High-Risk Drinking in College: What We Know and What We Need To Learn
An Entrenched Problem
Alcohol use on college campuses is not a new problem; it has been documented in the United States
for at least 50 years. However, recent concerns have centered on heavy episodic drinking, a
potentially dangerous practice often termed “binge drinking,” and usually defined as consuming
five drinks or more in a row for men and four drinks or more in a row for women. According to this
definition, about two out of five college students have engaged in binge drinking in the past 2
weeks. An additional two out of five college students drink—but not to excess—while one in five
does not use alcohol at all.
In recognition of the serious and sometimes fatal consequences of alcohol consumption among
college students, the National Advisory Council on Alcohol Abuse and Alcoholism, National
Institutes of Health, established two panels of nongovernment experts to help the Institute
develop a national research agenda to better address the problem. The panels included college
presidents and administrators, well-known alcohol researchers, and students. The two panels are
Contexts and Consequences (Panel 1) and Prevention and Treatment (Panel 2).
This report represents the work of the Panel on Contexts and Consequences and is based on 12
commissioned, peer-reviewed papers by experts in the field and extensive discussion among panel
members and the authors of the papers. It focuses on what is known about drinking in college and
its consequences and on gaps in knowledge that need further study. The report also places a
special emphasis on heavy drinking, including binge drinking, because of its potentially serious
Because colleges vary widely in their drinking rates, it would be inaccurate to characterize all
colleges as having an equally urgent drinking problem. But among college students who do drink
heavily, the problem is serious: the two out of five students who engage in binge drinking risk a
wide range of alcohol-related consequences, including grave injuries and death.
Student Alcohol Consumption: Multiple Influences
The Panel found that on many college campuses, heavy drinking is interwoven overtly or subtly
throughout the culture of the institution. As a result, students perceive this drinking pattern as
the social norm rather than as unhealthy and potentially destructive behavior. Research
consistently shows that there is no one cause of excessive alcohol use by college students, and
the Panel thought that it would be naive and misleading to adopt a simplistic view of, or approach
to, this problem.
College student drinking is the product of many factors working together. Among them are:
- Students’ value systems and personalities;
- Students’ expectations regarding alcohol’s effects (whether good or bad);
- Genetic predisposition, often reflected in a family history of alcoholism;
- Roles and influence of family background and peers;
- Social integration of drinking into college life;
- Social context in which drinking takes place (e.g., on- or off-campus parties, on- or
- Marketing mechanisms such as reduced-price drink specials and promotional efforts;
- Economic availability of alcohol, including its retail price and the amount of students’
- Legal availability of alcohol;
- Social and institutional structures, including law enforcement; and
- Public policy.
Developmental processes: Drinking problems among college students are also closely tied to
developmental processes. Binge drinking rates are lower at younger ages, increase in later
adolescence, and drop off in the mid-twenties.
The college years are a time of transition, involving challenges and changes in identity, social
relationships, and living arrangements. However, these transitions also affect noncollege peers,
suggesting that what is often interpreted as a campus-based problem may be attributable, in part,
to the broader social and biological processes that characterize late adolescence and early
adulthood in general. Factors such as greater personal freedom and independence, greater
involvement in social and dating relationships, and freedom from the responsibilities of marriage
and family life appear to be intricately linked to greater alcohol involvement.
Elevated drinking levels: College drinking occurs at a stage in life when drinking levels
are generally elevated. The age period from 19 to 24 is associated with the highest prevalence of
periodic heavy alcohol consumption during the life span (Johnston et al., 2001b). Although, on
average, college students may drink on fewer occasions than their noncollegiate peers, they drink
heavily (e.g., five or more drinks in a sitting) on a more frequent basis than nonstudents,
placing them at especially high risk for the consequences of heavy consumption.
Preexisting drinking problems: Because colleges and universities are the social
institutions that help many youth make the transition from adolescence to adulthood, they often
become the playing field on which the developmental problems of this life stage, including alcohol
misuse, unfold. Panel members pointed out that the drinking patterns of some college students
represent the continuation of behavior that began during high school or even earlier. When these
problems emerge at age 18 or 19, they are labeled “college problems,” although they may actually
be “high school” or “middle school problems.” Viewed from this perspective, while the college
experience may serve to “identify” or, in some cases, amplify excessive drinking, it does not
necessarily cause it.
Aspects of campus life supporting drinking: Research does, however, suggest that there are
aspects of certain college environments that may support or facilitate drinking among students.
These factors include commingling of students under the legal drinking age of 21 with those who
can drink legally, substantial amounts of unstructured time, and student-oriented alcohol
College student drinkers: Research shows that:
- Male college students tend to drink more than female college students;
- White college students tend to drink more than their African-American and Hispanic peers;
- Members of fraternities and sororities tend to drink more than students who do not participate
in the Greek system;
- College athletes tend to drink more than peers who are not involved with campus-based sports;
- As a group, college students are less likely to use drugs than their noncollege peers.
College students vary greatly in their use of alcohol and their beliefs about its positive and
negative effects. Studies show that two major drinking patterns appear dominant among college
students: (1) drinking related to impulsivity, disinhibition, and sensation-seeking; and (2)
drinking to manage negative emotional states, such as depression.
Multiple Negative Consequences
The negative consequences of excessive drinking can be severe for both those college students who
drink and those around them.
Personal consequences: Students who drink heavily may experience a range of personal
consequences that include missing class, academic difficulties, dropping out of school, problems
with friends, health problems, and unprotected or unwanted sex. Excessive use of alcohol can also
increase the likelihood that students will engage in high-risk sex, behave aggressively, or
perpetrate or experience sexual assault. These consequences are highlighted because they can have
severe, long-term repercussions including contracting a sexually transmitted disease, becoming
pregnant unintentionally, developing an arrest record, or living with the emotional devastation
caused by rape.
Research clearly demonstrates that heavy alcohol use by college students is associated with
high-risk sexual behavior. Alcohol impairs information processing and reasoning and
heightens the salience of simple cues to action (such as sexual arousal) while blunting the more
distal consequences of behavior (such as the risk of HIV infection). Students who drink
excessively are two to three times more likely to have had multiple sexual partners in the past
month than those who drink responsibly. Similarly, drinking on a first date is associated with a
twofold to threefold increase in the probability of having sex on that date.
Data also show that alcohol and physical and sexual aggression are linked.
Aggressive college students tend to drink more, but it may also be that heavier use increases the
likelihood of aggression. At least 50 percent of college student sexual assaults are associated
with alcohol use. Typically, both parties in such situations have been drinking when the sexual
assault occurs. Alcohol-related sexual assault is underreported, primarily because of the
misplaced shame and stigma that surround this violent and personal crime.
In addition, approximately one in three 18- to 24-year-olds admitted to emergency rooms for
serious injuries is intoxicated. Heavy alcohol use is also associated with homicides,
suicides, and drownings.
The link between excessive alcohol consumption and unsafe driving is well known. About one-half
of all fatal traffic crashes among those aged 18 to 24 involve alcohol; many of
those killed in this age group are college students. Alcohol can slow a driver’s reaction time,
affect concentration, interfere with steering, and impair response to pedestrians and traffic
signs and signals.
Secondhand effects: Noise and property damage, vomit, and unsightly litter are common
byproducts of a night of binge drinking on campus. Some researchers term these consequences
“secondhand effects,” because they are similar to the secondhand smoke from tobacco use (Wechsler
et al., 1998). More than one-half of college administrators from schools with high levels of
excessive drinking report problems with vandalism and property damage. In addition, students who
drink excessively are more likely to physically or sexually assault other students.
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Last reviewed: 9/23/2005