Background: Participation in drinking games (DG) has been identified as a common health-risk behavior among college students. However, research suggests that the frequency of DG participation alone may not pose a significant health risk; rather, gaming may be most hazardous when large amounts of alcohol are consumed. Objectives: The present study was designed to examine whether specific gaming behaviors (frequency of play and amount of consumption) place gamers at elevated risk for negative drinking outcomes. Method: Students from 30 U.S. colleges completed self-report questionnaires via the Internet about their drinking attitudes and behaviors. Four groups of student gamers ( N = 2,230) were examined: low frequency/low consumption ( n = 1,047), low frequency/high consumption ( n = 453), high frequency/low consumption ( n = 326), and high frequency/high consumption ( n = 404). Results: Multilevel regression analyses indicated that the frequency x consumption interaction emerged as a significant predictor of negative drinking consequences. Follow-up analyses indicated that quantity of alcohol consumed during DG predicted negative drinking consequences for high-frequency gamers only. Conclusions/Scientific Contribution: The present results challenge the assumption that all drinking-gaming practices pose equivalent health risks for gamers. Considering only participation in or level of consumption during DG may not tell the complete story with respect to the health hazards involved with gaming behaviors among college students.