Popular media accounts are strewn with information regarding the pros of moderate alcohol consumption, such as reducing risks associated with coronary heart disease or type 2 diabetes, and the cons of alcohol over-consumption, such as increasing the risks associated with certain types of cancer or high blood pressure. While debates still linger about the risks and benefits associated with alcohol consumption, it has been generally agreed upon that drinking alcohol in moderation—such as one alcoholic drink per day—poses little overall health risk for most healthy adults.

However, for some, the occasional drink becomes more frequent and excessive, progressing to what has been termed “heavy drinking,” which may potentially serve as a precursor to more serious alcohol problems. Excessive alcohol consumption, presenting in the form of either binge drinking or heavy drinking, or more serious forms, such as alcohol abuse, can affect a person’s life in a myriad of ways—friend and family relationships, employment, as well as health characteristics. Due to alcohol’s reach into the many facets of society, the public health community as well as the medical community have, together, taken on the task of addressing alcohol usage and misusage, through the efforts of surveillance, screening tools, and interventions. For example, one effective strategy to ameliorate the effects of alcohol over-consumption is the use of a diagnostic alcohol-screening tool, which can lead to appropriate referrals for treatment.

In recognition of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) September campaign, National Alcohol and Drug Addiction Recovery Month, the following article explores the characteristics of heavy drinking among adults (age 18 and older) in Southeastern Pennsylvania (SEPA) using data from PHMC’s most recent 2004 Household Health Survey. Relying on the category established by SAMHSA’s National Survey on Drug Use and Health, this analysis defines heavy drinking as consuming five or more alcoholic drinks on the same occasion for five or more days in the past month.

Alcohol Usage and Heavy Drinking: Demographic Characteristics

In Southeastern Pennsylvania, over two-fifths of adults (45.3%) report that they did not consume more than one alcoholic drink in the past month, a group largely composed of women (60.6%). However, more than one-in-twenty adults in the region (5.7%) are considered heavy drinkers, a percentage that has increased from 2000 (4.4%).

· Heavy drinkers are younger than non-heavy drinkers, with a median age of 33 years compared to 46 years, respectively.

· The heavy consumption of alcohol is subject to underreporting among adults of all age groups, especially among young adults. Nearly one-in-ten heavy drinkers (9.1%) are between the ages of 18 and 20 years. The distribution of heavy alcohol consumption peaks among adults between the ages of 21 and 29 years (34.5%), but then declines with increasing age (Figure 1).

· Nearly three-quarters of heavy drinkers (73.0%) are men, representing 122,163 adult men in the region. In addition, three-quarters of heavy drinkers (75.5%) are white adults, 17.6% are African-American adults, 3.9% are Latino adults, and 2.6% are Asian adults. And among heavy drinkers, nearly three-quarters (72.8%) are employed, either full- or part-time.

Heavy Drinking: Health Status, Access to Care, and Insurance Status

· While the majority of heavy drinkers in SEPA report excellent or good health, 15.5% indicate that they are in fair or poor health, representing 25,989 adults in the region; this percentage is lower than among non-heavy drinkers (19.1%).

· One-in-seven heavy drinkers (14.6%) have a chronic health condition, compared to one-quarter (24.9%) of non-heavy drinkers.

· Approximately one-quarter of heavy drinkers (22.3%) do not have a regular source of care, compared to 10.7% of non-heavy drinkers. In fact, when controlling for age, heavy drinkers remain more likely than non-heavy drinkers, in each age group, to not have a regular source of care.

· Moreover, 15.9% of heavy drinkers are without health insurance, compared to 6.9% of non-heavy drinkers. An additional 15.4% of heavy drinkers, who are currently insured, did not have health insurance coverage at some point in the past year, compared to 6.4% of non-heavy drinkers.

Heavy Drinking: Behavioral Characteristics

As noted above, heavy drinkers are younger than non-heavy drinkers, which may affect certain behaviors, such as cigarette smoking patterns. However, even when controlling for age, heavy drinkers remain more likely, and in some cases, twice as likely, as non-heavy drinkers to participate in high-risk behaviors.

· Nearly two-fifths of heavy drinkers (38.8%) smoke cigarettes every day, compared to 15.4% of non-heavy drinkers; additionally, 13.6% of heavy drinkers smoke cigarettes some days, compared to 5.2% of non-heavy drinkers (Figure 2). Among 18- to 20-year olds, 43.2% of heavy drinkers smoke cigarettes every day, compared to 13.3% of non-heavy drinkers.

· Four times as many heavy drinkers (12.2%) currently use tobacco products other than cigarettes, such as cigars, pipes, or chew tobacco, as non-heavy drinkers (3.1%). Among 21- to 29-year olds, one-in-ten heavy drinkers (11.1%) currently use other tobacco products, compared to 3.6% of non-heavy drinkers.

· Heavy drinkers (30.1%) are more likely to rate their stress levels as high over the past year than non-heavy drinkers (22.8%). Among 40- to 49-year olds, 35.6% of heavy drinkers experienced high levels of stress in the past year, compared to 28.7% of non-heavy drinkers.

· Heavy drinkers (12.3%) are four times as likely to report being subjected to an act of physical violence in the past year as non-heavy drinkers (3.4%). Among 21- to 29-year olds, 17.6% of heavy drinkers were subjected to violence in the past year, compared to 8.5% of non-heavy drinkers.

The above findings reveal that heavy drinkers are less likely than their non-heavy drinking counterparts to have a regular source of care or to have health insurance coverage. And while heavy drinkers are younger in age than non-heavy drinkers, and therefore, may have fewer health conditions in general, nevertheless, they are not regularly accessing the necessary health care services crucial to maintaining proper health. Additionally, even when controlling for age, heavy drinkers are more likely than their non-heavy drinking counterparts to engage in behaviors that are not advantageous to good health. Regardless of age, heavy drinkers are more likely than non-heavy drinkers to smoke cigarettes every day, experience high levels of stress, or have been subjected to an act of violence in the past year. Prolonged over-consumption of alcohol place adults at greater risk of developing conditions later in life, which can be either chronic or acute in nature, making early detection and intervention vital. For further information on this article, please contact Nicole Dreisbach at nicoled@phmc.org. To conduct further analyses of heavy drinkers, please refer to the drinker problem variable, “drinkpro.” For further information on alcohol usage, please visit the following links: Center for Substance Abuse Treatment http://www.samhsa.gov/centers/csat2002/csat_frame.html; National Clearinghouse for Alcohol and Drug Information http://www.health.org; National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov.

References:
Enoch M-A and Goldman D. “Problem Drinking and Alcoholism: Diagnosis and Treatment.” American Family Physician 2002:441-448.

Harvard School of Public Health. “Nutrition Source: Alcohol.” Available at: http://www.hsph.harvard.edu/nutritionsource/alcohol.html. Accessed September 2005.