AIMS: The aim of the study was to determine outcomes in adult life of binge drinking in adolescence in a national birth cohort. DESIGN AND SETTING: Longitudinal birth cohort: 1970 British Birth Cohort Study surveys at 16 years (1986) and 30 years (2000). PARTICIPANTS: A total of 11 622 subjects participated at age 16 years and 11 261 subjects participated at age 30 years. MEASUREMENTS: At the age of 16 years, data on binge drinking (defined as two or more episodes of drinking four or more drinks in a row in the previous 2 weeks) and frequency of habitual drinking in the previous year were collected. Thirty-year outcomes recorded were alcohol dependence/abuse (CAGE questionnaire), regular weekly alcohol consumption (number of units), illicit drug use, psychological morbidity (Malaise Inventory) and educational, vocational and social history. FINDINGS: 17.7% of participants reported binge drinking in the previous 2 weeks at the age of 16 years. Adolescent binge drinking predicted an increased risk of adult alcohol dependence (OR 1.6, 95% CI 1.3 to 2.0), excessive regular consumption (OR 1.7, 95% CI 1.4 to 2.1), illicit drug use (OR 1.4, 95% CI 1.1 to 1.8), psychiatric morbidity (OR 1.4, 95% CI 1.1 to 1.9), homelessness (OR 1.6, 95% CI 1.1 to 2.4), convictions (1.9, 95% CI 1.4 to 2.5), school exclusion (OR 3.9, 95% CI 1.9 to 8.2), lack of qualifications (OR 1.3, 95% CI 1.1 to 1.6), accidents (OR 1.4, 95% CI 1.1 to 1.6) and lower adult social class, after adjustment for adolescent socioeconomic status and adolescent baseline status of the outcome under study. These findings were largely unchanged in models including both adolescent binge drinking and habitual frequent drinking as main effects. CONCLUSIONS: Adolescent binge drinking is a risk behaviour associated with significant later adversity and social exclusion. These associations appear to be distinct from those associated with habitual frequent alcohol use. Binge drinking may contribute to the development of health and social inequalities during the transition from adolescence to adulthood.