Binge Drinking, Other Substance Use, and Concurrent Use in the U.S., 2016–2018


      The use of multiple substances heightens the risk of overdose. Multiple substances, including alcohol, are commonly found among people who experience overdose-related mortality. However, the associations between alcohol use and the use of a range of other substances are often not assessed. Therefore, this study examines the associations between drinking patterns (e.g., binge drinking) and other substance use in the U.S., the concurrent use of alcohol and prescription drug misuse, and how other substance use varies by binge-drinking frequency.


      Past 30–day alcohol and other substance use data from the 2016–2018 National Survey on Drug Use and Health were analyzed in 2020 among 169,486 U.S. respondents aged ≥12 years.


      The prevalence of other substance use ranged from 6.0% (nondrinkers) to 24.1% (binge drinkers). Among people who used substances, 22.2% of binge drinkers reported using substances in 2 additional substance categories. Binge drinking was associated with 4.2 (95% CI=3.9, 4.4) greater adjusted odds of other substance use than nondrinking. Binge drinkers were twice as likely to report concurrent prescription drug misuse while drinking as nonbinge drinkers. The prevalence of substance use increased with binge-drinking frequency.


      Binge drinking was associated with other substance use and concurrent prescription drug misuse while drinking. These findings can guide the implementation of a comprehensive approach to prevent binge drinking, substance misuse, and overdoses. This might include population-level strategies recommended by the Community Preventive Services Task Force to prevent binge drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density).
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        • Wilson N
        • Kariisa M
        • Seth P
        • Smith 4th, H
        • Davis NL
        Drug and opioid-involved overdose deaths - United States, 2017-2018.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 290-297
        • Gladden RM
        • O'Donnell J
        • Mattson CL
        • Seth P
        Changes in opioid-involved overdose deaths by opioid type and presence of benzodiazepines, cocaine, and methamphetamine - 25 States, July-December 2017 to January-June 2018.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 737-744
        • Jones CM
        • Einstein EB
        • Compton WM
        Changes in synthetic opioid involvement in drug overdose deaths in the United States, 2010-2016.
        JAMA. 2018; 319: 1819-1821
        • Tori ME
        • LaRochelle MR
        • Naimi TS
        Association of alcohol and benzodiazepine co-involvement with opioid overdose deaths in the United States, 1999-2017.
        JAMA Netw Open. 2020; 3e202361
        • Lyons RM
        • Yule AM
        • Schiff D
        • Bagley SM
        • Wilens TE
        Risk factors for drug overdose in young people: a systematic review of the literature.
        J Child Adolesc Psychopharmacol. 2019; 29: 487-497
        • Singh AK
        Alcohol interaction with cocaine, methamphetamine, opioids, nicotine, cannabis, and γ-hydroxybutyric acid.
        Biomedicines. 2019; 7: 16
        • Geller AI
        • Dowell D
        • Lovegrove MC
        • et al.
        U.S. emergency department visits resulting from nonmedical use of pharmaceuticals, 2016.
        Am J Prev Med. 2019; 56: 639-647
        • Esser MB
        • Guy Jr, GP
        • Zhang K
        • Brewer RD
        Binge drinking and prescription opioid misuse in the U.S., 2012-2014.
        Am J Prev Med. 2019; 57: 197-208
        • Han BH
        • Moore AA
        • Sherman SE
        • Palamar JJ
        Prevalence and correlates of binge drinking among older adults with multimorbidity.
        Drug Alcohol Depend. 2018; 187: 48-54
        • McCabe SE
        • Veliz P
        • Patrick ME
        High-intensity drinking and nonmedical use of prescription drugs: results from a national survey of 12th grade students.
        Drug Alcohol Depend. 2017; 178: 372-379
        • Connell CM
        • Gilreath TD
        • Hansen NB
        A multiprocess latent class analysis of the co-occurrence of substance use and sexual risk behavior among adolescents.
        J Stud Alcohol Drugs. 2009; 70: 943-951
        • Choenni V
        • Hammink A
        • van de Mheen D
        Association between substance use and the perpetration of family violence in industrialized countries: a systematic review.
        Trauma Violence Abuse. 2017; 18: 37-50
        • Mansoor K
        • Kheetan M
        • Shahnawaz S
        • et al.
        Systematic review of nephrotoxicity of drugs of abuse, 2005-2016.
        BMC Nephrol. 2017; 18: 379
        • DuPont RL
        • Han B
        • Shea CL
        • Madras BK
        Drug use among youth: national survey data support a common liability of all drug use.
        Prev Med. 2018; 113: 68-73
        • Jarlenski M
        • Barry CL
        • Gollust S
        • Graves AJ
        • Kennedy-Hendricks A
        • Kozhimannil K
        Polysubstance use among U.S. women of reproductive age who use opioids for nonmedical reasons.
        Am J Public Health. 2017; 107: 1308-1310
        • Cicero TJ
        • Ellis MS
        • Kasper ZA
        Polysubstance use: a broader understanding of substance use during the opioid crisis.
        Am J Public Health. 2020; 110: 244-250
        • Substance Abuse and Mental Health Services Administration
        2018 National Survey on Drug Use and Health: methodological summary and definitions.
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD2019 (Published August 20)
        • Klein R
        • Schoenborn CA
        Age adjustment using the 2000 projected U.S. population.
        Healthy People Stat Notes. 2001; : 1-10
        • Saunders KW
        • Von Korff M
        • Campbell CI
        • et al.
        Concurrent use of alcohol and sedatives among persons prescribed chronic opioid therapy: prevalence and risk factors.
        J Pain. 2012; 13: 266-275
        • Winstanley EL
        • Stover AN
        • Feinberg J
        Concurrent alcohol and opioid use among harm reduction clients.
        Addict Behav. 2020; 100106027
        • Subbaraman MS
        • Kerr WC
        Simultaneous versus concurrent use of alcohol and cannabis in the National Alcohol Survey.
        Alcohol Clin Exp Res. 2015; 39: 872-879
        • National Academies of Sciences Engineering and Medicine
        The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.
        The National Academies Press, Washington, DC2017
        • Stahre MA
        • Brewer RD
        • Fonseca VP
        • Naimi TS
        Binge drinking among U.S. active-duty military personnel.
        Am J Prev Med. 2009; 36: 208-217
        • Doran KM
        • Rahai N
        • McCormack RP
        • et al.
        Substance use and homelessness among emergency department patients.
        Drug Alcohol Depend. 2018; 188: 328-333
        • Elder RW
        • Lawrence B
        • Ferguson A
        • et al.
        The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms.
        Am J Prev Med. 2010; 38: 217-229
        • Campbell CA
        • Hahn RA
        • Elder R
        • et al.
        The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms.
        Am J Prev Med. 2009; 37: 556-569
        • Nelson DE
        • Naimi TS
        • Brewer RD
        • Nelson HA
        State alcohol-use estimates among youth and adults, 1993-2005.
        Am J Prev Med. 2009; 36: 218-224
        • Jones CM
        • Clayton HB
        • Deputy NP
        • et al.
        Prescription opioid misuse and use of alcohol and other substances among high school students - Youth Risk Behavior Survey, United States, 2019.
        MMWR Suppl. 2020; 69: 38-46
        • Xuan Z
        • Blanchette JG
        • Nelson TF
        • et al.
        Youth drinking in the United States: relationships with alcohol policies and adult drinking.
        Pediatrics. 2015; 136: 18-27
        • Blanchette JG
        • Lira MC
        • Heeren TC
        • Naimi TS
        Alcohol policies in U.S. states, 1999-2018.
        J Stud Alcohol Drugs. 2020; 81: 58-67
        • Dowell D
        • Haegerich TM
        • Chou R
        CDC guideline for prescribing opioids for chronic pain - United States, 2016 [published correction appears in MMWR Recomm Rep. 2016;65(11):295].
        MMWR Recomm Rep. 2016; 65: 1-49
        • Haegerich TM
        • Jones CM
        • Cote PO
        • Robinson A
        • Ross L
        Evidence for state, community and systems-level prevention strategies to address the opioid crisis.
        Drug Alcohol Depend. 2019; 204107563
        • Curry SJ
        • Krist AH
        • U.S. Preventive Services Task Force
        et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: U.S. Preventive Services Task Force recommendation statement.
        JAMA. 2018; 320: 1899-1909
        • Tansil KA
        • Esser MB
        • Sandhu P
        • et al.
        Alcohol electronic screening and brief intervention: a Community Guide systematic review.
        Am J Prev Med. 2016; 51: 801-811
        • Centers for Disease Control and Prevention
        • National Center for Injury Prevention and Control
        • Published July 11
        Alcohol screening and brief intervention for people who consume alcohol and use opioids.
        Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA2018
        • Khan MR
        • Young KE
        • Caniglia EC
        • et al.
        Association of alcohol screening scores with adverse mental health conditions and substance use among U.S. adults.
        JAMA Netw Open. 2020; 3e200895
        • Esser MB
        • Sherk A
        • Liu Y
        • et al.
        Deaths and years of potential life lost due to excessive alcohol use - United States, 2011-2015.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1428-1433