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High-Risk Drinking in College: What We Know and What We Need To Learn

The Panel on Contexts and Consequences

The Panel on Contexts and Consequences examined the current situation regarding alcohol consumption among college students to define the parameters, magnitude, and characteristics of problem drinking in college. It then summarized and integrated information from varying data sources in an effort to translate research findings more effectively for university administrators, faculty, staff, and students. The Panel’s ultimate goal was to develop a report that would help colleges and universities reduce excessive alcohol use on campus. The Panel’s deliberations included a special focus on heavy episodic drinking by college students under the legal drinking age of 21 because of the impact of this behavior on students and the institutions they attend.

The purpose of the Panel’s report was to:

  • Provide a current overview of alcohol consumption among college students;
  • Integrate research findings, summarize what is known, and identify gaps in knowledge about college student drinking;
  • Suggest factors, problems, and issues that colleges and universities should consider in developing strategies to reduce excessive student drinking; and
  • Suggest factors, problems, and issues that researchers and NIAAA should consider in designing and supporting studies to bridge gaps in knowledge.

In a series of meetings held in the Washington, D.C., metropolitan area, members of the Panel on Contexts and Consequences discussed the topics to be included in the commissioned papers; invited authors with the necessary backgrounds and expertise to develop the papers; listened to the authors of the papers present their draft articles; critiqued multiple drafts of the papers in an ongoing peer-review process; and identified areas in need of more research (see Exhibit 2 for a list of commissioned papers). The Panel’s sessions were marked by a free sharing of scientific ideas and discussion that gave every Panel member and author an opportunity to present his or her point of view.

Exhibit 2. Papers Commissioned by the Panel on Contexts and Consequences

Studying College Alcohol Use: Widening the Lens, Sharpening the Focus
George W. Dowdall, Ph.D., Professor, Department of Sociology, St. Joseph’s University, and Henry Wechsler, Ph.D., Lecturer and Director of College Alcohol Studies, Department of Health and Social Behavior, Harvard School of Public Health

Epidemiology of Alcohol and Other Drug Use among American College Students
Patrick M. O’Malley, Ph.D., Senior Research Scientist, Institute for Social Research, University of Michigan, and Lloyd D. Johnston, Ph.D., Distinguished Research Scientist, Institute for Social Research, University of Michigan

Student Factors: Understanding Individual Variation in College Drinking
John S. Baer, Ph.D., Research Associate Professor, Department of Psychology, University of Washington, and Coordinator of Education, Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System

A Developmental Perspective on Alcohol Use and Heavy Drinking during Adolescence and the Transition to Young Adulthood
John E. Schulenberg, Ph.D., Senior Research Scientist, Institute for Social Research, Professor, Department of Psychology, and Research Scientist, Center for Human Growth, University of Michigan, and Jennifer L. Maggs, Ph.D., Associate Professor, Family Studies and Human Development, University of Arizona

The Adolescent Brain and the College Drinker: Biological Basis of Propensity to Use and Misuse Alcohol
Linda P. Spear, Ph.D., Distinguished Professor and Chairperson, Department of Psychology, Center for Developmental Psychobiology, Binghamton University

College Factors That Influence Drinking
Cheryl A. Presley, Ph.D., Director, Student Health Programs and Assistant to the Vice Chancellor for Student Affairs for Research, Executive Director, Core Institute, Southern Illinois University; Philip W. Meilman, Ph.D., Director, Counseling and Psychological Services, Courtesy Professor of Human Development, Associate Professor of Psychology in Clinical Psychiatry, Cornell University; and Jami S. Leichliter, Ph.D., Behavioral Scientist, Division of STD Prevention, Centers for Disease Control and Prevention

Surveying the Damage: A Review of Research on Consequences of Alcohol Misuse in College Populations
H. Wesley Perkins, Ph.D., Professor of Sociology, Department of Anthropology and Sociology, Hobart and William Smith Colleges

Alcohol Use and Risky Sexual Behavior among College Students and Youth: Evaluating the Evidence
M. Lynne Cooper, Ph.D., Professor of Psychology, Department of Psychology, University of Missouri at Columbia

Alcohol-Related Sexual Assault: A Common Problem among College Students
Antonia Abbey, Ph.D., Associate Professor, Department of Community Medicine, Wayne State University

Alcohol-Related Aggression during the College Years: Theories, Risk Factors and Policy Implications
Peter R. Giancola, Ph.D., Assistant Professor of Psychology, University of Kentucky

Today’s First-Year Students and Alcohol
M. Lee Upcraft, Ph.D., Senior Scientist, Center for the Study of Higher Education, Professor Emeritus of Higher Education, and Assistant Vice-President Emeritus for Student Affairs, The Pennsylvania State University

So What Is an Administrator to Do?
Susan Murphy, Ph.D., Vice President, Student and Academic Services, Cornell University

The following sections summarize and synthesize the principal points made in the commissioned papers and during the Panel’s discussions. Figures providing a graphic presentation on the scope of the problem can be found in the appendix.

Overview of College Student Drinking

Alcohol misuse on college campuses is not a new problem. It is entrenched in the culture of many institutions of higher learning and in students’ social lives. U.S. youth and college administrators alike cite alcohol as the most pervasively misused substance on campus. Recent news stories publicizing alcohol-related deaths on college campuses have drawn attention to this public health problem. Alcohol misuse among college students is taking its toll not only on the students who drink alcohol to excess, but also on other students affected by the behavior of their drinking peers, college administrators, health care personnel who counsel student drinkers, the community, and the institution’s physical plant and grounds, which often sustain heavy damage from vandalism by inebriated college students.

Recent concerns have often focused on the practice of binge drinking, typically defined as consuming five or more drinks in a row for men, and four or more drinks in a row for women. A shorthand description of this type of heavy episodic drinking is the “5/4 definition.” Approximately two of five college studentsmore than 40 percenthave engaged in binge drinking in the past 2 weeks, according to this definition. It should be noted, however, that colleges vary widely in their binge drinking ratesfrom 1 percent to more than 70 percentand a study on one campus may not apply to others (Wechsler et al., 1994, 1998, 2000b).

The U.S. Surgeon General and the U.S. Department of Health and Human Services (USDHHS) have identified binge drinking among college students as a major public health problem. In Healthy People 2010, which sets U.S. public health goals through the year 2010, the Federal government has singled out binge drinking among college students for a specific, targeted reduction (i.e., from 39 to 20 percent) by the year 2010. Healthy People 2010 notes that: “Binge drinking is a national problem, especially among males and young adults.” The report also observes that: “The perception that alcohol use is socially acceptable correlates with the fact that more than 80 percent of American youth consume alcohol before their 21st birthday, whereas the lack of social acceptance of other drugs correlates with comparatively lower rates of use. Similarly, widespread societal expectations that young persons will engage in binge drinking may encourage this highly dangerous form of alcohol consumption” (USDHHS, 2000).

There is evidence that more extreme forms of drinking by college students are escalating. In one study, frequent binge drinkers grew from 20 to 23 percent between 1993 and 1999. The number of students who reported three or more incidents of intoxication in the past month also increased (Wechsler, et al., 2000b). It should be noted, however, that the number of college students who do not drink is also growing. In the same study, the percentage of abstainers increased from 15 to 19 percent.

Binge drinking is not unique to the United States. Although the cross-cultural literature is scant, college students in the United States seem to drink somewhat less than their counterparts in European countries and somewhat more than their counterparts in Asian countries. There is some evidence that problematic drinking-related behaviors such as rowdiness, aggressiveness, and inappropriate actions are more pronounced in the United States than in some other countries (Delk and Meilman, 1996; Hong and Isralowitz, 1989; Leadley and Greenfield, 1999).

Glossary of Alcohol Terminology

There are three broad domains to consider when discussing alcohol involvement: (1) alcohol consumption, (2) alcohol-related consequences or problems, and (3) alcohol dependence. Although conceptually and empirically related, each refers to a distinct set of phenomena and each has important implications for those concerned with college student drinking.

The term alcohol consumption refers to the frequency with which alcohol is consumed and/or quantity consumed over a given time. Frequency refers to the number of days or, sometimes, occasions on which someone has consumed alcoholic beverages during a specified interval such as a week, month, or year. Quantity refers to the amount consumed on a given drinking occasion. Most typically, consumption is assessed using “standard drinks.” In the United States these are defined as 5 ounces of wine, 12 ounces of beer, or 1.25 ounces of distilled spirits. Quantity and frequency measures can be combined to form a measure of quantity/frequency (Q/F), which estimates the total volume consumed over a specified time. Because individuals do not drink the same amount on each drinking occasion, some surveys attempt to assess the frequency of drinking various amounts of alcohol (e.g., one to two drinks, three to four drinks, five to six drinks, seven or more drinks) over a specified period. This approach, although cumbersome, probably provides a more accurate assessment of total volume consumed as well as variability of drinking pattern.

However, assessing the frequency of drinking varying amounts of alcohol is complex. Moreover, for many purposes, the primary concern is not “light” or “moderate” consumption but rather “heavy consumption.” As a result, it is common to assess heavy consumption using the frequency of consuming a number of drinks meeting or exceeding a certain threshold.

Heavy-drinking occasions are often referred to as “binges” in the college student drinking literature. Based on the influential work of Henry Wechsler and colleagues (who define “binge” as five or more drinks in a row for men and four or more drinks in a row for women), the prevalence of binge drinking has become a key metric in estimating the extent of the alcohol problem on college campuses.

There has been some controversy surrounding the use of the term “binge drinking.” Historically, binge drinking has referred to an extended period of heavy drinking (for example, a “bender” lasting 3 days or more) that is seen in some alcoholic patients. Some clinicians believe that using the term “binge” to refer to a less severe phenomenon is potentially confusing and blurs this very important distinction. On the other hand, Dr. Wechsler has argued that the term “binge” is used in a variety of contexts (e.g., with respect to eating and shopping) and the new usage with respect to alcohol is consistent with the more general meaning. Other writers have criticized the failure to specify the drinker’s body mass and the time period over which five (or four) drinks are consumed, both of which affect blood alcohol concentration (BAC). Dr. Wechsler believes that “in a row” implies a relatively short time, and has argued further that consumption at these levels is associated with a greatly enhanced likelihood of experiencing a range of negative consequences (Wechsler and Nelson, 2001). Whether terms such as “heavy drinking,” “binge drinking,” or “drinking to intoxication” are used, it is clear that consumption of large quantities of alcohol on a single drinking occasion is an important variable in assessing college students’ alcohol involvement.

Alcohol-related consequences refer to a variety of negative life events that are the direct result of alcohol consumption. These consequences include:

  • Social problems (e.g., physical or verbal aggression, marital difficulties, loss of important social relationships),
  • Legal problems (e.g., arrests for driving while intoxicated, public inebriation),
  • Educational/vocational problems (e.g., academic difficulties, termination from employment, failure to achieve career goals), and
  • Medical problems (e.g., physical injury, liver disease, central nervous system disease).

To many, consumption by itself is a major social issue only to the extent that it generates adverse consequences. Consequently, it is possible to conceive of prevention strategies (e.g., designated driver programs) that might not reduce consumption but still reduce consequences.

The term alcohol dependence replaces the older term “alcoholism” and refers to a syndrome consisting of signs and symptoms signifying the importance of alcohol consumption in the life of the drinker. Among these signs and symptoms are the following (Edwards, 1986; Edwards and Gross, 1976):

  • “A narrowing of the drinking repertoire” (i.e., a tendency for drinking patterns to become fixed, less influenced by environmental cues or contingencies, and motivated by the avoidance of or escape from withdrawal symptoms),
  • “Salience of drinking” (i.e., alcohol comes to play an increasingly central role in the life of the drinker relative to other life tasks and challenges),
  • Increased tolerance to alcohol,
  • Withdrawal symptoms upon cessation or reduction of alcohol intake,
  • Drinking to escape from or avoid withdrawal symptoms,
  • “Subjective awareness of the compulsion to drink,” and
  • Rapid reinstatement of dependence symptoms upon resumption of drinking after a period of abstinence.

Both alcohol-related consequences and the alcohol dependence syndrome can be viewed as dimensional constructs that can be graded in intensity from absent to severe. Notably missing from these descriptions is reference to the amount of alcohol consumed. Although individuals who drink excessive amounts of alcohol are more likely to incur alcohol-related problems and alcohol dependence symptoms, current diagnostic practice focuses more on the consequences of drinking and on the psychological and physiological significance of drinking to the individual than on the quantity or frequency of consumption per se. The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes two major categories of alcohol use disorder, (1) alcohol abuse and (2) alcohol dependence, that roughly correspond to the distinction between alcohol-related disabilities and the alcohol dependence syndrome (American Psychiatric Association (APA), 1994; Edwards and Gross, 1976). Within DSM-IV, alcohol dependence is the more severe disorder, and its presence or history excludes the diagnosis of alcohol abuse.

Barriers to Reducing Alcohol Misuse

Barriers to reducing alcohol misuse on college campuses are numerous. Alcohol use is woven into U.S. culture, is sanctioned by adults for the pleasure of adults, and is associated with times of celebration and happiness. From an early age, many American children see adults drinking at home, in restaurants and clubs, and at parties. They expect to participate in this activity as they grow into adulthood. Although the legal U.S. drinking age is 21 in all States, students know that enforcement of this law is lax in many college environments.

All too frequently, adults sell liquor to underage students without asking for proper identification. Underage students also obtain alcoholic beverages from older students or obtain false identification so they can buy liquor before they reach the age of 21. As one student put it, “[Our] campus culture is most easily identified by the drinking culture. Within weeks of their arrival, freshmen have purchased fake IDs and are frequenting the bars…” (Murphy and Trejos, 2000). Drink specials in bars such as two-for Tuesdays (days on which two beers can be had for the price of one) reinforce drinking as a cultural norm and a way for college students to socialize. “Part of college life is drinking, and you’re not going to change that,” said another student. “I like the bar scene because it’s one way I get to hang out with my friends” (Murphy and Ly, 2000).

Drinking alcohol to excess impairs judgment and self-control. When drinking among college students leads to destructive consequences, including fights, college students themselves are often hard-pressed to explain what happened. “It’s a really weird mix of testosterone, alcohol, and some really unseemly behavior,” said one young man (Murphy and Trejos, 2000).

While recognizing that students and colleges and universities are increasingly diverse, this report focuses primarily on students who attend 4-year, residential colleges immediately or shortly after high school. The report focuses on this group because of concerns that certain factors related to the “traditional” college experience may inadvertently encourage, permit, or even reward excessive drinking behavior.


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Historical document
Last reviewed: 9/23/2005

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