Sexual identity differences in high-intensity binge
drinking: ﬁndings from a US national sample
Jessica N. Fish
, Tonda L. Hughes
& Stephen T. Russell
Population Research Center, Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
and School of Nursing, Columbia University,
New York, NY, USA
To estimate sexual identity differences in high-intensity binge drinking.
Design and setting
adult health survey from 2014 and 2015.
US adults aged 18 and older (n = 215 684; n = 203 562
heterosexual, n = 2784 lesbian/gay, n =2892bisexual,n =686‘other’ and n =1947don’t know/unsure).
Self-reported past 30-day standard binge and high-intensity binge drinking. Standard binge drinking
cut-off values were 4+/5+ drinks for women and men, respectively. High-intensity binge drinking was measured as two
and three times the standard level (8+ and 12+ drinks for women and 10+ and 15+ drinks for men).
and bisexual women were more likely than heterosexual women to report consuming 4+ drinks (adjusted odds ratio [aOR]
=1.57, conﬁdence interval [CI] = 1.18, 2.09 and aOR = 1.83, CI = 1.45, 2.30 for lesbian and bisexual women, respec-
tively); 8+ drinks (aOR = 3.86, CI = 2.39, 6.24, aOR = 2.07, CI = 1.39, 3.07); and 12+ drinks (aOR = 3.81, CI = 1.77,
8.19, aOR = 2.54, CI = 1.25, 5.14) on a single occasion in the past 30 days. Generally, gay and bisexual men were no more
likely than heterosexual men to report standard or high-intensity binge drinking. However, bisexual men were more likely
than heterosexual men to consume 15+ drinks (aOR = 1.76, 95% CI = 1.01, 3.06). Rates of standard and high-intensity
binge drinking were similar between heterosexual and unsure men and women. Men and women who indicated ‘other’
sexual identities were generally less likely than heterosexuals to report standard and high-intensity binge drinking, with
the exception of 4+ drinks for women and 10+ drinks for men.
In the United States, sexual minority
women are more likely, and sexual minority men are equally likely, to drink at standard and high-intensity binge drinking
levels as their heterosexual counterparts.
Keywords Alcohol, Behavioral Risk Factor Surveillance Survey, health disparities, heavy episodic drinking, high-
intensity binge drinking, LGB, sexual identity, sexual minorities, sexual minority.
Correspondence to: Jessica N. Fish, Population Research Center, Human Development and Family Sciences, University of Texas at Austin, 305 East 23rd Street,
Stop G1800, Austin, TX 78712, USA. E-mail: jessica.ﬁsh@utexas.edu
Submitted 22 May 2017; initial review completed 7 August 2017; ﬁnal version accepted 15 September 2017
There has been growing attention to the health status
and health behaviors of lesbian, gay and bisexual people
[1–3]. One area of concern is the disproportionate rate
of alcohol use among sexual minority youth and adults.
A robust and growing body of research indicates that
sexual minorities have an elevated risk across a variety
of alcohol-related behaviors, including early initiation
, frequency of use , heavy episodic drinking ,
alcohol-related problems  and alcohol use disorders
[8,9]. The studies documenting sexual orientation dis-
parities in alcohol use also typically ﬁnd larger differ-
ences between sexual minority and heterosexual
women than between sexual minority and heterosexual
Given its short- and long-term health consequences,
heavy episodic (binge) drinking is an important health risk
behavior [14–16]. Researchers have proposed recently
that the commonly used standard binge drinking measure
of 4+ drinks for women and 5+ drinks for men may mask
the prevalence and consequences of high-quantity alcohol
consumption [17–19]. A substantial proportion of binge
drinkers, particularly young adults, consume two or three
times the standard 4+/5+ binge drinking level [18–21].
Hingson and colleagues , for example, found that 8%
of US adults reported drinking at two times the standard
binge level and 3% reported drinking at three times the
© 2017 Society for the Study of Addiction Addiction, 113,749–758