National Institute on Alcohol Abuse and Alcoholism No. 29 PH 357 July 1995

Message From Secretary of Health and Human Services
Donna E. Shalala

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 (1). 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 (1). By comparison, 61.7 percent of young people not in college reported monthly alcohol use in 1994 (1). 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 (1-3). In 1994, by this definition, 40 percent of college students reported binge drinking at least once within 2 weeks of being surveyed (1). Thirty-one percent of college women binge drank compared with 52 percent of college men (1). 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 (4). Developmentally, the ages 18 through 21 is the period of heaviest alcohol consumption for most drinkers in the United States (5). However, within this heavy-drinking age group, binge drinking is more prevalent among college students than nonstudents (1).

Binge drinking prevalence varies among campuses , ranging from almost 0 to nearly 70 percent of the students (3). 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 (2,3).

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 (2). This pattern of drinking differences among ethnic groups is also seen in high school students (6).

Students' drinking patterns vary with their ages and their years in college (7). One survey reported that more students under age 21 binge drink and have alcohol-related problems than those over 21 (2). 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) (3). Any variation by age group in students' drinking rates does not differ noticeably from variation between the same age groups in the noncollege population (8).

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 (3,9). Alcohol-related problems of this nature increased between the early and late 1980's (10,11). Interestingly, frequent binge drinkers and those who report experiencing specific alcohol-related problems do not perceive themselves as problem drinkers (3).

Among men, research indicates that greater alcohol use is related to greater sexual aggression (12). 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 (13). 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 (3).

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 (3,14). The former also more often report having their studies disturbed or having to take care of a drunken student (3,14). Students who consume alcohol but do not binge drink seem to have a lower frequency of drinking and getting drunk than do binge drinkers (3). The former also experience fewer of the alcohol-related problems cited above than their binge drinking peers (3).

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 (3). 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 (3). College students reported a decrease in drinking and driving incidents between 1982 and 1991 (9).

Factors Associated With Heavy Drinking

Heavy drinking or alcohol-related problems during college may be associated with personality characteristics, such as being impulsive (15); psychological problems, such as depression or anxiety (15-17); or early deviant behavior (18). As in the general population (19), a positive family history of alcohol abuse appears to be a risk factor for problem drinking in college students (17,20,21), although not all studies report this relationship (22,23).

Several studies indicate that students generally perceive their peers' drinking levels to be higher than their own (24-26) and higher than they actually are (24). Some studies further indicate that exaggerated perceptions of others' drinking are associated with greater individual consumption (24,26,27) but not with more alcohol problems (25,27).

Research indicates that students' expectancies that alcohol will loosen inhibitions or promote relaxation appear to be correlated with increased drinking (28). Such expectancies also predict changes in drinking by college students and other youth (28).

Binge drinking during high school, especially among men, is strongly predictive of binge drinking in college (20,29,30). Research has shown that expectancies develop well before students enter college, even before they have begun to drink (28,31). Furthermore, students' perceptions of the drinking behaviors of which their peers approve may exist before they enter college (32).

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 (33).

Fraternity and sorority members drink more and drink more frequently than their peers (7,20,30) and accept as normal high levels of alcohol consumption and associated problems (32). Fraternity-sponsored parties also may foster heavy drinking (34). 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 (9,30).

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 (35). In another study, beer drinkers assigned to serve themselves at a fraternity party drank more than those assigned to receive beer from a bartender (34). 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 (7).

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 (36), these programs appear to have minimal effect on drinking and on the rates of alcohol problems (37).

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 (7,38).

Interventions that challenge erroneous alcohol expectancies can reduce drinking (7,28,38,39). 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 (40). However, students given a choice of beverages preferred standard beer to low-alcohol beer, suggesting that this intervention may be unrealistic (41). Simple sobriety tests designed to demonstrate unfitness for driving also have been tested (42). 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
NIAAA Director Enoch Gordis, M.D.

It 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.

References

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The natural history of drug use from adolescence to the mid-thirties in a general population sample. American Journal of Public Health 85(1):41-47, 1995. (6) Bachman, J.G.; Wallace, J.M., Jr.; O'Malley, P.M.; Johnston, L.D.; Kurth, C.L.; & Neighbors, H.W. Racial/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89. American Journal of Public Health 81(3):372-377, 1991. (7) Marlatt, G.A.; Baer, J.S.; & Larimer, M. Preventing alcohol abuse in college students: A harm-reduction approach. In: Boyd, G.M.; Howard, J.; & Zucker, R.A., eds. Alcohol Problems Among Adolescents: Current Directions in Prevention Research. Hillsdale, NJ: Lawrence Erlbaum Associates, 1995. pp. 147-172. (8) Crowley, J.E. Educational status and drinking patterns: How representative are college students? Journal of Studies on Alcohol 52(1):10-16, 1991. (9) Wechsler, H., & Isaac, N. 'Binge' drinkers at Massachusetts colleges: Prevalence, drinking style, time trends, and associated problems. Journal of the American Medical Association 267(21):2929-2931, 1992. (10) Hanson, D.J., & Engs, R.C. College students' drinking problems: A national study, 1982-1991. Psychological Reports 71(1):39-42, 1992. (11) Engs, R.C., & Hanson, D.J. Boozing and brawling on campus: A national study of violent problems associated with drinking over the past decade. Journal of Criminal Justice 22(2):171-180, 1994. (12) Koss, M.P., & Gaines, J.A. The prediction of sexual aggression by alcohol use, athletic participation, and fraternity affiliation. Journal of Interpersonal Violence 8(1):94-108, 1993. (13) Frintner, M.P., & Rubinson, L. Acquaintance rape: The influence of alcohol, fraternity membership, and sports team membership. Journal of Sex Education and Therapy 19(4):272-284, 1993. (14) Wechsler, H.; Moeykens, B.; Davenport, A.; Castillo, S.; & Hansen, J. 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(30) Wechsler, H.; Dowdall, G.W.; Davenport, A.; & Castillo, S. Correlates of college student binge drinking. American Journal of Public Health 85(7):921-926, 1995. (31) Johnson, H.L., & Johnson, P.B. Children's alcohol-related cognitions: Positive versus negative alcohol effects. Journal of Alcohol and Drug Education 40(2):1-12, 1995. (32) Baer, J.S. Effects of college residence on perceived norms for alcohol consumption: An examination of the first year in college. Psychology of Addictive Behaviors 8(1):43-50, 1994. (33) Nezlek, J.B.; Pilkington, C.J.; & Bilbro, K.G. Moderation in excess: Binge drinking and social interaction among college students. Journal of Studies on Alcohol 55(3):342-351, 1994. (34) Geller, E.S., & Kalsher, M.J. Environmental determinants of party drinking: Bartenders versus self-service. Environment and Behavior 22(1):74-90, 1990. (35) Geller, E.S.; Russ, N.W.; & Altomari, M.G. Naturalistic observations of beer drinking among college students. Journal of Applied Behavior Analysis 19(4):391-396, 1986. (36) Flynn, C.A., & Brown, W.E. The effect of a mandatory alcohol education program on college student problem drinkers. Journal of Alcohol and Drug Education 37(1):15-24, 1991. (37) Gonzalez, G.M. Five-year changes in alcohol knowledge, consumption and problems among students exposed to a campus-wide alcohol awareness program and a rise in the legal drinking age. Journal of Alcohol and Drug Education 37(1):81-91, 1991. (38) Kivlahan, D.R.; Marlatt, G.A.; Fromme, K.; Coppel, D.B.; & Williams, E. Secondary prevention with college drinkers: Evaluation of an Alcohol Skills Training Program. Journal of Consulting and Clinical Psych ology 58(6):805-810, 1990. (39) Darkes, J., & Goldman, M.S. Expectancy challenge and drinking reduction: Experimental evidence for a mediational process. Journal of Consulting and Clinical Psychology 61(2):344-353, 1993. (40) Geller, E.S.; Kalsher, M.J.; & Clarke, S.W. Beer versus mixed-drink consumption at fraternity parties: A time and place for low-alcohol alternatives. Journal of Studies on Alcohol 52(3):197-204, 1991. (41) Russ, N.W., & Geller, E.S. Exploring low alcohol beer consumption among college students: Implications for drunk driving. Journal of Alcohol and Drug Education 33(2):1-5, 1988. (42) Russ, N.W., & Geller, E.S. Using sobriety tests to increase awareness of alcohol impairment. Health Education Research 1(4):255-261, 1986.

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