One More Round? Investigating the Relationship Between Number of Drinks & Risk of Physical Injury

Alcohol use is the 5th leading risk factor for “disability adjusted life years” (i.e., years of life lost and years living with disability), and 1st for individuals aged 15 to 35. Among the most prominent reasons for alcohol’s risk is increased vulnerability to physical injury.

Studies have found, for example, that alcohol use increases someone’s chance of serious injury (requiring emergency department services) by almost three times.

It is important from both public health and clinical perspectives to understand how that risk changes with the amount of alcohol consumed, and whether those risks depend on gender, age, and country-specific cultural drinking norms.

In the current research study, Cherpitel and her co-authors analyzed data collected by the World Health Organization (WHO), covering approximately 13,000 individuals, in 37 emergency departments, across 18 countries (including continental Europe, Asia, North America, South America, and Central America, and Australia).

Although demographics differed somewhat by country, the study included a majority of males (ranging from 54% to 81%) and about equal proportions of young (18-30) relative to older (31+) adults (ranging from 30% to 59%). Country-specific cultural norms were measured by the detrimental drinking pattern score (a categorical WHO measure of drinking customs).

Drinking-related risk was calculated through comparison of the number drinks consumed in the 6 hours prior to injury compared with the average number of drinks consumed in the week before the injury – this kind of comparison accounts and controls for the influence of other potential risk factors in any given individual.


The analyses found that an individual’s risk of injury increases in a linear fashion with each additional drink consumed. For example, with only 1 drink, the odds of injury is more than 2 times greater than if sober, by five drinks this risk increase jumps to almost 7, and by ten drinks, the odds of someone becoming injured is 10 times greater than when sober.

Females and males have about the same risk up to three drinks, though with four or more drinks, females take on added injury risk relative to males. For example, females having consumed ten drinks are 14 times more likely to suffer injury, compared to 10 times greater likelihood for males.

Regarding age, despite their reputation for poorer judgment and decision-making, young adults had about the same drink-injury risk relationship relative to older adults. Regarding the influence of country-specific norms, as expected, at lower levels of alcohol consumption, patients in countries with the greatest detrimental drinking pattern (e.g., Eastern European countries) had greater alcohol-injury relationships than those in countries with lower detrimental drinking patterns. This could be related to more rapid intake, and greater acute intoxication.

The alcohol-injury risk relationship also differed by type of injury. Alcohol consumption was the strongest predictor of violence-related injuries, for example, with about a 12-fold increase at five drinks and a 20-fold increase at ten drinks.


Alcohol misuse and alcohol use disorders cost high-income countries like the United States on average, about 250 billion dollars per year.

A substantial proportion of that financial burden is related to the impact of alcohol on physical injury.

A substantial proportion of that financial burden is related to the impact of alcohol on physical injury.

This international study showed that someone’s risk of injury increases two-fold with just a single drink, and that each additional drink leads to further increased risk of injury, the relationship between alcohol consumption and injury appears to be even greater for women than men.


It is important to remember that while young adults did no not have an elevated alcohol-injury risk relative to older adults, they are far more likely to consume alcohol, engage in binge drinking, and to meet clinical thresholds for alcohol use disorder than their older counterparts.

The results from this study could supplement what we already know about the risks of harm owed to alcohol use, and should be incorporated into psychoeducational and prevention-based interventions at colleges and universities, workplace settings, and primary care offices.



Cherpitel, C. J., Ye, Y., Bond, J., Borges, G., & Monteiro, M. (2015). Relative risk of injury from acute alcohol consumption: modeling the dose–response relationship in emergency department data from 18 countries. Addiction, 110(2), 279-288.