Social Developmental Overview of Heavy Episodic or Binge Drinking Among U.S. College Students
By Elissa R. Weitzman, Sc.D., M.Sc.
February 1, 2004
Dr. Weitzman is a social and psychiatric epidemiologist at the Harvard School of Public Health. She is co-principal investigator of the HSPH College Alcohol Study and Study of College Health Behaviors.
Environmental Influences on Binge Drinking
Features of college environments play a powerful role in promoting heavy alcohol(Drug information on alcohol) use (National Institute on Alcohol Abuse and Alcoholism, 2002; Substance Abuse and Mental Health Services Administration, 1999; Treno et al., 2001). Rates of binge drinking vary dramatically by college, geographic region (lower in the West), and by the sets of policies and laws governing alcohol sales and use (Wechsler et al., 2002b, 2000).
Among the most important environmental determinants of binge drinking are pricing and promotion of alcoholic beverages (Chaloupka and Wechsler, 1996). Low prices and easy access promote underage alcohol use (Kuo et al., 2003). High density of alcohol outlets around campuses correlates with higher levels of frequent and heavy drinking and drinking-related problems including among women, underage students and those who report they were not binge-drinkers in high school but picked up the behavior in college (Weitzman et al., 2003a).
Select campus and community factors may help control binge drinking in college. Substance-free residences, where students are prohibited from using alcohol and tobacco products, are associated with less alcohol use and fewer secondhand effects of alcohol (Wechsler et al., 2001). The National Minimum Legal Drinking Age law appears effective (Toomey and Wagenaar, 2002; Wagenaar and Toomey, 2002). Extensive laws restricting underage and high-volume drinking at state and local levels are associated with lower odds of drinking and binge drinking among underage students (Wechlser et al., 2002b, 2002c) and college students (Wechsler et al., 2003).
The effects of environmental risk and protective factors are under-researched as they may affect particularly vulnerable groups, including children of alcoholics or young people with mental health problems, such as depression.
Harms and Health Consequences
As a result of binge drinking, college students experience substantial harm, from academic problems to physical and sexual assault, overdose, injury and death (Perkins, 2002; Wechsler et al., 2002a). Problems increase with consumption (Wechsler et al., 1995). Some 1,400 U.S. college students die annually from alcohol-related motor vehicle crashes and unintentional injuries, while over 2 million drive under the influence, 3 million ride with an intoxicated driver and half a million are unintentionally non-fatally injured under the influence (Hingson et al., 2002).
As with young people in other types of settings, alcohol use/abuse in college predicts other drug use, including tobacco (Rigotti et al., 2000), marijuana and other illicit drug use (Gledhill-Hoyt et al., 2000). Binge drinking may be a marker for multiple problems or high-risk profile that includes elevated odds for firearm possession on campus (Miller et al., 2002).
Approximately one-third of college students and three in five frequent binge-drinkers qualify for a diagnosis of alcohol abuse, while one in 17 (one in five frequent binge-drinkers) could be diagnosed as alcohol dependent (Knight et al., 2002) based on DSM-IV criteria. Despite their alcohol-related problems, few students who drink heavily perceive that they are heavy or problem drinkers and even fewer report that they have sought treatment or counseling (Knight et al., 2002), findings that hold even among presumably high-awareness groups such as self-identified children of problem drinkers (Weitzman and Wechsler, 2000). The effects of binge drinking in college on later, post-college outcomes are not known.
In addition to their adverse effects on drinkers, heavy drinking patterns in college negatively impact others--so called "secondhand" effects (Wechsler et al., 1995). Secondhand effects range in severity from typically nuisance disorders such as finding vomit in one's residence, to serious offenses including sexual and/or physical assault. Risks for secondhand effects mount substantially in high-binge college settings. Secondhand effects are also experienced by residents of communities nearby colleges, particularly those in which larger percentages of students binge drink (Wechsler et al., 2002a), a finding almost entirely explained by the density of alcohol outlets in neighborhoods adjacent to universities.
Binge drinking is a serious and heterogeneous problem affecting a substantial minority of young people in college today. It is exacerbated both by factors students bring with them to college--such as positive family histories of alcohol problems, or established histories of heavy or binge drinking in high school--and by features of the college environment. Effective prevention and treatment will require a nuanced approach to assess risk, recognize individual vul-nerabilities and reduce individual, as well as environmental, hazards that play on them.
1. Bachman JG, O'Malley PM, Johnston LD (1984), Drug use among young adults: the impacts of role status and social environment. J Pers Soc Psychol 47(3):629-645.
2. Bahr SJ, Marcos AC, Maughan SL (1995), Family, educational and peer influences on the alcohol use of female and male adolescents. J Stud Alcohol 56(4):457-469.
3. Centers for Disease Prevention and Control (1997), Youth risk behavior surveillance: National College Health Risk Behavior Survey-United States, 1995. MMWR 46(suppl 6):1-54.
4. Chaloupka FJ, Wechsler H (1996), Binge drinking in college: the impact of price, availability, and alcohol control policies. Contemporary Economic Policy 14:112-124.
5. Coleman JS (1988), Social capital in the creation of human capital. Amer J Sociol 94(suppl):95-120.
6. Douglas KA, Collins JL, Warren C et al. (1997), Results from the 1995 National College Health Risk Behavior Survey. J Am Coll Health 46(2):55-66.
7. Fombonne E (1998), Increased rates of psychosocial disorders in youth. Eur Arch Psychiatry Clin Neurosci 248(1):14-21 [see comment].
8. Gledhill-Hoyt J, Lee H, Strote J, Wechsler H (2000), Increased use of marijuana and other illicit drugs at U.S. colleges in the 1990s: results of three national surveys. Addiction 95(11):1655-1667.
9. Grant BF (1997), Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol 58(5):464-473.
10. Hawkins JD, Catalano RF, Miller JY (1992), Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychol Bull 112(1):64-105.
11. Hingson R, Heeren T, Zakocs RC et al. (2002), Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24. J Stud Alcohol 63(2):136-144.
12. Johnston LD, O'Malley PM, Bachman JG (1997), National survey results on drug use from the Monitoring the Future Study, 1975-1995. Volume II: College students and young adults. Publication No. 98-4140. Rockville, Md.: National Institute on Drug Use.
13. Kandel DB (1978), Convergences in prospective longitudinal surveys of drug use in normal populations. In: Longitudinal Research on Drug Use: Empirical Findings and Methodological Issues, Kandel DB, ed. Washington, D.C.: Hemisphere Publishing, pp3-38.
14. Kessler RC, Walters EE (1998), Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depress Anxiety 7(1):3-14.
15. Knight JR, Wechsler H, Kuo M et al. (2002), Alcohol abuse and dependence among U.S. college students. J Stud Alcohol 63(3):263-270.
16. Kuo M, Wechsler H, Greenberg P, Lee H (2003), The marketing of alcohol to college students: the role of low prices and special promotions. Am J Prev Med 25(3):204-211.
17. Miller M, Hemenway D, Wechsler H (2002), Guns and gun threats at college. J Am Coll Health 51(2):57-65 [see comment].
18. Naimi TS, Brewer RD, Mokdad A et al. (2003), Binge drinking among U.S. adults. JAMA 289(1):70-75 [see comment].
19. National Institute on Alcohol Abuse and Alcoholism (NIAAA) Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism (2002), A call to action: changing the culture of drinking at U.S. colleges. Publication No.:02-5010. Bethesda, Md.: National Institute on Alcohol Abuse and Alcoholism. Available at: www.collegedrinkingprevention.gov/Reports
20. TaskForce/TaskForce_TOC.aspx. Accessed Jan. 5, 2004.
21. Nelson TF, Wechsler H (2001), Alcohol and college athletes. Med Sci Sports Exerc 33(1):43-47.
22. Nelson TF, Wechsler H (2003), School spirits: alcohol and collegiate sports fans. Addict Behav 28(1):1-11.
23. O'Malley PM, Johnston LD (2002), Epidemiology of alcohol and other drug use among American college students. J Stud Alcohol 14(suppl):23-39.
24. Perkins HW (2002), Surveying the damage: a review of research on consequences of alcohol misuse in college populations. J Stud Alcohol 14(suppl): 91-100.
25. Perkins HW, Wechsler H (1996), Variation in perceived college drinking norms and its impact on alcohol abuse: a nationwide study. J Drug Issues 26:961-974.
26. Putnam RD (1993), The prosperous community. Social capital and public life. Am Prospect 13:35-42.
27. Rigotti NA, Lee JE, Wechsler H (2000), U.S. college students' use of tobacco products: results of a national study. JAMA 284(6):699-705.
28. Schulenberg J, O'Malley PM, Bachman JG et al. (1996), Getting drunk and growing up: trajectories of frequent binge drinking in the transition to young adulthood. J Stud Alcohol 57(3):289-304.
29. Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention, Division of State and Community Systems Development (1999), Preventing Problems Related to Alcohol Availability: Environmental Approaches, Reference Guide, Third in the PEPS Series. Publication No. (SMA) 99-3298. Rockville, Md.: Department of Health and Human Services. Available at: www.health.org/govpubs/PHD822/aar.htm. Accessed Jan. 9, 2004.
30. Toomey TL, Wagenaar AC (2002), Environmental policies to reduce college drinking: options and research findings. J Stud Alcohol 14(suppl):193-205.
31. Treno AJ, Gruenewald PJ, Johnson FW (2001), Alcohol availability and injury: the role of local outlet densities. Alcohol Clin Exp Res 25(10):1467-1471.
32. Wagenaar AC, Toomey TL (2002), Effects of minimum drinking age laws: review and analyses of the literature from 1960 to 2000. J Stud Alcohol 14(suppl):206-225.
33. Wechsler H, Davenport A, Dowdall G et al. (1994), Health and behavioral consequences of binge drinking in college: a national survey of students at 140 campuses. JAMA 272(21):1672-1677.
34. Wechsler H, Dowdall GW, Davenport A et al. (1995), Correlates of college student binge drinking. Am J Public Health 85(7):921-926.
35. Wechsler H, Kuh G, Davenport A (1996), Fraternities, sororities and binge drinking: results from a national study of American colleges. NASPA Journal 33(4):260-279.
36. Wechsler H, Lee JE, Hall J et al. (2002a), Secondhand effects of student alcohol use reported by neighbors of colleges: the role of alcohol outlets. Soc Sci Med 55(3):425-435.
37. Wechsler H, Lee JE, Kuo M (2002b), Trends in alcohol use, related problems and experience of prevention efforts among U.S. college students 1993-2001: results from the 2001 Harvard School of Public Health College Alcohol Study. J Am Coll Health 50(5):203-217.
38. Wechsler H, Lee JE, Kuo M, Lee H (2000), College binge drinking in the 1990s: a continuing problem. Results of the Harvard School of Public Health 1999 College Alcohol Study. J Am Coll Health 48(5):199-210.
39. Wechsler H, Lee JE, Nelson TF (2001), Drinking levels, alcohol problems, and secondhand effects in substance-free college residences: results of a national study. J Stud Alcohol 62(1):23-31.
40. Wechsler H, Lee JE, Nelson TF (2002c), Underage college students' drinking behavior, access to alcohol, and the influence of deterrence policies: findings from the Harvard School of Public Health College Alcohol Study. J Am Coll Health 50(5):223-236.
41. Wechsler H, Lee JE, Nelson TF (2003), Drinking and driving among college students: the influence of alcohol control policies. Am J Prev Med 25(3):212-218.
42. Weitzman, ER, Folkman A, Folkman KL et al. (2003a), The relationship of alcohol outlet density to heavy and frequent drinking and drinking-related problems among college students at eight universities. Health Place 9(1):1-6.
43. Weitzman ER, Kawachi I (2000), Giving means receiving: the protective effect of social capital on binge drinking on college campuses. Am J Public Health 90(12):1936-1939.
44. Weitzman ER, Nelson TF, Wechsler H (2003b), Taking up binge drinking in college: the influence of personal, social and environmental factors. J Adolesc Health 32(1):26-35.
45. Weitzman ER, Wechsler H (2000), Alcohol abuse and related problems among children of problem drinkers: findings from a national survey of college alcohol use. J Nerv Ment Dis 188(3):148-154.
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