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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
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
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