College Students and Alcohol
Even
as college students discover the intricacies of quantum physics and
American history, many do not grasp an enormous health problem on
our college campuses--alcohol abuse. As a former university chancellor,
I know that the culture of drinking on many campuses puts these students
at risk for many serious problems, ranging from car crashes to date
rape. Heavy drinking over a long period of time can lead to health
problems, such as cirrhosis and various types of cancer.
Prevention,
early detection, and timely intervention are vital if we are to reduce
the number of alcohol-related problems on college campuses today.
For example, NIAAA research shows that college students who receive
a single individual counseling session often will significantly reduce
their drinking.
A growing
number of colleges and universities are addressing campus drinking
problems by providing prevention education; expanding counseling services;
and offering more alternatives, such as alcohol-free parties. It is
encouraging to see these activities gaining in force across the country.
At the same
time, all of us must encourage college students--our national future--to
take personal responsibility for making healthy choices with the only
lives they will ever have. Getting drunk doesn't need to be a rite
of passage, and hangovers aren't a prerequisite for graduation. College
Students and Drinking
An
overwhelming majority of college students (88 percent), including
those under the legal drinking age, have used alcohol. In 1994, 67.5
percent of college students had used alcohol within the past 30 days,
a rate that has been in an overall decline since 1980. By comparison,
61.7 percent of young people not in college reported monthly alcohol
use in 1994. This Alcohol Alert reviews drinking--especially
binge drinking and its consequences--among college students and compares
it to that of noncollege peers. It also considers some colleges' attempts
to prevent and treat abusive drinking on campus.
Binge
Drinking
Most research
on drinking among college students focuses on the widespread pattern
of binge drinking. Many researchers define binge drinking for men
and women as drinking five or more drinks at one sitting . In 1994,
by this definition, 40 percent of college students reported binge
drinking at least once within 2 weeks of being surveyed. Thirty-one
percent of college women binge drank compared with 52 percent of college
men. However, a strong argument has been made that a more equivalent
bingeing criterion for women is four drinks per occasion (3,4) and
that the five-drink level may underestimate binge drinking among women.
Developmentally, the ages 18 through 21 is the period of heaviest
alcohol consumption for most drinkers in the United States. However,
within this heavy-drinking age group, binge drinking is more prevalent
among college students than nonstudents.
Binge drinking
prevalence varies among campuses, ranging from almost 0 to nearly
70 percent of the students. Rates vary depending on the type of college
and its geographical location as well as on the ethnic and gender-based
makeup of the student body.
In one multicampus
survey, white students reported the highest percentage of binge drinking
in a 2-week period (43.8 percent), followed by Native American (40.6
percent), Hispanic (31.3 percent), Asian (22.7 percent), and black
(22.5 percent) students. This pattern of drinking differences among
ethnic groups is also seen in high school students.
Students'
drinking patterns vary with their ages and their years in college.
One survey reported that more students under age 21 binge drink and
have alcohol-related problems than those over 21. However, Wechsler
and colleagues found that age differences in drinking rates apply
only to older students (i.e., above age 23), who drink less than traditional-age
students (i.e., ages 17 to 23). Any variation by age group in students'
drinking rates does not differ noticeably from variation between the
same age groups in the noncollege population.
Students who
binge drink are more likely to damage property, have trouble with
authorities, miss classes, have hangovers, and experience injuries
than those who do not. Alcohol-related problems of this nature increased
between the early and late 1980's. Interestingly, frequent binge drinkers
and those who report experiencing specific alcohol-related problems
do not perceive themselves as problem drinkers.
Among men,
research indicates that greater alcohol use is related to greater
sexual aggression. Sixty-seven percent of the male sexual aggressors
at one university, as well as about 50 percent of female victims,
had been drinking at the time of the sexual assault or other incident
of victimization. Binge drinkers appear to engage in more unplanned
sexual activity and to abandon safe sex techniques more often than
students who do not binge drink.
Students living
on campuses with higher proportions of binge drinkers experience more
incidents of assault and unwanted sexual advances as a result of their
peers' drinking than do students residing on campuses with lower proportions
of binge drinkers. The former also more often report having their
studies disturbed or having to take care of a drunken student. Students
who consume alcohol but do not binge drink seem to have a lower frequency
of drinking and getting drunk than do binge drinkers. The former also
experience fewer of the alcohol-related problems cited above than
their binge drinking peers.
Drinking and
driving has been reported by more than 60 percent of college men and
almost 50 percent of college women who binge drink at least three
times in a 2-week period. By comparison, drinking and driving has
been reported by 20 percent of college men and 13 percent of college
women who do not binge drink. College students reported a decrease
in drinking and driving incidents between 1982 and 1991.
Factors
Associated With Heavy Drinking
Heavy drinking
or alcohol-related problems during college may be associated with
personality characteristics, such as being impulsive; psychological
problems, such as depression or anxiety; or early deviant behavior.
As in the general population, a positive family history of alcohol
abuse appears to be a risk factor for problem drinking in college
students, although not all studies report this relationship.
Several studies
indicate that students generally perceive their peers' drinking levels
to be higher than their own and higher than they actually are. Some
studies further indicate that exaggerated perceptions of others' drinking
are associated with greater individual consumption but not with more
alcohol problems.
Research indicates
that students' expectancies that alcohol will loosen inhibitions or
promote relaxation appear to be correlated with increased drinking.
Such expectancies also predict changes in drinking by college students
and other youth.
Binge drinking
during high school, especially among men, is strongly predictive of
binge drinking in college. Research has shown that expectancies develop
well before students enter college, even before they have begun to
drink. Furthermore, students' perceptions of the drinking behaviors
of which their peers approve may exist before they enter college.
Irrespective
of the alcohol-related problems that college students experience,
their degree of social acceptance may be tied to drinking behavior.
In one report, for example, students who binge drink fewer than three
times per week have reported more intimacy in their relationships
than those who do not binge drink and those who binge drink more frequently.
Fraternity
and sorority members drink more and drink more frequently than their
peers and accept as normal high levels of alcohol consumption and
associated problems. Fraternity-sponsored parties also may foster
heavy drinking. Studies have found that students who consider parties
or athletics important and those who drink to get drunk appear most
likely to binge drink or to drink heavily.
Drinking in
groups and serving oneself may promote higher levels of alcohol consumption.
In one study, college students at bars drank more beer when in groups
and when ordering pitchers than when alone and when ordering glasses
or bottles. In another study, beer drinkers assigned to serve themselves
at a fraternity party drank more than those assigned to receive beer
from a bartender. In simulated natural settings (i.e., a simulated
tavern), the amount of alcohol consumed by college students was influenced
by the social behavior and drinking of those around them.
Interventions
Alcohol abuse
prevention and treatment programs exist on many campuses, but few
have been evaluated. Interventions include education programs and
efforts to change drinking behavior.
Some campuses
sponsor alcohol awareness events and classroom lectures and disseminate
information about alcohol use. Although such education programs raise
students' awareness of issues surrounding alcohol use, these programs
appear to have minimal effect on drinking and on the rates of alcohol
problems.
Behavioral
interventions have been more successful than education. The Alcohol
Skills Training Program focuses on giving students the cognitive behavioral
skills they need to monitor and moderate their own drinking. Heavy-drinking
students who completed the course reported significantly less drinking
1 year later, compared with similar students who took an alcohol education
course. More recently, a single individual motivational session providing
feedback on drinking practices for heavy-drinking freshmen has proven
effective in reducing alcohol-related problems over the first 2 years
of college.
Interventions
that challenge erroneous alcohol expectancies can reduce drinking.
Students are encouraged to examine their own beliefs about the likely
effects of alcohol. Their expectancies may be "challenged" by administering
nonalcoholic placebo "drinks" or by presenting contradicting factual
information.
Other interventions
target specific aspects of drinking behavior or environments. Students
served low-alcohol beverages at one fraternity party had lower blood
alcohol concentrations (BAC's) upon leaving the party than students
served standard alcoholic beverages at another party. However, students
given a choice of beverages preferred standard beer to low-alcohol
beer, suggesting that this intervention may be unrealistic. Simple
sobriety tests designed to demonstrate unfitness for driving also
have been tested. However, the higher the students' BAC's, the less
impact test performance had on their decision to drive (42). College
Students and Drinking--A Commentary by
I t
is clear that an overwhelming number of college students, many of
whom are below the minimum drinking age, use alcohol and that the
pattern of binge drinking is widespread among our college campuses.
Binge drinking is of particular concern, not only because of its risks
to the drinker but because of the problems it causes for those around
the drinker. Research on the extent of the problem is detailed and
persuasive. Unfortunately, comparatively little evidence exists about
which interventions would be successful if applied widely and at an
acceptable cost. Not only must future research inform us on effective
interventions, but other questions must be answered that involve both
science and social policy. For example, proscribing alcohol on campus
may drive students onto the highway with risk of crashes. Risk of
this complication might differ between urban and rural schools. Restrictions
on advertising are not only of unknown impact but raise issues of
rights of expression because many students are 21 or older. Even when
these questions are answered, within any campus administration, faculty
and alumni may differ on the degree to which schools are obligated
to act as surrogate parents and on which measures are acceptable.
We have much to learn. All material
contained above was obtained from NIAAA For more information on alcoholism
from the NIAAA contact: Scientific Communications Branch, Office of
Scientific Affairs, NIAAA, Willco Building, Suite 409, 6000 Executive
Boulevard, Bethesda, MD 20892-7003. Telephone: 301-443-3860. U.S. DEPARTMENT
OF HEALTH AND HUMAN SERVICES
Public Health
Service * National Institutes of Health
NIAAA Director Enoch Gordis, M.D.