ReviewAddiction (Abingdon, England)2016
Questioning the validity of the 4+/5+ binge or heavy drinking criterion in college and clinical populations.
Review in Addiction (Abingdon, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
58 citing papers in PubMed, 1 synthesis or guideline pooled it, 102 citations in OpenAlex.
- Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies.Drug and alcohol dependence · 2018Pooled it
- Prediction Rules Identify Which Young Adults Have Higher Rates of Heavy Episodic Drinking After Exposure to 12-Week Text Message Interventions.Substance use & addiction journal · 2024Trial
- Abstinence and low risk drinking during treatment: Association with psychosocial functioning, alcohol use, and alcohol problems 3 years following treatment.Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors · 2018Trial
- The search for an elusive cutoff remains: Problems of binary classification of heavy drinking as an endpoint for alcohol clinical trials.Drug and alcohol dependence · 2017Trial
- Finding success in failure: using latent profile analysis to examine heterogeneity in psychosocial functioning among heavy drinkers following treatment.Addiction (Abingdon, England) · 2016Trial
- Association between Adverse Childhood Experiences and Binge Drinking among Adults: The Moderating Effect of Race/Ethnicity.Journal of racial and ethnic health disparities · 2026Article
- Cannabis Use Among People Aged 65 and Older: Results From an Intercept Survey in New York City.Journal of the American Geriatrics Society · 2026Article
- Alcohol consumption dynamics and day-to-day experiences of alcohol-related problems: Combining transdermal alcohol concentration sensors and daily self-reports in young adults' natural settings.Experimental and clinical psychopharmacology · 2026Article
- The measurement of harm reduction goals and outcomes for substance use: Current state and future directions.Journal of prevention and health promotion · 2026Article
- Evaluating a drink-counting and a breathalyzer-coupled app for monitoring alcohol use: A comparison with timeline followback and peth biomarker.Addictive behaviors reports · 2025Article
- Reductions in World Health Organization Risk Drinking Levels as a Primary Efficacy End Point for Alcohol Clinical Trials: A Review.JAMA psychiatry · 2025Review
- Factors Associated with Substance Use and Physical Activity Among German University Students 20 Months into the COVID-19 Pandemic.Journal of prevention (2022) · 2025Article
- Integrating gut microbiome and neuroplasticity genomics in alcohol use disorder therapy.Human genomics · 2025Observational
- Associations between neonicotinoids and inflammation in US adults using hematological indices: NHANES 2015-2016.Environmental epidemiology (Philadelphia, Pa.) · 2025Article
- Self-Determined Motivation for Alcohol Use and Drinking Frequency, Intensity, and Consequences.Substance use & misuse · 2025Article
- Altered Expression of Neuroplasticity-Related Genes in Alcohol Addiction and Treatment.International journal of molecular sciences · 2024Article
- Retrospective self-reports of sensitivity to the effects of alcohol: Trait-like stability and concomitant changes with alcohol involvement.Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors · 2024Article
- Alcohol use disorder and fitness to drive: Discrepancies between health professionals' evaluations and objective measures of alcohol use and cognitive functioning.Nordisk alkohol- & narkotikatidskrift : NAT · 2024Article
- Subjective intoxication predicts alcohol-related consequences at equivalent alcohol concentrations in young adults using ecological momentary assessment and alcohol sensors.Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors · 2024Article
- Baseline protective behavioral strategy use predicts more moderate transdermal alcohol concentration dynamics and fewer negative consequences of drinking in young adults' natural settings.Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors · 2024Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsThe terms 'binge drinking' and 'heavy drinking' are both operationalized typically as 4+/5+ standard drinks per occasion for women/men, and are used commonly as a proxy for non-problematic (<4/<5) versus problematic (4+/5+) drinking in multiple research contexts. The Food and Drug Administration in the United States recently proposed the 4+/5+ criterion as a primary efficacy end-point in their guidance for trials examining new medications for alcohol use disorders (AUDs). Internationally, similar cut-offs have been proposed, with the European Medicines Agency having identified reductions in the number of heavy drinking days (defined as 40/60 g pure alcohol in women/men) as a primary end-point for efficacy trials with a harm reduction goal. ANALYSIS AND EVIDENCE: We question the validity of the 4+/5+ cut-off (and other similar cut-offs) on multiple accounts. The 4+/5+ cut-off has not been shown to have unique predictive validity or clinical utility. The cut-off has been created based on retrospective self-reports and its use demonstrates ecological bias. Given strong evidence that the relationship between alcohol consumption and problems related to drinking is at least monotonic, if not linear, there is little existing evidence to support the 4+/5+ cut-off as a valid marker of problematic alcohol use.
conclusionsThere is little empirical evidence for the 4+/5+ standard drinks per occasion threshold for 'binge' or 'heavy' drinking in indexing treatment efficacy. Further consideration of an appropriate threshold seems to be warranted.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.