DRUNKOREXIA AND BINGE DRINKING

Dr Rita Santacroce

Cattedra di PsichiatriaUniversità “G.d’Annunzio” Chieti

Dipartiment of Pharmacy, Pharmacology and Clinical Sciences, University of Hertfordshire

Theterm“drunkorexia”hasbeenproposedbyajournalistofthe“NewYorkTimes” (2008)

Only inrecent years it has been investigated inacademic studies.

HISTORY

DEFINITION

Drunkorexia: anew,abnormalanddangerouseatinghabit,prevalentamongadolescents.

Restrictedeating,untilfasting,tobeabletointakelargeamountsofalcohol.

Thechoiceoffasting isrelatedtoboththepossibilityofdrinkingfreely,withoutworryingaboutthecalories,andtoenjoymorethe

intoxicatingeffectsofalcoholPurging,increased physical activity,self-induced vomiting to

compensateplanned over-drinking have been reported inyoungadults

Piazza-GardnerAK,BarryAE.Appropriateterminologyforthealcohol,eating,andphysicalactivityrelationship.JAmCollHealth.2013;61(5):311-313BlackmoreN.P.,Gleaves D.H.,“Self-inducedvomitingafterdrinkingalcohol”,inInternationalJournalofMentalHealthandAddiction,2013,11(4):453-457.Lupi Metal.“Drunkorexia”:apilotstudyinanitalian sample.ResearchandAdvancesinPsychiatry2015,2(1):28-32

ALCOHOL:CALORICISSUES

BenendenHealth:https://www.benenden.co.uk/healthier-you/christmas-health/how-to-measure-your-alcohol-units/

ALCOPOPSISSUE

• dangerousinhighdoses• containupto15% alcoholdespite

verylittlealcoholictaste• alargenumberofoverashort

periodbeforefeelingtheeffects• highappealforyoungdrinkers• often advertised inwaysthatmake

themappeartobeharmlesssodadrinks

Report2015.Available onlineat:http://www.ukhealthforum.org.uk/prevention/pie/?entryid43=54505

• Despitemedicalprofessionalsrecommendingmendrink6– 8unitsofalcoholperweek,andwomen4– 6units

• ‘Mr Average’drinksaround13.6 unitsperweek

• ‘Mrs Average’intakeof8.4unitsperweek

AlcoolinItalia• Nel2014,il63%dellapopolazionedi11anniepiùhaconsumatoalmenouna

bevandaalcolicanell’anno• Trail2005eil2014aumentalaquotadiquanticonsumanoalcol

occasionalmente(dal38,6%al41%)equelladicolorochebevonoalcolicifuoridaipasti (dal25,7%al26,9%).

• Nel2014,bevevinoil50,5%dellapopolazionedi11anniepiùchehaconsumatoalcolicinell’anno, mentreil45,1%consumabirraeil39,9%aperitivialcolici,amari,superalcolici oliquori

• Ilconsumononmoderatodapartedeigenitoriinfluenzailcomportamentodeifigli.Il22,8%deiragazzidi11-17annichevivonoinfamigliedovealmenoungenitorehaunconsumodialcolcheeccedeleraccomandazioniha anch’esso abitudini alcoliche nonmoderate(18,7%traigiovanichevivonocongenitoriastemiochebevonoinmaniera moderata)

• Consumanoalcolquasiottouominisudiecicontrocircacinquedonneognidieci

AlcoolinItalia

Ilconsumodialcolgiornalierodiminuisceall’aumentaredeltitolodistudio

AlcoolfuoridaipastiinItalia• Riguardail43,2%dellapopolazionedi11anniepiù,chehaconsumatoalmenouna

bevandaalcolicanell’anno (invaloreassoluto14milionie649milapersone)• Circaunuomosudue(50,2%)eunadonnasutre(33,2%)• Ledifferenzedigenere sonorilevantifragliadulti, mentrerisultanomenoevidentitragli

adolescentieigiovaniunder24• Rispettoal2013laquotadeiconsumatoridialcolfuoripastopassada40,8%a43,2%;

Incrementiparticolarmentesignificativisiregistranofragliadulti25-44enni(da51,5%a54,6%).

• Alivelloterritoriale,laquotamaggioreinresidentinelNord-est,piùdiffusoneicomunifinoa10milaabitanti,increscitasiaalNordchealSud

• Laquotadichiconsumaalcolicifuoridalpastocresceconiltitolodistudio

BINGEDRINKING

• Theconsumptionof5ormoredrinksinsuccession(4ormoredrinksforwomen,inoneormoreoccasionsduringthepast2weeks

• TheNationalInstituteofAlcoholAbuseandAlcoholism(NIAAA),identifiesinsteadabingedrinkingbehaviour whenfiveormorealcoholicdrinks(fourormoreforwomen)areingestedonanyoccasion,atleastonceaweek

• definitionsdonotincludethetypeofalcoholicbeverage,orwhetheralcoholdependencecoexists:themainpurposeof“bingedrinkers”isinfactanimmediateintoxication,aswellasthelossofcontrol

WechslerH,NelsonTF.BingedrinkingandtheAmericancollegestudent:What’sfivedrinks?PsychologyofAddictiveBehaviors.2001;15:287-291NationalInstituteonAlcoholAbuseandAlcoholism.NIAAACouncilApprovesDefinitionofBingeDrinking,NIAAANewsletter,No.3.NationalInstituteonAlcoholAbuseandAlcoholism;Bethesda,MD:2004

BINGEDRINKINGEPISODE

• excessivealcoholconsumption• rapidalcoholintake• drinking withtheaimofgettingdrunk• upsettingofdailyactivities,friendships,relationships,familydynamics,becauseofthesubjectbeingfrequentlyfoggyandconfused

Lupietal.Drunkorexia:anemerging trendinyoung adults (2016).Insubmission at Am J AddWellmanRJetal.DeterminantsofSustainedBingeDrinkinginYoungAdults.Alcohol Clin Exp Res.2014Feb11.

BINGEDRINKINGINITALIA

• Consumoabitualeeccedentarioebinge drinking riguardano8milionie265milapersone(15,2%dellapopolazione)

• Preoccupantelafrequenzatragliultrasessantacinquenni,traigiovanidi18-24annietragliadolescentidi11-17anni

• Lapopolazionepiùarischioèquellagiovanile(18-24anni):il14,5%deigiovani(21%deimaschie7,6%dellefemmine)perlopiùdurantemomentidisocializzazione

• Considerando l’ultimo episodio di binge drinking,iluoghidovesieccededipiù:o casadiamicioparenti(41,8%)o bar,pubobirreria(27,4%)o ristorante,pizzeria,osteria(24,4%)o casapropria(23,8%)o discoteca/night(13,3%)o luoghi all’aperto o strada (4,7%)o altriluoghi,es.postididegustazioneovinoforum (3,2%)

Slide 15 of 21

•Rate/ContentofConsumption PeoplewhohaveafewdrinksinonehourhaveahigherBACthanpeoplewhodrinkthesameamountoverseveralhours;onelitre ofvodkaismorethanonelitre ofbeer!

Factors Affecting Blood Alcohol Concentration

• Gender MalesgenerallywillhavealowerBACthanfemales.

• BodySize Ingeneral,smallerpeople—byweightandheight—feeltheeffectsofalcoholmorethanlargerpeople.

•AmountofFoodintheStomach Drinkingonanemptystomachincreasestherateofalcoholabsorptionintothebloodstream.

BINGEDRINKINGINEUROPA

• OneinthreeEuropeanswhoconsumedalcoholwithinthepast30daysreportatleastoneepisodeofbingedrinkingperweek

• Youngpeople(18-26yearsold)representthesegmentofpopulationinwhichthedistributionofriskybehaviours ishigher(sex,drugs,dangerousactionsect)

• theconsumptionpatternmostcommonamongyoungpeopleseesahighprevalenceofbingedrinking(22.1%ofmalesand6.5%offemales),whichrepresentsalmostthetotaloftheoverallrisk

WellmanRJ,ContrerasGA,Dugas EN,O’Loughlin EK,O’Loughlin JL.DeterminantsofSustainedBingeDrinkinginYoungAdults.Alcohol Clin Exp Res.2014

BINGEDRINKINGWORLDWIDE• Onaverageeverypersonintheworldaged15yearsorolderdrinks6.2litres ofpure

alcoholperyear;consideringthatlessthanhalfthepopulation(38.3%)actuallydrinksalcohol,thismeansthatthosewhododrinkconsumeonaverage17litres ofpurealcoholannually

• ahigherpercentageofdeathsamongmen(7,6%)thanamongwomen(4%)arefromalcohol-relatedcauses

• worldwideabout16%ofdrinkersengageinBingeDrinking• Europeistheregionwiththehighestconsumptionofalcoholpercapita,withsome

ofitscountrieshavingparticularlyhighconsumptionrates

ReportGlobalStatusonAlcoholandHealth,WHO(2014)callsongovernmentstodomoretopreventalcohol-relateddeathsanddiseases

Globalstatusreportonalcoholandhealth–2014ed.

g/dL

Slide 20 of 21

• Progressiveloss of judgmentandself-control

Effects on Behavior

• Atthesametime,alcoholdecreases naturalfearsandinhibition(riskybehaviorsincreased)

• Ablackout isaperiodoftimethatthedrinkercannotrecall

Intoxication thestateinwhichaperson’smentalandphysicalabilitiesareimpairedbyalcoholoranothersubstance

•Il66.5%delcampioneerasolitomostrareunamodalitàdiconsumoalcolicoditipobinge,quasilatotalità(90%)delcampionecheriportavalapresenzadiusodialcolinmanieraabituale

•Nei30giorniprecedentiilbinge,il21%deisoggettiavevaintrapresounadietaperperderepeso,il2%avevavomitatoopresolassativi,il3%avevaeffettuatoeserciziofisicoinmanieracompulsiva

•Il32%delcampionehadichiaratodiaverridottol’introitodicalorieprimadiassumerealcolici.Questotipodicomportamentoèrisultatopiùdiffuso(p<0.01)neiconsumatoriabitualirispettoaquellioccasionali

GRAZIEPER

L’ATTENZIONE