The social context of drinking and its association with days of heavy episodic drinking in the past month among a nationally representative sample of adolescents and young adults in the United States, 2021-23.

INTRODUCTION: Prior research links solitary drinking under the age of 21 years, the legal drinking age in the USA, with adverse health later in life. This study examines associations between the social context of drinking (i.e. drinking alone vs with others) and the frequency of heavy episodic drinking (HED) days in the past 30 days among 12-20-year-olds in the USA.

MATERIALS AND METHODS: We aggregated National Survey on Drug Use and Health data from 2021 to 2023 for all individuals aged 12-20 years who drank alcohol in the past month (unweighted n = 6 261). The focal independent variable of interest was the social context of drinking in the past month, and the primary outcome was the categorical frequency of HED days in the past month. Weighted multinomial logistic regression was used to estimate associations, adjusting for sociodemographic factors.

RESULTS: Drinking alone, compared to drinking with others, was associated with a higher likelihood of HED on 20-30 days in the past month compared to 0 days in the adjusted model [relative risk ratio: 5.48, 95% confidence interval: 2.45, 12.25].

CONCLUSIONS: Among this nationally representative sample of adolescents and young adults under the legal drinking age in the USA who drank alcohol in the past month, we found that drinking alone compared to drinking with others was associated with the highest frequency of HED days in the past month. This association was not observed across lower HED day frequency categories. Tailored interventions targeting individuals in this age range who drink alone may be necessary to help reduce high-frequency HED.