High-Intensity Drinking Versus Heavy Episodic Drinking: Prevalence Rates and Relative Odds of Alcohol Use Disorder Across Adulthood

Abstract

Background: Heavy episodic drinking (HED) or consuming 4+/5+ drinks in 1 occasion for women/men is linked consistently with alcohol-related harms. Recent research suggests that many individuals drink at levels more than twice this cutoff (8+/10+ drinks), commonly referred to as "high-intensity drinking." Prevalence rates of high-intensity drinking and its dynamic association with alcohol use disorder (AUD) across all ages, however, remain unknown. The current study used data from a nationally representative sample to document age-varying prevalence rates of HED-only drinking and high-intensity drinking, prevalence rates of AUD for HED-only drinkers and high-intensity drinkers, and relative odds of experiencing an AUD for high-intensity drinkers as compared to HED-only drinkers.

Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III. The final analytic sample consisted of past-year drinkers aged 18 to 64 years (n = 22,776).

Results: Time-varying effect modeling revealed that high-intensity drinking and HED-only drinking were equally prevalent during young adulthood and prevalence rates of both types of drinking generally became less common with increasing age. At all ages, high-intensity drinkers were at 3 or more times greater odds of meeting criteria for an AUD than HED-only drinkers. The association between high-intensity relative to HED-only drinking was strongest earlier in adulthood with approximately 83% of 18-year-old high-intensity drinkers having AUD relative to 42% of HED-only drinkers.

Conclusions: Future research aiming to identify drinkers most at risk of harms and in need of treatment may benefit from assessing the extent to which an individual exceeds the 8+/10+ threshold of drinking.

Keywords: Alcohol Use Disorder; Heavy Episodic Drinking; High-Intensity Drinking; Time-Varying Effect Modeling; Young Adults.

Figure 1

Prevalence rates of heavy episodic drinking-only (HED-only) (gray line) and high-intensity (black line) drinkers by age among current drinkers overall (Figure 1a) and prevalence rates of alcohol use disorder (AUD) for HED-only (gray line) and high-intensity (black line) drinkers (Figure 1b). Dashed lines represent 95% confidence intervals. Models were estimated using intercept-only weighted time-varying effect models (TVEMs).

Figure 2

Age-varying odds ratio indicating the increase in odds of past-year alcohol use disorder among high-intensity compared to HED-only drinkers. Models were estimated using weighted time-varying effect modeling (TVEM). Dashed lines represent 95% confidence intervals.

Figure 3

Age-varying odds ratio indicating the increase in odds of past-year moderate to severe alcohol use disorder relative to mild alcohol use disorder among high-intensity compared to HED-only drinkers. Models were estimated using weighted time-varying effect modeling (TVEM). Dashed lines represent 95% confidence intervals.