Misuse and abuse of alcohol are among the most prevalent mental health problems among young adults today (Grant, 1997), and there is good evidence that these problems have increased along with depression and anxiety disorders (Fombonne, 1998; Kessler and Walters, 1998). Young adults are among the heaviest drinkers in the United States (Naimi et al., 2003), and college students drink more heavily than their non-college attending peers (Johnston et al., 1997). In fact, colleges have proven uniquely risky for several mental health and behavioral problems, including alcohol, tobacco and illicit drug use (Hingson et al., 2002; Johnston et al., 1997; O'Malley and Johnston, 2002).
Heavy episodic or binge drinking may be the most frequently reported and researched mental health problem among college youth. About 44% of U.S. college students binge drink--consuming five or more drinks in a row for males and four or more drinks for females on one or more occasions during a two-week period. Half of these students do so frequently (i.e., three or more times within two weeks) (Centers for Disease Control and Prevention, 1997; Douglas et al., 1997;Wechsler et al., 1994).
This article includes a summary of research on social and developmental aspects of binge drinking in college, and an overarching framework for considering vulnerability and life course issues relevant to prevention and treatment.
Social and Developmental Correlates of Binge Drinking
Young people come to campus with social demographic, family and drinking histories that influence their drinking in college. For example, one out of every 10 college students reports growing up with a problem drinking parent and, once in college, these young people either abstain from alcohol at greater than expected rates or disproportionately engage in binge drinking and abuse alcohol (Weitzman and Wechsler, 2000).
In college, a range of factors related to students' peers, affiliations, normative surrounds and living contexts influence the students' alcohol consumption and harms (Figure 1) (Wechsler et al., 1995). Both personal and institutional attachments affect high-risk drinking (Hawkins et al., 1992). High rates of binge drinking exist among athletes and sports fans (Nelson and Wechsler, 2003, 2001), fraternity and sorority members, and highly social students, while female, racial/ethnic minority, religious, married, older or non-traditional students all tend to consume less alcohol (Wechsler et al., 1995).
Peer norms, activities, and patterns of social connection and activity correlate positively with binge drinking (Bachman et al., 1984; Perkins and Wechsler, 1996), as do residence with multiple roommates or in a group house (Wechsler et al., 1995). Volunteering, working for pay and engagement with outside community organizations are associated with decreased risks (Wechsler et al., 1995; Weitzman and Kawachi, 2000). Levels of social bonding and trust within the campus community protect against heavy episodic drinking. For example, exposure to high campus community norms of volunteering, an indicator of social trust, individual investment in the group or social capital (Coleman, 1988; Putnam, 1993), appears to lessen individual risks for heavy episodic drinking even after controlling for individual volunteering (Weitzman and Kawachi, 2000).
The reciprocal relationships that exist between peers, residence and lifestyle factors are hypothesized to have a synergistic influence on what young people know, believe, endorse and do with regard to alcohol and on harms resulting from its misuse. This process involves self-selection as well as social influence. For example, students who join fraternities are more likely to engage in heavy episodic drinking in high school (Treno et al., 2001; Wechsler et al., 1996; Weitzman et al., 2003b). Parental supervision and friends' drinking-related norms and behaviors also influence adolescent drinking (Bahr et al., 1995; Kandel, 1978).
Adolescent Development and Drinking Progression
The transition to college from high school is a point at which parental supervision diminishes and friendships, attachments to work and extracurricular activities shift (Bachman et al., 1984). Upon entering college, students re-establish attachments and social roles with new peers and institutions, and this transition may comprise a key developmental moment in which drinking behaviors shift.
While a large minority of college students binge drink during their high school years, a substantial number of them adopt binge drinking oncein college. In fact, binge drinking isnot invariant in young adulthood (Schulenberg et al., 1996). From high school to college it appears to reflect at least four distinct progression patterns described in Figure 2 as: acquisition or uptake of binge drinking in college, continuation of binge drinking from high school to college, discontinuation in college, and avoidance in high school and college (Weitzman, unpublished data). The uptake or acquisition pattern is explained by a range of predictors, including: student demographic characteristics, residence with parents (protective), residence in a high-binge school or fraternity/sorority house (risky), ease of access of alcohol (risky), close peer networks that involve alcohol (risky), attitudes that favor heavier and/or younger drinking (risky), very low or discounted price for alcohol (most risky) (Weitzman et al., 2003b). From a prevention and treatment perspective, it may be important to match interventions onto particular progression patterns and subgroups for maximum effect.
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