Pre-drinking is a risky way to begin an evening out

Previous research from the U.S. and the U.K. has shown that "pre-drinking" or "frontloading" often leads to heavy drinking by young people in public settings and can lead to greater harm. Pre-drinking typically occurs in locations where low-cost alcohol that is usually bought off-premise is consumed, rapidly and in large quantities. A study using Swiss data has found that pre-drinking, when combined with on-premise drinking, leads to almost twice as much drinking and negative outcomes.

Results will be published in the February 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"At first glance, it might seem that pre-drinking is not so prevalent in Switzerland," said Florian Labhart, a researcher at Addiction Switzerland as well as corresponding author for the study. "However, pre-drinking has been found in about one third of all on-premise drinking, which is a very high rate. Considering that pre-drinking leads people to consume nearly twice the normal amount of on a given night, its prevalence should not be underestimated from a public-health perspective."

"Only recently has pre-drinking – also referred to as pre-partying, pre-gaming, pre-loading, or pre-funking – been identified and introduced into the empirical alcohol literature," said Shannon R. Kenney, visiting assistant research professor and associate director of the Heads Up Research Lab in the Psychology Department at Loyola Marymount University in Los Angeles, California. "Although pre-drinking has not received the attention it deserves thus far, it appears that researchers are beginning to recognize the importance of gaining a better understanding of this risky and prevalent drinking context."

Kenney added that existing studies of pre-drinking/pre-partying have revealed similar prevalence rates in the United States and Europe. "In fact, due to U.S. legal drinking age requirements, pre-drinking may be most prevalent among underage drinkers in the U.S.," she said. "Research shows that underage drinkers may be motivated to pre-drink to achieve a 'buzz' or become intoxicated before going to a licensed premise where they cannot legally consume alcohol, such as a bar, club, concert, or sporting event."

Researchers examined the drinking practices of 183 young adults (97 women, 86 men) with a mean age of 23 years from three higher-education institutions in Switzerland, using the recently developed Internet-based Cell phone optimized Assessment Technique (ICAT) to assess alcohol consumption and drinking location at six time points (from 5 p.m. to the next morning) on Thursdays, Fridays, and Saturdays during five consecutive weeks by means of the participants' cell phones. A total of 7,828 assessments were provided for analysis for 1,441 evenings. The study authors examined the association between pre-drinking, overnight drinking levels, and adverse outcomes.

"Pre-drinking is a pernicious drinking pattern that is likely to lead people to cumulate two normal drinking occasions – one off-premise followed by one on-premise – and generally results in excessive alcohol consumption," said Labhart. "Excessive consumption and adverse consequences are not simply related to the type of people who pre-drink, but rather to the practice of pre-drinking itself."

"Moreover," said Kenney, "pre-drinking tended to involve further drinking throughout the evening. That is to say that pre-drinking did not reduce or replace the amount of post pre-drinking consumption, but enhanced risk through increased consumption."

"In terms of specific adverse or risky outcomes from drinking," said Labhart, "47.5 percent of the men and women in the study reported the following outcomes: hangover (40.7% men, 36.1% women), unplanned substance use (20.9% and 12.4%), blackouts (11.6% and 7.2%), unintended or unprotected sexual intercourse (8.1% and 5.2%), injured self or someone else (5.8% and 3.1%), and property damage or vandalism (3.5% and 0.0%). Logically, given the large amounts of alcohol consumed, blackouts and hangover were especially prevalent on pre-drinking evenings."

"These findings hold important implications for prevention practices by highlighting the advantages of event-level intra-individual assessment," said Kenney. "The authors utilized a cell-phone based method that allowed for the assessment of participant's alcohol consumption and drinking locations throughout the evening. This type of novel data collection technique appears to offer much promise for research of young adult and adolescent drinking, both with respect to pre-drinking and more generally."

"Changing the location during a night increases the overall amount of ," added Labhart. "It's important that young people count the number of drinks they have during a night and to remember how many drinks they had already when they reach a new drinking location." The study authors also recommend prevention practices that incorporate educational interventions as well as structural measures such as reduced late-night off-sale opening hours, and more staff training regarding responsible beverage-service practices.

"Social drinkers can also use protective behavioral strategies," said Kenney, "such as being mindful of internal bodily sensations, pacing drinks, or avoiding chugging or drinking games, which may enable drinkers to more fully enjoy safer experiences and avoid negative consequences."

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