College students' heavy drinking: risk factors and intervention strategies across cultures

College Students and Alcohol Use

THE CONNECTION AND THE SOLUTION

International Perspective

Findings of studies conducted in 13 countries found that college students are at a high risk for heavy drinking with serious immediate health consequences (Karam, Kypri & Salamoun, 2007). These consequences included drink-driving and other substance use and longer-term consequences, such as alcoholism. Perilous drinking appears more prevalent in Australasia, Europe, and South America than in Africa and Asia, according to the studies. They also said alcohol consumption has been increasing, especially among young people who are college students, in the U.S.A. (Karam, et al.).

These studies surveyed a mixed set of other recent studies from Africa, Asia, Australasia, Europe and South America (Karam et al., 2007). They found that alcohol was more used by male college students who belonged to higher socio-economic status, with higher educational levels and whose families indulged in excessive alcohol. On the other hand, belief in God, the practice of faith and negative family attitudes towards excessive drinking went against an indulgence. Some of the studies revealed that increased alcohol consumption occurred in the 1990s. These students were inclined to drink on Fridays, when classes end for the week, and if they live in a residential hall. Moreover, alcohol use also increased anxiety, smoking, the use of other substances and drink-driving. College student drinking was an alarming problem in Europe, Australasia and South America. Evidence continued to mount that it was reaching problem levels also in countries in other continents and with similar risk factors. Web-based screening, brief intervention, motivational intervention and psycho-education have been attempted in countries like Sweden and New Zealand to respond to the problem (Karam, et al.).

The most frequent consequences of excessive drinking by college students were damaged property, poor class attendance, hangovers, police arrests, injuries and fatalities (Labrie, Hummer & Pedersen, 2007). The National Institute on Alcohol Abuse and Alcoholism sought to identify the reasons for indulgence in order to design and establish intervention measures. Earlier researches identified peer influence, availability of alcoholic drinks and pressure with their studies as influences and social purposes and emotional escape or relief as the reasons for drinking. The factors to these were mood enhancement, tension reduction or coping, and social motives. Each of the factors possessed unique characteristics in relation to the behavior and the outcomes. Enhancement and coping motives often led to excessive consumption and its consequences. Social reasons did not conduce to excessive consumption or ensuing problems (Labrie, et al.).

A recent research project reaffirmed the findings of earlier studies on the influence of social reasons for drinking among college students (Labrie et al., 2007). It also showed that female students engaged in drinking and incurred related consequences mainly for social reasons. Social camaraderie was the most frequent reason and the stronger social motivator, which determined alcohol consumption levels, than enhancement or coping motives. There was a clear gender difference in motive, the drinking and the consequences among college students. The social facilitation effect seemed to affect them through increased drinking. Drinking, in turn, led to negative consequences. Female students drank mainly for social reasons and this incurred harmful effects not previously considered.(Labrie, et al.).

Deliberate Use of Alcohol among College Students

A survey of 206 American college students on social cognitive and psychosocial factors found that alcohol use was a reasoned decision among them (Kuther & Temoshin, 2003). It has become common knowledge that alcohol use is highly prevalent among American college students. This is evident in popular newsmagazines, which feature problems on the use of alcohol in college campuses. Of the nationally surveyed college students, 85% said they consumed alcohol within the previous year, 70% every month, and 40% five or more in a row or in binge drinking in the previous two weeks. Another sample of more than 17,000 college students from 140 colleges throughout the U.S. said they indulged in binge drinking at least once in the last two weeks (Kuther & Temoshin).

Social cognitive models have been identified as strong predictors of alcohol use among adolescent and young adults, including college students (Kuther & Temoshin, 2003). Psychosocial factors, such as depression, anxiety and social support, also induce drinking. This study confirmed that social cognitive factors drove college students to report on their own drinking. Psychosocial motives drove them to do so only at 1%. Social support was the only significant psychosocial predictor. The awareness of both the positive and negative consequences of drinking was quite likely behind the willingness of college students to report on their own drinking. This implied that drinking was a deliberate and conscious decision on their part. Heavy drinkers viewed their drinking as something negative in that they perceived themselves as having reduced control over it. Peer norms were also found to be an important predictor of drinking as a perceived norm and behavior, which supports drinking. Parental drinking norms also surfaced, although not as strong as the preceding predictors (Kuther & Temoshin).

Environmental Policies

Many new studies attempted to determine if the preponderance of alcohol establishments enticed more drinking among college students but produced mixed results (Trommey et al., 2007). Three subsequent studies on college campuses provided the evidence that alcohol consumption and drinking-related problems increased where alcohol establishments teemed. These recent studies also showed that licensed establishments and community festivals commonly sold alcohol even when it was illegal. Training alcohol servers and managers to reduce the sale may be advantageous but required further investigation. Six studies concluded that increasing alcohol prices or taxes could discourage sales and decrease risky alcohol use and related problems. Another policy was banning alcohol use in college residences or at campus. Bans resulted in lower levels of consumption and alcohol-related problems. Finally, more recent studies found that multi-strategy approaches could be effective (Trommey, et al.).

A 2002 four-year survey of 747 residential colleges and universities throughout the U.S. conducted a social norms campaign (Trommey et al., 2007). Three recent surveys showed that the campaigns reduced students' misperceptions on peer alcohol use and, as a result, reduced alcohol use by students. Ensuing studies produced conflicting findings. One more recent study suggested that the problem was in the construction of the message and the presentation of the advertisements. Students liked the advertisement but the main message of the campaign did not seem to have adequately communicated it. Meanwhile, a national study evaluated changes in misperceptions on peer alcohol use and alcohol use at 37 colleges, which conducted social-norms campaigns between 1997 and 2001. The results were compared with those, which did not implement campaigns. The study found no decreases on drinking rates but increases in two of the five drinking policies. No changes in drinking rates were recorded. Environmental strategies have been recommended but received little or no evaluation. These have proved difficult to implement, have not been studied or subjected to publication bias (Trommey, et al.).

School Leaders Drink More

Over-active student leaders tended to drink thrice as much as other students and twice the national average (Spratt and Turrentine, 2001). This was the result of a random survey of 2,000 students drawn from the Core Survey national data. The respondents were 62% female and 50% non-White from minority and religious sectors. The result indicated that school leadership was a risk factor for alcohol use. The more positions a school leader occupied, the more she indulged in alcohol. In 1990, college presidents reported alcohol abuse as a nagging and grave concern for them. Almost two decades today, the problem persists as the most serious in colleges and universities (Spratt & Turrentine).

This random study targeted groups, which were perceived to use alcohol less than the average college students (Spratt & Turrentine, 2001). The prevailing assumption at the time of the study was that leaders in these groups would use alcohol less than non-leaders. Leaders would be chosen because they represented the groups' values against alcohol use. Researchers furthermore assumed that a leader with multiple positions or responsibilities would drink the least. The assumption was proved in the case of a leader who occupied only one position but proved false in a leader with two positions. When she occupied more positions, she drank all the more than the average student (Spratt & Turrentine).

Comparative figures on the average drinks per week for both high-use and low-use organizations showed that leaders drank more than members (Spratt & Turrentine, 2001). The striking differences in alcohol use between leaders and members appeared unexpectedly among low-use organizations. The leaders' average alcohol consumption per week was higher among those who occupied multiple positions than that of athletic and sorority leaders. Only fraternity members and leaders drank more in an average week than female student leaders belonging to surveyed religious and minority organizations (Spratt & Turrentine).

One explanation to the differences was that some students became leaders, not because they embodied the group's ideals, but because they sought the leadership role itself (Spratt & Turrentine, 2001). This made leadership a risk factor to alcohol use. The leader factor, even among low-use organizations, pushed student leaders towards higher rates of drinking. Another explanation was their internalizing cultural norms and moral values. Imbibing some personality attributes in leadership could make some student leaders more vulnerable to higher alcohol use. Researchers found that frequent drinkers were likelier than non-drinkers to be extroverted, social and entertainment-inclined. Student leaders who occupied multiple positions were likelier to adopt this disposition to adjust to personal interactions, which characterized leadership (Spratt & Turrentine).

The influence of other student leaders could explain this finding (Spratt & Turrentine, 2001). Leaders from these low-use organizations tended to absorb the wider culture of leaders who drank heavily in order to fit into that culture. Student leaders with multiple positions found more occasions to drink than those who occupied only one position of leadership. The interaction between the first two effects could further clarify the finding. The person-environment theory views behavior as the interaction between the person and the environment. To a student who occupies many leadership positions, alcohol use is the behavior, while the extroverted, social personality is the personal factor and the leader culture is the environment. Student leaders in low-use organizations could be at risk for high rates of alcohol use as a result of the merging of their social orientation with the wider culture of leadership. Those who occupy multiple positions were likelier to become extroverted and socially oriented, personality traits of those who drink frequently. At the same time, they had the greatest opportunity to interact with other student leaders of high-use organizations. These students would be at the highest risk of alcohol use (Spratt & Turrentine).

The Effect of Protective Behavioral Strategies on Alcohol Use

It is common knowledge that heavy drinking produces negative consequences.

College students know that it leads to absences, legal problems, injuries or death

(Martens, Ferrier & Cimini, 2007). Oftentimes, these negative consequences affect even un-involved innocent persons. Using two models, researchers tested if the introduction of protective behavioral strategies or PBS would reduce alcohol use. Results showed that those who would consume alcohol for positively reinforcing reasons engaged in fewer PBS. The strategies were associated with higher consumption of alcohol and more frequent alcohol-related problems (Martens et al., 2007).

The results sustained the argument that PBS would rouse alcohol use only for positive motives (Martens et al., 2007). They are consistent with the principles of basic operant conditioning and related theories of motivation. Those with strong motivations to drink would not tend to engage in strategies, which would reduce the chances of experiencing pleasant outcomes. The results also suggested the possibility of intervening processes occurring between motivation and actual consumption, which could either incline or disincline one to drink. But these processes appeared to affect only positively reinforcing drinking motives (Martens, et al.).

Binge drinking is connoted as self-destructive, intentional and unrestrained drinking for at least two days (Hanson, 2007). The drinker becomes so intoxicated that he must stop regular activities, ignore responsibilities, squander money and engage in harmful behaviors, like fights and risky sex. Prolonged use and the giving up of usual activities, which comprise the purview of clinical binge drinking (Hanson).

Within the context of college life, heavy episodic or binge drinking has been a major concern (Weitzman & Nelson, 2004). Although the heaviest drinkers in campus were at the greatest risk for harm, they were generally few and incurred only small amounts of harm associated with alcohol. Lower-level drinkers in college were, however, not to be dismissed as incurring zero level of the harm because they were numerous and accounted for most of alcohol-related harms. Analyses of national survey data showed that the greatest level of harm reported by college student drinkers was at the non-extreme levels. These are drinkers erroneously believed to be less than high-risk. Harms increase with consumption, but most drinkers did not consume extreme amounts of alcohol. The greatest risk of drinking-related harms was found among low-to-moderate drinking multiplied by the huge number of non-extreme drinkers. The national data used were drawn from 10 high-binge schools, which participated in the "A Matter of Degree" program. The connection between consumption and harm was consistent with that advanced by the prevention paradox (Weitzman & Nelson).

Findings recommended the use of environmental prevention strategies to reduce harm in the school community, including non-extreme drinkers (Weitzman & Nelson, 2004). Encouraging small reductions in consumption among the majority of drinkers could be more effective than drastically changing the chronic drinking patterns of heavy drinkers. These heavy drinkers and their drinking should be the subject of intensive clinical intervention efforts, instead (Weitzman & Nelson).

Environmental Strategies

Analyses of case data said that reducing consumption would also reduce harms associated with alcohol consumption (Weitzman & Nelson, 2004). Environmental

interventions in high-prevalence communities could do this. More specifically, if the strategies reduce or modify access and availability as well as expose consumption links to supervising school agents would reduce the incidence of harm in the college setting. Exploring naturally occurring and planned interventions would prove the usefulness and effectiveness of environmental approaches (Weitzman & Nelson).

Under-aged Drinkers

A set of 2001 data compared the responses of under-aged student drinkers and those aged 21-23-year-old peers (Welchsler, Lee, Nelson & Kuo, 2002). Under-aged college students drank alcohol less often than older student drinkers but to excess. School efforts and other deterrent measures had limited outreach. Half of these under-aged student drinkers were able to secure alcohol quite easily. Those who lived in States with stringent laws against minors' drinking limited their drinking and binge drinking. A majority of them also supported efforts at curbing under-aged drinking. Results of the study suggested that increased efforts and additional policies to control under-aged drinking could be workable and effective (Wechsler, et al.).

Counseling Heavy Drinkers

College and university administrators and law enforcers are always looking for ways to control the damage inflicted by overdrinking (Levin, 2004). Drunkenness, vandalism, absences, injuries and trouble with the law are among the consequences. Researchers suggested that heavy drinkers could benefit from brief but compulsory counseling interventions to reduce their drinking and prevent ensuing problems. Brown University researchers reported that non-mandated students who attended alcohol intervention programs had significantly higher grades and lower fewer heavy drinking days in the previous month than mandated students. Non-mandated students also had fewer alcohol-related problems (Levin).

An average college student drinker consumed an average of 7 drinks each session (Levin, 2004). Researchers found that drinkers could benefit from alcohol education and brief motivational interventions. Alcohol education provided factual knowledge about alcohol and its effects independently of insinuations to cut its use. Student drinkers' experience, their reasons for drinking, frequency and information on blood levels during heavy drinking were merged with brief motivational interventions. Researchers observed a general inclination in both groups of high-risk drinkers to reduce drinking after the interventions were presented. They internalized the interventions and responded well to the individual one-hour sessions. The effect of the non-judgmental change remained in them and resulted in less drinking six months later. In general, they were inclined to reduce the harm produced by drinking more than to abstain from drinking entirely. The results were quite consoling and encouraging to both school officials and the student drinkers. Campus counselors could find and institute workable alternatives for these students (Levin).

Effects of Heavy Episodic Drinking

A study examined the effects of heavy episodic alcohol use on academic engagement Porter & Pryor, 2007). It gathered the responses of more than 40,000 drinking college students from 28 select private colleges and universities to the issue. The strongest effects were on student-faculty interaction, more common in research universities and less common in coed and women's colleges. Heavy episodic drinking four or more times in two weeks by women at investigated research universities adversely affected their academic engagement. Women who drank less did not suffer as much. Men, who drank as much, did not experience a change in their learning (Porter & Pryor).

Heavy episodic drinking at examined coed and women's colleges did not significantly affect these students' academic performance (Porter & Pryor, 2007). Women college students at the research universities registered different responses. The more they drank, the less time they devoted to academic activities and the more time they spent on recreation and sports. The study also showed the effect of alcohol use on engagement. These women students at research universities who engaged in heavy episodic drinking also had lower grade point averages. The study likewise confirmed earlier researchers that women students at coed colleges drank more heavily. Women at the research universities drank less heavily than men. And students at women's colleges were least likely to engage in heavy episodic drinking among the three examined groups (Porter & Pryor).

The study also found a difference by institution type. The most positive educational outcomes proceeded from the student-faculty interaction (Porter & Pryor, 2007). Students who had maximum interaction with the faculty reached the highest levels of achievement and satisfaction. Students at the coed and women's colleges had richer interactions with faculty than students at research universities. It appeared that those at coed and women's colleges remained engaged in faculty-student interaction despite alcohol use, which served as protection. That level of engagement and interaction was lower in research universities. In the latter, both faculty and students may not be tolerant of the unpleasant effects of frequent heavy episodic drinking (Porter & Pryor).

Illicit Use of Prescription Stimulants

Alcohol use is often accompanied by drugs and tobacco. A survey was recently conducted with 269 random college students to determine what prescription stimulants they used, their motives for taking them and the routes of administration they used for these drugs (Teter, McCabe, LaGrange, Cranford & Boyd, 2006). Approximately three-fourths or 75.8% said they used amphetamine dextroamphetamine combination agent,

such as Adderal in the previous year. Approximately one fourth or 24.5% of them said they used methylphenidate, such as Ritalin, Concerta, Metadate or Methylin. They were thrice likelier to be Caucasian [CLOSE WINDOW]

and Hispanics than African-Americans and twice as many as Asians. The most common motives were to help them concentrate at 65.2%, study at

59.8%, and increase alertness at 47.5%. Other motives were to get high at 31% and to experiment (29.9%). Almost all illicit used took the drugs orally at 95% while 38.1% snorted the stimulants. The survey concluded that the most illicitly used prescription stimulant among college students was amphetamine-dextroamphetamine (Teter, et al.).

Non-Medical Use of Prescription Stimulants

College students reported lifetime non-medical use of prescription stimulants and at an increasing rate (McCabe, Knight, Teter & Wechsler, 2005). This was part of the conclusion of a survey conducted on the response of 10,904 college students from 119

colleges and universities from 39 States. The usage was 6.9 in the survey year, 4.1% in the previous year and 2.1% in the past month. The result affirmed those of other national studies on the use among college students and other young people. The survey found that non-medical use was higher among male white students who were members of fraternities and who had lower grades. These qualities were shared with those who were heavy substance users in American colleges (McCabe, et al.).

The survey also said that college students who used prescription stimulants non-medically also smoked cigarettes, engaged in frequent binge drinking, drank to get drunk, smoked marijuana and used ecstasy, cocaine, and opiates other than heroin (McCabe et al., 2005). In addition, they drove after binge drinking, and rode in vehicles with a drunk driver. Undergraduate male college students were likelier to report non-medical use of prescription stimulants than female college students. Risk factors, however, were similar between the sexes, however. The use of non-medical prescription stimulants was higher among white college students than among other racial groups. It was also higher among members of social fraternities and sororities than other students (McCabe, et al.).

The study also found similar geographical characteristics to those of young adults, aged 19-30 (McCabe et al., 2005). The annual rates of non-medical use were highest among young adults who lived in small colleges in the Northeastern region of the United States. The non-medical use of prescription stimulants was an effort at adjusting to more competitive admission standards in these learning institutions and membership in certain fraternities or sororities. The adjustment presented as a substitute for higher socio-economic status, as at least one study found that non-medical use was higher among college students with higher family incomes (McCabe, et al.).

Anecdotal reports and epidemiological studies said that non-medical use of prescription stimulants could lead to dependence behaviors (McCabe et al., 2005). Furthermore, a random study of 9,161 undergraduate users said that more than 90% of them obtained the stimulants from peers and friends. They were likely to be unaware of the drugs' interaction with other drugs and their contraindications and precautions (McCabe, et al.).

Tobacco Use

A study endeavored to determine and assess the exposure of young adults to tobacco use through the industry's marketing strategies (Rigotti, Moran & Wechsler, 2005). These strategies included sponsorship of social events at bars, nightclubs and college campuses. The study secured and analyzed data from the 2001 Harvard College Study and the responses of 10,904 random students at 119 colleges and universities in the United States It found that during the 2000-2001 school year, 8.5% of the respondents went to a bar, nightclub or campus social events where free cigarettes were offered. The study said that such events were held in 118 of the 119 schools. The high level of attendance was interpreted as a high student smoking prevalence among non-regular smokers before they turned 19 but not for regular smokers by age 19 (Rigotti, et al.).

This study concluded that attendance at a tobacco-industry-sponsored event at a bar, nightclub or campus party enhanced or greatly encouraged smoking among college students (Rigotti et al., 2005). Promotional events, such as these, were occasions during which non-smokers were exposed to, or encouraged to imitate, smokers. These occasions could drive irregular smokers to smoke regularly (Rigotti, et al.).