Binge drinking among students a new addictive disorder
Binge drinking among students: a new addictive disorder? Pierre Maurage 17 th October 2019
What’s on the menu ? - The context: Alcohol’s paradox. - The issue: Binge drinking among students. - The facts: Binge drinking cognitive/brain consequences. - The (potential) solutions: Societal, personal and clinical perspectives.
The context
On the one side: social overvalue of alcohol
On the other side: stigmatization of alcohol Pescosolido et al. , 2010; Schomerus et al. , 2012
One substance, two dimensions Alcohol as a social drug Alcohol as a lethal drug Binge drinking as a (normal) consequence of an (abnormal) social evaluation of alcohol.
The issue
Definition - Binge = Excess, dysregulation. - Qualitative: Drunkeness + consumption speed. - Quantitative: USA Onl y stu den ts? EUROPE in 2 h 1 X / month - Difference with alcohol-dependence. in 2 h 2 X / month
Binge drinking score: 3 questions (4 X Q 1) + Q 2 + (2 X Q 3) For the last 6 months: (4 X 2) + 8 + (2 X 4) 8 + 8 = 24 Example Q 1: Mean consumption speed (doses/hour) ? 2 Q 2: How many times drunk (last 6 months) ? 8 Q 3: 10 last drinking occasions: How many times drunk ? 4
Total ? >24: Intense binge drinker 16 -24: Moderate binge drinker <16: Non binge drinker
S. LANNOY Epidemiology % of participants Yes, students drink a lot. 0 Two questions 35, 5% 8, 4% 7, 6% 2 3 4 5 consumption 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Hazardous Harmful consumption Possible dependence 1 (1) Festive pleasure or addiction? (2) Is it really a problem? Lannoy & Maurage, 2016
Binge drinking: a festive pleasure? Questionnaire on drinking motivations: - Stimulation (e. g. « to feel euphoria/happiness » ) - Coping (e. g. « to forget my problems, to lessen my anxiety» ) - Social (e. g. « to party with my friends » ) - Conformity (e. g. « because my friends urge me to drink» ) A festive pleasure ? YES, particularly in its social dimension Lannoy et al. , 2019
Binge drinking: an addiction ? Impulsive system: Control system: Action initiation Action regulation Alcoholdependence Wiers et al. , 2010
Binge drinking: an addiction ? Imbalance already present in binge drinking ? REDUCED INHIBITION STRONG IMPULSE Underactivated Control system Overactivated impulse system
Binge drinking: an addiction ? Overactivated impulsive system among binge drinkers But. CHOOSE preserved control Alcohol-related expectancies 10 euros NOW Have fun now Alcohol-dependent Addiction ? patients NO, « controlled loss of control » 20 euros IN A WEEK So a harmless Study to get your festive pleasure? Refusal diploma in 5 years abilities Well, well… Oei & Morawska, 2004; Lannoy et al. , 2017
The facts
Short and long term consequences - Short term: Violence Unwanted/ regretted sex Neglected studies During the last year 8% 12% 44% + Reduced quality of life due to alcohol SLEEP - Long term: QUALITY FINANCIAL PROBLEMS SELF-ESTEEM NEGATIVE EMOTIONS Lannoy & Maurage, 2016 Dormal et al. , 2018 Bonomo et al. , 2004
Mid-term consequences ? But… (1) Young people drink a lot (2) Maturing brain (3) Repeated withdrawals « Vulnerability window » Gogtay et al. , 2004 Compton et al. , 2007 Sullivan & Pfefferbaum, 2005
Reduced cognitive abilities Neuropsychological studies Parada et al. , 2010; Sanhueza et al. , 2011; Lannoy et al. , 2019
Brain consequences of binge drinking First-year students Brain recording at 2 sessions Session 1 Session 2 « Light drinkers » 9 months Intense Binge drinkers Maurage et al. , 2009
Amplitude (µv) = Brain’s efficiency Lower amplitude: Reduced functioning Delayed latency: Slowing down Latency (ms) = Brain’s speed
Time 1 No group differences After only 9 months of binge drinking, brain functioning is SLOWED DOWN. Time 2 SLOWER brain functioning in binge drinking Maurage et al. , 2009; 2012
15 Total 10 30 -40 Quantity effect 20 5 Consumption pattern effect 3 20 0 0 Mon Tue Wed Thu Fri Sat Sun
Brain consequences of binge drinking Effect of: - The amount of alcohol : Low vs High binge drinkers - The way you drink it: Low binge drinkers vs daily drinkers Maurage et al. , 2012
Brain consequences of binge drinking Anger Compensation hypothesis. Fear %Fear 5% 20% 35% 50% 65% 80% 95% Activation Maurage et al. , 2013
To sum up… - Binge drinking alters brain activity. - Quantity AND consumption pattern effects. - Not a mere consequence of recent consumption. - These deficits appear very early (9 months of binge drinking) - And they will last for several years, affecting memory, attention, …
What we still don’t know - Causal relation between consumption and deficits - Influence of comorbidities (e. g. cannabis, drugs) - Reversibility of the deficits
The (potential) solutions
Social level: Ban alcohol advertising?
Social level: Increase prices?
Personal level: re-think «responsible drinking» ? « The health impact increases with consumption, and the consumption level minimizing health risks is ZERO » LESS IS BETTER ! Wood et al. , 2018
Clinical level: Develop new interventions - Change the key factors: motivations (and control) - Some clinical perspectives: - Motivational interviewing - Modifying social norms related to alcohol - Increasing assertiveness and self-esteem - Many available tools to work on drinking motivations - Need to individualize interventions Lannoy et al. , 2019
Conclusion - Binge drinking is largely Personal present levelstudents (and beyond). Clinical Socialamong level - Binge Should drinkerswe have: Why do alcohol? Should go beyond wewe banovervalue the alcohol classical advertising? focus on SAUD? (1) Strong consumption motives (2) A still quite preserved control on their consumption Can we without italcohol (for a while)? Should welive we consider increase binge drinkers prices as a (3) Long-term altered cognitive and brain functioning and/or (pre-)clinical reducepopulation? availability? - We can’t fight binge drinking without revisiting our social, personal and clinical relation with alcohol.
Conclusion A hard fight, but reducing binge drinking now is reducing alcohol-dependence in 20 -30 years. PLEASURE INITIATION AUTOMATICITY REPEATED CONSUMPTION CONTEXT ADDICTION
Thank you for your attention pierre. maurage@uclouvain. be My lab’s website: http: //www. uclep. be Laboratory for Experimental Psychopathology
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