Updated: 2023

Alcohol misuse: Drinking in a manner, situation, amount, or frequency that could cause harm to users or to those around them. For individuals younger than the legal drinking age of 21, or for pregnant females, any alcohol use constitutes alcohol misuse.

Alcohol use disorder (AUD): AUD is a chronic, relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can range from mild to severe, and recovery is possible regardless of severity. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM-5, integrates the two DSM-IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder, or AUD, with mild, moderate, and severe subclassifications.

Alcohol-impaired driving fatality: A fatality in a crash involving a driver or motorcycle rider (operator) with a blood alcohol concentration (BAC) of 0.08 g/dL or more (a BAC of 0.08% corresponds to 0.08 grams of alcohol per deciliter, or 0.08 grams per 100 milliliters).

Any alcohol use treatment: The 2021 National Survey on Drug Use and Health (NSDUH) defines any alcohol use treatment as treatment received at any location, such as a hospital (inpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private doctor’s office, self-help group, prison/jail, and virtual services.1

Binge drinking:

  • The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08%—or 0.08 grams of alcohol per deciliter—or more. This typically happens if a woman has four or more drinks, or a man has five or more drinks, within about 2 hours.2
  • The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual NSDUH, defines binge drinking as consuming five or more alcoholic drinks for males or four or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month, regardless of frequency in the past year.
  • The Monitoring the Future (MTF) survey defines binge drinking as having five or more drinks in a row in the past 2 weeks.

Disability-adjusted life years: A measure of years of life lost or lived in less than full health.

Heavy alcohol use (or heavy drinking):

  • NIAAA defines heavy alcohol use as follows:
    • For men, consuming five or more drinks on any day or 15 or more per week
    • For women, consuming four or more drinks on any day or 8 or more per week
  • SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.

High-intensity drinking:

  • Consumption of two or more times the gender-specific thresholds for binge drinking, which means 10 or more standard drinks (or alcoholic drink equivalents) for males and eight or more for females. High-intensity drinking is consistent with drinking at binge levels II and III. The levels correspond to one to two times (I), two to three times (II), and three or more times (III) the standard gender-specific binge thresholds.5
  • The MTF survey defines high-intensity drinking among adolescents as consuming 10 or more (8th, 10th, and 12th grade) or 15 or more (12th grade only) drinks in a row in the past 2 weeks.4

Patterns of drinking associated with AUD: Binge drinking and heavy alcohol use can increase an individual’s risk of AUD. According to the Dietary Guidelines for Americans, 2020–2025, adults of legal drinking age can choose not to drink or to limit intake to two drinks or less in a day for men and one drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more. Some individuals should avoid alcohol completely.

Underage drinking: Alcohol use by anyone under the age of 21. In the United States, the legal drinking age is 21.

According to SAMHSA, caution should be used when comparing estimates from the 2020 and 2021 NSDUH to those from prior years due to methodological changes. Prior to the COVID-19 pandemic, data for NSDUH were collected during in-home visits, using computer-assisted techniques. The COVID-19 pandemic necessitated a delay in data collection during 2020 and the introduction of web-based data collection, with very limited in-person data collection. Because these changes in data collection coincided with the spread of the COVID-19 pandemic and any related behavioral or mental health changes, we cannot fully separate the effects of methodological changes from true changes in the outcomes. Please see the Methodological Summary and Definitions [PDF – 4 MB] for more information.


  1. SAMHSA, Center for Behavioral Health Statistics and Quality. 2021 National Survey on Drug Use and Health. Table 5.13A—Received alcohol use treatment at any location in past year: among people aged 12 or older; by age group and demographic characteristics, numbers in thousands, 2021. [cited 2023 Jan 24]. Available from:   
  2. NIAAA. What colleges need to know now. Bethesda (MD): NIAAA; 2007 Nov. Defining binge drinking; p. 2.
  3. SAMHSA, Center for Behavioral Health Statistics and Quality. 2021 National survey on drug use and health: methodological summary and definitions. Rockville (MD): SAMHSA; 2022 [cited 2023 Jan 24], p. 149. Available from:
  4. Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future National Survey Results on Drug Use 1975–2021. 2021 Overview: key findings on adolescent drug use. Ann Arbor (MI): Institute for Social Research, University of Michigan; 2022 Jan. Study design and methods; p. 10-1 Available from:
  5. Hingson RW, Zha W, White AM. Drinking beyond the binge threshold: predictors, consequences, and changes in the U.S. Am J Prev Med. 2017;52(6):717-27. PubMed PMID: 28526355
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