Psychiatric Times.
No. 2
Social Developmental Overview of Heavy Episodic or Binge Drinking Among U.S. College Students
By Elissa R. Weitzman, Sc.D., M.Sc.
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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.
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