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Alcohol & Drug Use Measurement Strategies

The only widespread tool for measuring alcohol consumption is through self-reported surveys. There are four common measures of alcohol consumption used for estimating health risks:

  1. Current drinking defined as having one or more alcoholic drinks in the past 30 days.
  2. Binge drinking defined as the percentage of the population that drinks more than four (women) or five (men) alcoholic beverages on an occasion at least once a month.
  3. Heavy drinking defined as the percentage of the population that drinks more than one (women) or two (men) drinks per day on average.
  4. Excessive drinking defined as the percentage of the population who are defined as either a binge drinker or a heavy drinker.

Previously, the number of drinks was asked with no regard to gender. However, starting in 2006, the definition of binge drinking changed to 5 or more drinks on an occasion for men and 4 or more drinks on an occasion for women, and the definition of heavy drinking changed to more than two drinks per day for men and more than one drink per day for women [1,2].

The Centers for Disease Control and Prevention (CDC) sponsors many types of surveys that collect information on alcohol consumption including the Behavioral Risk Factor Surveillance System (BRFSS). It collects data on the number of drinking days, the average number of drinks per occasion, the maximum number of drinks consumed, and the frequency of alcohol consumption.

Motor vehicle crashes are often used as a proxy for excessive alcohol use due to the burden of injury possible through impaired driving [1]. The percentage of motor vehicle crash deaths with alcohol involvement directly measures the relationship between alcohol and motor vehicle crash deaths.

Self-reported surveys are also frequently used for measuring drug use. However, several potential biases arise in self-reported drug use due to recall bias and reporting bias as a result of social disapproval and fear of reprisal [3]. Biochemical measures of drug use are the gold standard for measurement as there is a greater availability of biochemical markers for illicit drug use, but this measurement is not feasible on a national scale and even urinalysis is subject to false negatives [3].

Several national surveys, including the National Survey on Drug Use and Health (NSDUH), the National Institute of Drug Abuse (NIDA) Monitoring the Future (MTF) survey, and the CDC’s Youth Risk Behavior Survey, are conducted to monitor illicit drug use in the population, assessing ever and current use of substances including marijuana, cocaine, heroin, inhalants, non-medical use of prescription drugs, and many more. However, these studies have limitations for finding county-level population data for illicit drug use. The National Survey on Drug Use and Health (NSDUH) includes only national and state data, the National Institute of Drug Abuse (NIDA) Monitoring the Future (MTF) survey includes only national data for the adolescent population, and the Youth Risk Behavior Survey includes only data for the adolescent population with not all states participating every round or reporting at the county level.

To address the issue of prescription drug overdoses, many states have created prescription drug monitoring programs (PDMP), which use databases to track prescriptions of controlled substances [4]. However, not all states have a prescription drug monitoring program and many do not publically release data or statistics for their state.


[1] Health risks in the United States: Behavioral Risk Factor Surveillance System. Centers for Disease Control and Prevention Web Site. Updated February 23, 2010. Accessed February 13, 2017.
[2] Centers for Disease Control and Prevention. Alcohol Use Among Pregnant and Nonpregnant Women of Childbearing Age --- United States, 1991--2005. MMWR Morb Mortal Wkly Rep. 2009;58:529-532.
[3] Brener ND, Billy JO, Grady WR. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. Journal of adolescent health 2003;33.6:436-457.
[4] Drug Overdose: Prevention Research & Activities. Centers for Disease Control and Prevention Web Site. Updated July 2, 2013. Accessed March 12, 2014