Drinking patterns associated with heavy drinking carry with them potential for social and physiological harm (see ICAP Health Briefings). One such pattern, involving rapid heavy drinking to intoxication is extreme drinking, also referred to in the literature as “binge” or “heavy episodic” drinking.

Extreme drinking is characterized by:

• Intoxication: Excessive or heavy drinking and its physiological effects.
• Motivation: The clear presence of intent and a directed quest for some degree of altered state of consciousness or loss of control (albeit neither unbridled nor limitless).
• Process: Typically, a social and positive process in which the pursuit of pleasure and excitement goes beyond the boundaries or norms of usual social drinking within a given culture.
• Outcomes: Attention to drinking outcomes, both positive and negative.
• Alcohol Experience: The capacity for a "controlled loss of control," balanced with the development of so-called "alcohol maturity."

There has been a lack of consensus on the definition of other terms, such as “binge,” used to describe this drinking pattern.

• The clinical definition of "a binge" is characterized by the consumption of alcohol to intoxication, usually a solitary and self-destructive activity lasting up to several days and involving a loss of control.
• Epidemiological definitions have relied on measurements of quantity, setting the threshold at 5 or more drinks for men and 4 or more for women per occasion.

Other definitions have included:

The lack of specificity regarding the duration of an "occasion," and of the size, strength, or type of drinks involved may compromise the ability to apply this definition to actual drinking behavior (e.g., alcohol content of drinks varies, especially between international definitions of a "standard drink").

Aside from these unit-based definitions, other, less widely used definitions exist that rely on self-reported frequency of "feeling drunk" rather than on quantity of alcohol consumed.

Extreme drinking behavior is in large part shaped by cultural view on drinking and its role and meaning in society:

• Some cultures regard extreme drinking as an acceptable drinking pattern for men but not for women.
• Some cultures include rapid and heavy drinking episodes into rites of passage for young people.
• Extreme drinking may be associated with particular celebrations is some cultures but is otherwise absent from drinking occasions.
• Extreme drinking may represent a "time-out" from conventional behavior, often in association with celebrations and holidays (e.g., Mardi Gras, Fastnacht).

Whatever its cultural roots, extreme drinking contributes to health and social costs (see ICAP Health Briefings). It is of particular concern with regard to young people, but also occurs among adults.

Some of the health outcomes include:

• increased risk for stroke and other cardiovascular problems;
• during pregnancy, adverse effects on the health of the fetus;
• elevated risk for neurological damage.

Adverse social consequences include:

• impaired work performance and absenteeism from the workplace;
• impaired academic performance;
• increased risk of motor vehicle crashes;
• association with other risky behaviors, such as unprotected sexual activity.

Numerous prevention and policy measures are aimed at preventing or reducing the incidence of  extreme drinking.

These have focused on changing cultural attitudes toward drunkenness and making the drinking environment safer.

Initiatives include education, changing social norms around drinking, screening and brief interventions to reduce problems, and responsible hospitality measures to prevent extreme drinking and to reduce potential for harm.

See the ICAP Blue Book for examples of interventions implemented internationally.

• 1/2 bottle of spirits or 2 bottles of wine on the same occasion (Sweden);
• 6+ drinks per occasion for women / 8+ drinks per occasion for men (U.K.);
• 6+ bottles of beer per session (Finland);
• blood alcohol concentration (BAC) raised to 0.08g/ml or above (U.S. NIAAA).