in autonomy, parental
professor, all in the Department
control, norms, and attitudes affect binge drinking behaviors. This article reviews
of Psychology, University of those changes, as well as the individual and environmental factors that increase or
Houston, Houston, Texas. decrease the risk of participating in binge drinking behaviors. Risk factors include
risky drinking events (e.g., 21st birthdays), other substance use, and drinking to cope,
while protective factors include religious beliefs, low normative perceptions of drink-
ing, and use of protective behavioral strategies. Additionally, this article discusses
the physical, social, emotional, and cognitive consequences of consuming alcohol
at binge levels. Alcohol policies and prevention and intervention techniques need
to incorporate these factors to reduce experiences of alcohol-related problems. Tar-
geting policy changes and prevention and intervention efforts toward young adults
may increase effectiveness and prevent both short- and long-term consequences of
binge drinking.

Key words: Alcohol consumption; binge drinking; consequences; risk and protective
factors; young adults

Binge drinking, particularly among ity of the literature regarding binge tion of consumption. When individu-
college-age individuals, has been a sig- drinking focuses specifically on college als who met these binge drinking cri-
nificant topic of research for more students. Further, there is variability in teria had consumed the alcohol over a
than 20 years because of associations the definition of college students. long period of time, they did not reach
between greater quantity and fre- Some studies sampled only full-time BACs higher than .08%.2,3
quency of alcohol consumption and students from four-year institutions, In 2004, the National Institute
alcohol-related consequences. To iden- whereas other studies included part- on Alcohol Abuse and Alcoholism
tify factors associated with binge time and community college students. (NIAAA) provided a revised definition
drinking over time, several large-scale The term “binge drinking” has of binge drinking, acknowledging that
studies have assessed trends in binge a somewhat controversial history. consuming 5/4+ drinks in a 2-hour
drinking among young adults. This The term was originally defined by time period would result in a BAC
article aims to summarize those trends Wechsler and colleagues as five or of at least .08% for most individuals.
and the developmental and social fac- more drinks for men, or four or more Although subsequent questions con-
tors that impact the likelihood of, the drinks for women (5/4+), on a single tinue to be raised regarding the validity
risk and protective factors related to, occasion.1 Criticisms of this conceptu- of defining binge drinking at 5+ or
and the negative alcohol-related conse- alization of binge drinking were based 5/4+ on one occasion, these are still
quences of binge drinking behaviors. largely on the substantial variability in the most commonly used definitions
Some studies examined young adults blood alcohol concentrations (BACs) in the literature. Research covered in
who are not in college, but the major- due to differences in weight and dura- this review includes studies on binge

Binge Drinking Among College-Age Individuals | e1

drinking that use the 5/4+ criteria or a also attempted to assess student dents engaged in binge drinking in the
BAC of at least .08%. drinking rates. At 120 colleges, the previous 30 days (31.6% of females
CAS measured alcohol use among and 49.4% of males) than Hispanic
college students at four time points students (22.6% of females and 39.9%
Trends in Young Adult between 1993 and 2001.8 The survey of males).12 Also, African American
Binge Drinking Rates included more than 14,000 students students (6.1% of males) were less like-
and provided the first gender-specific ly to report binge drinking than White
Binge drinking among young adults measure of binge drinking (i.e., 5/4+ students (22.8% of males), although
has concerned researchers and educa- drinks for males/females). Contrary to this difference was less pronounced
tors for decades, prompting multiple findings from the MTF study and the among females.
national initiatives to track patterns in Core Alcohol and Drug Survey, the Rates of binge drinking have also
binge drinking. The longest continu- CAS found little change between 1993 been assessed in military samples.
ous running national survey of drug (43.2%) and 2001 (44.5%) in the Starting in 1980, the U.S. Department
and alcohol use among adolescents number of students reporting binge of Defense issued several large-scale,
and young adults is the Monitoring drinking in the previous 2 weeks.9 anonymous health surveys (most
the Future (MTF) study, which is The most recently initiated nation- recently called the Health Related
funded by the National Institute on wide survey of college student alcohol Behaviors Survey) to active-duty
Drug Abuse and conducted by the use is the National Epidemiologic military personnel, with the first as-
University of Michigan’s Institute Survey on Alcohol and Related sessment of binge drinking appearing
for Social Research.4 Approximately Conditions. This survey began the in 1998. Rates of binge drinking for
15,000 high school seniors in 133 first of three waves of data collection military personnel overall increased
schools are surveyed each year, and, in 2001, which included data from from 35% in 1998 to 47% in 2008.13
since 1976, a subset of about 2,400 approximately 43,000 individuals.10 The 2008 survey sampled more than
have been followed biennially by mail. Prevalence rates, only reported for 28,000 service members and found
Survey results indicate that the rate 2001, indicate that 57% of 18- to that young adult military personnel
of self-reported college student binge 24-year-olds binge drank in the previ- (ages 18 to 25) had the highest rates of
drinking in the previous 2 weeks ous year, and 40% binge drank 12 or frequent binge drinking (once a week
dropped from 1980 (44%) to 1993 more times in the previous year. or more) at 26%.14 This is significantly
(40%) and continued to decrease College attendance, gender, and higher than the rate for same-age ci-
through 2014 (35%). Estimates for ethnic variations in binge drinking vilians (16%), as reported in the 2007
college student engagement in extreme have been identified. A number of NSDUH.15 Rates of binge drinking
binge drinking, defined as consuming studies have examined differences in also differ by military branch.14
10 or more drinks on one occasion in alcohol use between college and same-
the previous 2 weeks, varied from 14% age noncollege peers, consistently
in 2005 to 20% in 2014. finding higher rates of heavy drinking Developmental and
Another national survey assessing and alcohol-related problems among Social Factors
college student binge drinking is the college students than among noncol-
Substance Abuse and Mental Health lege peers.11 The annual prevalence of Developmental and social factors
Services Administration’s (SAMHSA) alcohol use reported in the MTF study are important contributors to binge
National Survey on Drug Use and suggested small differences between drinking among college-age adults.
Health (NSDUH), which includes male and female drinking rates and The college-age years (approximately
yearly assessments of 60,000 to 70,000 modest decreases over time.4 However, ages 18 to 24) correspond with the
individuals ages 12 and older. Results a declining gender gap exists for binge developmental stage widely referred to
indicate that for young adults ages drinking rates, with female binge as “emerging adulthood.”16,17 Dramatic
18 to 25, rates of binge drinking in drinking (i.e., 4+) decreasing from cultural changes in the United States
the previous 30 days decreased slight- 31% in 1988 to 26% in 2014, and and other countries with similar so-
ly from 44.6% in 1988 to 37.7% male binge drinking (i.e., 5+) decreas- cioeconomic structures have occurred
in 2014.5 ing more substantially, from 52% to over time. Arnett notes that post–high
The Core Alcohol and Drug Survey 43%. school education rose from 14% in
sampled more than 140,000 students Currently, the MTF study does 1940 to more than 60% in the mid-
and found a slight decline in the not report racial or ethnic differenc- 1990s.16 College attendance has re-
percentage of students who binge es in binge drinking among college sulted in the delay of traditional adult
drank in the previous 2 weeks, from students. However, the U.S. Centers responsibilities. Consequently, in re-
45.9% in 2006 to 43.9% in 2013.6,7 for Disease Control and Prevention cent decades this developmental period
The College Alcohol Survey (CAS) reported that more White college stu- has become a time when individuals

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explore new freedoms and experiment changes in alcohol problems, attitudes age is not a strong predictor of norma-
with behaviors that were previously regarding heavy drinking, and heavy tive perceptions of drinking.
less accessible, including alcohol con- drinking or drug-using peers. The MTF study collected data (for
sumption.18,19 Interrelated factors associated with ages 18 to 30) on perceived close-
In their seminal paper, “Getting increased heavy drinking and alcohol- friend disapproval of respondents’
Drunk and Growing Up: Trajectories related problems include moving out binge drinking once or twice per
of Frequent Binge Drinking During of the parent home, going to college, weekend. Respondents ages 19 to 22
the Transition to Young Adulthood,” and decreased parental involvement, and 23 to 26 reported less disapproval
Schulenberg and colleagues identified each of which has a unique from their friends (54.5% and 52.3%,
five distinct trajectories of binge drink- contribution. Moving out of the respectively) relative to respondents
ing that occur in young adults ages 18 parent home contributed to the risk of ages 18 (65.6%) and ages 27 to 30
to 24.20 This analysis was one of the increased drinking, but additional risk (57.1%).4 Few studies have directly
first to use a national sample to identi- was found for students who lived on examined perceived norms and their
fy distinct patterns of changes in binge campus.21 White and colleagues found influence on college versus noncollege
drinking over time. The national sam- that living in a college environment young adult binge drinking, but the
ple included four consecutive waves contributed to increases in heavy available evidence suggests perceived
of data from the MTF study. More drinking more than all the other norms have less influence on noncol-
than 90% of the sample was catego- developmental factors they examined.22 lege young adults.31
rized as engaging in no binge drinking Further, although peer influences are Related to social norms, member-
during any wave (35.9%). Or, they paramount among college students, ship in specific groups has been associ-
were categorized as one of five binge one study found that parental ated with higher rates of binge drink-
drinking trajectories: involvement played a protective role ing. Foremost among these are college
in reducing the likelihood of problem fraternity or sorority affiliation,32-34
1. Rare (16.7%): binge drinking drinking.23 participation in collegiate athletics,35,36
during at least one wave but no For young adults ages 18 to 24, and being in the military, especially the
frequent binge drinking, defined as many of the factors attributed to high U.S. Army or U.S. Marines.14,37,38
two or more binge episodes in the rates of binge drinking are social in
past 2 weeks. nature. Perceptions and overestima-
2. Decreasing (11.7%): frequent tions of the prevalence and approval Risk and Protective Factors
binge drinking during Wave 1 and of heavy drinking among one’s peers
decreasing or no frequent binge have been consistently documented Person-level risk factors. Demo-
drinking by Wave 4. and associated with heavier drinking. graphic factors such as age, sex,
Reducing normative misperceptions and race have been linked to binge
3. Fling (9.9%): frequent binge drink- has been the most consistently sup- drinking rates among college students.
ing during Wave 2 or Wave 3 but ported brief intervention strategy for Individuals who began drinking
no binge drinking in Wave 1 or reducing heavy drinking among young before age 16 were found to be more
Wave 4. adults. Most studies that successfully likely to binge drink in college.39 An
4. Increasing (9.5%): no frequent used such interventions to reduce per- examination of MTF data found that,
binge drinking during Wave 1 in- ceived norms also demonstrated reduc- among recent cohorts, individuals
creasing to frequent binge drinking tions in drinking.24-28 entering the 18 to 26 age range
by Wave 4. The vast majority of research on reported less binge drinking than
the influence of social norms on previous cohorts, and individuals
5. Chronic (6.7%): frequent binge
heavy drinking has been done using leaving the 18 to 26 age range reported
drinking throughout Waves 1, 2, 3, more binge drinking than previous
college samples. Similar results have
and 4. cohorts.40 Several longitudinal studies
been found in the general adult pop-
Most young adults reported binge ulation, with heavy drinkers more found that male college students were
drinking during at least one of the four likely to view heavy drinking as nor- more likely than female students to
assessment waves, but less than half of mative and to overestimate drinking binge drink.41,42 Also, studies have
the sample drank at rates that could norms.29 In a large general population shown that White college students
be considered problematic.20 Young study of adults who drank alcohol were more likely to engage in binge
adults in the Increasing and Chronic at least monthly (N = 14,009), age drinking than non-White students.39,43
categories were identified as having the was negatively associated with nor- Personality traits and individual
most difficulty navigating the transi- mative misperceptions of drinking.30 difference variables have also been
tion to adulthood. Identified trajecto- However, the magnitude of the cor- identified as risk factors for binge
ries were associated with stability and relation was only .07, suggesting that drinking. A longitudinal investigation

Binge Drinking Among College-Age Individuals | e3

using MTF data from 18- to 24-year- in binge drinking at an earlier age binge drinking have been identified.
olds found that individuals lower in during young adulthood.46 Gender is one of these factors. Females
self-efficacy had a greater likelihood of In conclusion, several consistent risk tend to drink less than males.62 Also,
engaging in binge drinking over time.42 factors for binge drinking have been females and individuals with higher
Similarly, another longitudinal study identified, including early onset of grade point averages tend to use
among adults ages 18 to 31 found that, alcohol use, being male, identifying as more protective behavioral strategies,
across time points, problem drinkers White, having low self-efficacy, scoring such as alternating drinking alcohol
scored higher on disinhibition.41 high on disinhibition, scoring high and water.63 Protective behavioral
Binge drinking also has been on neuroticism-anxiety (for women), strategies have been shown to reduce
positively correlated with neuroticism- being impulsive and sensation-seeking the likelihood of experiencing negative
anxiety and impulsive sensation- (especially for men), having higher alcohol-related consequences.62,64
seeking. In particular, one study found scores on antisocial personality disor- Protective contexts and events.
that women who engaged in binge der measures, using alcohol to cope Certain cultural climates that promote
drinking tended to score higher on or fit in with others, using alcohol for a normative perception of disapproval
neuroticism-anxiety, and men who sex-seeking purposes, drinking to get toward excessive drinking can protect
engaged in binge drinking were more drunk, exhibiting problem behavior, their adherents against binge drinking.
likely to score highly on impulsivity scoring low on depression, and engag- For example, parental disapproval
and sensation-seeking.44 Another study ing in other substance use. of alcohol use protects against binge
found that binge drinkers tended to Risky contexts and events. Specific drinking.39,61 Many religions disap-
be less conscientious and more thrill- events and contexts that promote prove of drinking heavily and promote
seeking than those who did not engage heavy drinking are additional factors drinking only in moderation or ban
in binge drinking.45 Also, individuals that contribute to high rates of binge drinking among members altogether.
who scored higher on measures drinking. Such events include New As such, religion can exert a protective
of antisocial personality disorder Year’s Eve, St. Patrick’s Day, and influence on college student binge
were more likely to engage in binge Halloween.47,48 Some high-risk drink- drinking.61,65 Neighborhood norms
drinking.46 ing events tend to be more prevalent in against heavy drinking have also
young adulthood. For example, home- been found to protect against binge
Other studies report that motiva-
coming, athletic events, weddings, and drinking.66
tions for drinking and attitudes toward
graduations are all relatively common College environments tend to en-
drinking can influence the likelihood events for people in this age range and courage heavy drinking; however,
of binge drinking. Drinking to cope have been associated with heavy drink- some contextual factors surrounding
with negative affect and drinking to fit ing.49,50 In addition, 21st birthdays,51 students can protect against binge
in with peers have both been associated spring break,48 football tailgating,52 drinking and negative alcohol-related
with binge drinking.45 Sex-seeking as pregame partying,53-55 and drinking consequences. Drinking in college is
a motivation for drinking has been games56,57 have all been associated with often a social activity among friends.
associated with binge drinking among excessive drinking among college stu- Close friends who encourage safe
college men.45 Individuals who report- dents. For undergraduates, weekends drinking can help protect against the
ed drinking alcohol for the purpose of and the beginning of a semester have negative consequences of excessive
getting drunk were also more likely to been associated with higher levels of drinking.67 College drinking that oc-
engage in binge drinking.42 Positive at- drinking.47,49 curs in locations that provide food and
titudes toward drinking have also been Social influences, often from close water or that accompanies a meal has
associated with an increased likelihood relationships, can contribute to in- been shown to reduce negative alcohol
of binge drinking among college creased risk of binge drinking among consequences.68 Additionally, drinking
students.39 college students. For example, having that occurs in bars is somewhat regu-
Problem behaviors and other sub- parents who are alcoholics, having lated, because bartenders can stop serv-
stance use also have been associated friends who drink, and participating in ing individuals who appear drunk.69
with binge drinking. For example, Greek life have all been associated with These specific college drinking contexts
one longitudinal study found that, a greater likelihood of binge drink- allow for use of protective behavioral
across ages 18 to 31, heavy drinkers ing.46,58-60 Also, peer drinking and use strategies, such as eating food, drinking
were more likely to exhibit problem of cigarettes and marijuana have been water, limiting the number of drinks
behavior.41 A longitudinal examination associated with an increased likelihood consumed, and drinking with close
of trajectories of binge drinking found of binge drinking.61 friends.62
that adolescents who reported using Person-level protective factors. Other factors specific to certain col-
drugs and scored low on measures of Several protective factors associated leges have been associated with lower
depression were more likely to engage with a lower likelihood of engaging in rates of binge drinking. For instance,

e4 | Vol. 39, No. 1 Alcohol Research: C u r r e n t Reviews

college students who attended schools Consequences of lowing a binge drinking episode than
with higher social capital (defined as Binge Drinking a nonbinge episode.1 Few longitudinal
the average time students spent vol- studies have examined associations
unteering) were less likely to engage Overall, binge drinking and frequent between emotions and binge drinking;
in binge drinking.70 Furthermore, binge drinking have been consistently, however, frequent binge drinking in
research has suggested that attending significantly, and positively associated young adulthood has been found to
commuter schools, all-female colleges, with alcohol-related problems.78,79 increase risk for depression 5 years
and Protestant religious colleges is These problems impact multiple later.88
associated with lower rates of binge aspects of life for young adults and Social outcomes related to binge
drinking.39 the people around them and include drinking often involve negative
Certain social roles and their inher- physical, legal, emotional, social, and interpersonal interactions and failure
ent responsibilities can lead to lower cognitive consequences, as well as an to meet relational obligations. When
likelihood of binge drinking. For increased likelihood of having an alco- compared to infrequent and non–
example, studies have found that co- hol use disorder. binge drinkers, frequent binge drinkers
habitation, getting married, and hav- Physical and legal outcomes. Binge are twice as likely to experience
ing children all protect against heavy drinking is associated with significant interpersonal consequences, including
drinking.71-75 increased risk for experiencing con- arguing with friends,1 experiencing
Alcohol-related laws and policies sequences, including physical harm, strain on relationships,89 and getting
and their connections to the likelihood legal problems, and failure to meet role into physical fights.38 Binge drinkers
of binge drinking have been examined. obligations (e.g., work responsibilities). in college were two to three times as
Plunk, Cavazos-Rehg, Bierut, and Active-duty military personnel who likely to miss class and twice as likely
Grucza found that more permissive binge drink are about five times as to perform poorly or get behind on
laws regarding the minimum legal likely to report drinking and driving schoolwork.1,80 Among active-duty
drinking age were associated with or riding with someone who has been military personnel, frequent binge
more binge drinking.76 Using MTF drinking.38 College students who binge drinking was associated with failure to
data collected from 1976 to 2011 drank in the previous year were more be promoted and substandard work
than twice as likely to be taken advan- performance.38
from high school seniors who were
tage of sexually or have unplanned sex, Cognitive outcomes. Binge drink-
followed up to age 26, Jager, Keyes,
and they were four times as likely to be ing results in high concentrations
and Schulenberg found that laws dic- of alcohol entering the bloodstream
physically injured.80 Additionally, indi-
tating the minimum legal drinking age quickly, which can affect cognitive
viduals who engaged in frequent binge
were associated with decreases in binge drinking reported experiencing more processing. One of the most prevalent
drinking for 18-year-olds, but those sick days and having poorer overall cognitive effects of binge drinking
laws were associated with increases in physical and mental health than non– is blacking out, a failure to encode
binge drinking rates across all male binge drinkers.81 Binge drinkers also memories. Frequent binge drinkers
participants ages 18 to 22.40 Another reported having greater sleep prob- are twice as likely as infrequent binge
study found that lower age require- lems, including having more trouble drinkers to experience blackouts.1
ments for purchasing and consuming falling asleep and staying asleep than Several studies reported that the con-
alcohol were associated with more those who did not binge drink.82 Binge sumption of alcohol at binge levels was
hazardous and problematic drinking. drinking also increases an individual’s associated with poor performance on
These findings have clear implications likelihood of driving after drinking.80,83 cognitive tasks, such as recall, spatial
for alcohol policy.76 Emotional and social outcomes. recognition, search, and planning
Another study investigated whether Binge drinking has been associated tasks.86,90-92 Also, gender differences in
personal endorsement of alcohol poli- with a variety of negative emotional cognitive function have been noted,
cies was associated with college student and social outcomes. For exam- with women being more susceptible to
drinking. The authors found that col- ple, binge drinkers tended to score the negative cognitive effects of binge
lege students who personally endorsed higher on measures of depression drinking.87,93
the alcohol laws and policies were and anxiety84-86 and reported lower Research suggests that binge
significantly less likely to binge drink.77 positive mood than nondrinkers.86,87 drinking affects the amygdala and
Thus, laws that set a minimum drink- Furthermore, students who binge prefrontal cortex, and that repeated
ing age or a low BAC level for drivers, drank in the previous year were more binge drinking can damage these brain
and personal endorsements of college than twice as likely to report having structures.94 One study reported that
alcohol policies, can serve as protective serious thoughts of suicide.80 Another extreme binge drinkers (those who
contextual factors against college stu- study reported that feelings of remorse consumed 10 or more drinks per occa-
dent binge drinking. after drinking were more common fol- sion) displayed electroencephalography

Binge Drinking Among College-Age Individuals | e5

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in binge drinking and related problems among
extreme binge drinking can alter the with increased or decreased risk for
American college students between 1993 and
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