Subjective measures of binge drinking and alcohol-specific adverse health outcomes: a prospective cohort study Tapio Paljärvi 1,5 , Pia Mäkelä 2 , Kari Poikolainen 3 , Sakari Suominen 4 , Josip Car 1 & Markku Koskenvuo 5 Department of Primary Care and Public Health, Imperial College London, London, UK, 1 National Institute for Health and Welfare, Helsinki, Finland, 2 Finnish Foundation for Alcohol Studies, Helsinki, Finland, 3 Department of Public Health, University ofTurku,Turku, Finland 4 and Depar tment of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland 5 ABSTRACT Aim To determine the performance of subjectively defined intoxications, hangovers and alcohol-induced pass-outs in identifying drinkers at risk for adverse health outcomes. Design Prospective population-based cohort study. Setting Working-aged Finnish general population. Participants A total of 21 204 alcohol-drinking men and women aged 20–24, 30–34, 40–44 and 50–54 years at baseline who participated in the Health and Social Support (HeSSup) postal survey in 1998. Measurements Binge drinking was measured by subjectively defined intoxications/ drunkenness, hangovers and alcohol-induced pass-outs. Hazardous drinking was defined according to Finnish guide- lines as weekly total intake of >287 g of ethanol for men, and for women > 191 g of ethanol (24 and 16 standard drinks, respectively). Study participants were followed-up for 7 years for alcohol-specific hospitalizations and deaths. Proportional hazard models and areas under the receiver operating characteristics curves (AUC) were used to analyse the data. Findings Of the drinkers, 6.5% exceeded the weekly limit for hazardous drinking, and 1.5% experienced the alcohol-specific end-point during the follow-up. Subjective intoxications, hangovers and alcohol-induced pass-outs all predicted future alcohol-specific diagnoses independently of average intake and of several other potential confounders. In identifying baseline hazardous drinking, subjective intoxications had a superior performance in relation to other subjective measures of binge drinking. In identifying future alcohol-specific hospitalizations or death, subjective intoxi- cations had also the best performance, but this was not significantly different from the other binge drinking measures, or average intake. Conclusions Subjectively defined intoxications, hangovers and alcohol-induced pass-outs are population-level proxy measures of at-risk drinking patterns. Keywords Alcohol drinking, alcoholic intoxication, alcohol-related, drinking pattern, follow-up studies, hangover, hospitalization, mortality. Correspondence to: Tapio Paljärvi, Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W68RP, UK. E-mail: tapio.paljarvi@helsinki.fi Submitted 19 January 2011; initial review completed 23 March 2011; final version accepted 22 July 2011 INTRODUCTION The impairing effects of alcohol intoxication generally start to become apparent when the blood alcohol concen- tration (BAC) exceeds 0.10% [1]. Subjectively defined intoxications/drunkenness, i.e. subjective measures of binge drinking, have a potential to capture the adverse health effects of high BAC by indirectly controlling factors which determine the resulting BAC, such as individual differences in susceptibility to the effects of alcohol and differences in characteristics of drinking occasions [2]. Despite the potential benefits related to measuring subjective intoxications [3–5], only few studies have used subjective measures of binge drinking in predicting health outcomes at a population level [6–8]. Although experiencing the intoxicating effects of alcohol is subjective and likely to vary according to char- acteristics of the drinker, the drinking occasion and RESEARCH REPORT doi:10.1111/j.1360-0443.2011.03596.x © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction Addiction, 107, 323–330