High-intensity drinking (HID) is defined as drinking 10 or more alcoholic beverages in a row. HID is a major public health concern among young adults as 1 in 10 young adults report HID behaviors in the past 2 weeks. HID is also associated with a variety of short-term and long-term negative consequences including unintentional injuries and alcohol use disorder. Among those who report HID, the patterns of HID initiation and haste of escalation vary and may be different than those observed for binge drinking behaviors. This study examines characteristics associated with young adults’ initiation of HID and speed of escalation from initial drink and initial binge to first HID.  

The study’s sample consisted of 451 young adults who reported initiating HID by modal age 20. Participants were asked when they first tried an alcoholic beverage, when they first had more than 5 drinks in a row, and when they first had 10 or more drinks in a row. Alcohol use measures at age 20 years included typical weekly alcohol consumption, current HID frequency, and Alcohol Use Disorders Identification Test (AUDIT) scores. Participants were also asked to report family history of alcohol problems, college status, race/ethnicity, and sex. Data was analyzed using linear regression and negative binomial regression.  

Results of the data analysis showed mean weekly alcohol use was 9.2 drinks and mean HID frequency was 0.5 occurrences. Initiation of all three levels of alcohol consumption occurred between grades 9 and 12. Around 47% of participants initiated HID before 12th grade and the remaining participants initiated HID by the second year after high school. Additionally, the mean number of years between first drink and first HID was 1.9 and the mean number of years between first binge and first HID was 0.7.  Family history of alcohol problems was related to earlier initiation of HID and being a current college student was associated with later HID initiation. Lastly, HID initiation before 11th grade was associated with higher average weekly drinks reported at age 20 years and higher rate of past 2-week HID occasions at age 20 years.  

Takeaway: Among young adults, age of initiation of high intensity drinking (HID) and speed of escalation from first drink to HID may impact future alcohol use behaviors. 

Patrick, M.E., Evans-Polce, R.J., Arterberry, B.J., Terry-McElrath, Y.. Initiation of and Escalation to High-Intensity Drinking in Young Adults [published online ahead of print, 2023 Jan 30]. JAMA Pediatrics. 2023;10.1001/jamapediatrics.2022.5642. doi:10.1001/jamapediatrics.2022.5642