The tradition of drinking has developed into a kind of culture—beliefs and customs—entrenched in every level of college students' environments. Customs handed down through generations of college drinkers reinforce students' expectation that alcohol is a necessary ingredient for social success. These beliefs and the expectations they engender exert a powerful influence over students' behavior toward alcohol.
Customs that promote college drinking also are embedded in numerous levels of students' environments. The walls of college sports arenas carry advertisements from alcohol industry sponsors. Alumni carry on the alcohol tradition, perhaps less flamboyantly than during their college years, at sports events and alumni social functions. Communities permit establishments near campus to serve or sell alcohol, and these establishments depend on the college clientele for their financial success.
Students derive their expectations of alcohol from their environment and from each other, as they face the insecurity of establishing themselves in a new social milieu. Environmental and peer influences combine to create a culture of drinking. This culture actively promotes drinking, or passively promotes it, through tolerance, or even tacit approval, of college drinking as a rite of passage.
The Answer: Change the Culture. The Question: How?
When a student dies from intoxication or another alcohol-related incident makes headlines, college drinking captures the public's attention, for a while. On the campus itself, administrators deal with the immediate problem, and campus life soon returns to normal. Generally, the incident doesn't result in effective, long-term changes that reduce the consequences of college drinking.
Among the reasons for this seeming inattention to long-term solutions is that administrators see college drinking as an unsolvable problem. When schools have made efforts to reduce drinking among their students—and many have made considerable effort—they haven't had significant, campus-wide success. With each failed effort, the image of college drinking as an intractable problem is reinforced, administrators are demoralized, and the likelihood that schools will devote resources to prevention programs decreases.
One reason for the lack of success of prevention efforts is that, for the most part, schools have not based their prevention efforts on strategies identified and tested for effectiveness by research. Research on college drinking is a relatively young field, and the data is incomplete. Until the recent formation of the Task Force on College Drinking, administrators and researchers did not typically collaborate on this topic. Without the expertise of the research community, administrators were at a disadvantage in trying to identify and implement strategies or combinations of strategies to address alcohol problems specific to their schools.
The Task Force on College Drinking brought together experienced administrators and scientists, who assessed what both schools and researchers need to do to establish effective prevention programs. On the basis of their findings, they made the recommendations contained in this report. Their recommendations focus not on how to effect some type of blanket prohibition of drinking, but on changing the culture of drinking on campuses and involving the surrounding communities.
Foremost among their recommendations is that to achieve a change in culture, schools must intervene at three levels: at the individual-student level, at the level of the entire student body, and at the community level. Research conducted to date strongly supports this three-level approach. Within this overarching structure, schools need to tailor programs to address their specific alcohol-related problems. Underlying each recommendation is the Task Force's understanding that no two schools are alike, that environmental influences as well as individual student characteristics impact alcohol consumption, and that effective strategies extend beyond the campus itself to encompass the surrounding community.
The Task Force's focus is on how to change the culture that underlies alcohol misuse and its consequences on campus, rather than on simply determining the number of negative alcohol-related incidents that occur each year. But because data on the consequences of college drinking underscore the need for effective prevention strategies, these data are included in the section that follows. The report offers (1) a general approach to incorporating prevention programs on campus, (2) specific interventions that schools can combine to meet the needs of their campuses, and (3) recommendations for future research on college drinking.
A Snapshot of Annual High-Risk College Drinking Consequences
The consequences of excessive and underage drinking affect virtually all college campuses, college communities, and college students, whether they choose to drink or not.
Death: 1,400 college students between the ages of 18 and 24 die each year from alcohol-related unintentional injuries, including motor vehicle crashes (Hingson et al., 2002).
Injury: 500,000 students between the ages of 18 and 24 are unintentionally injured under the influence of alcohol (Hingson et al., 2002).
Assault: More than 600,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking (Hingson et al., 2002).
Sexual Abuse: More than 70,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape (Hingson et al., 2002).
Unsafe Sex: 400,000 students between the ages of 18 and 24 had unprotected sex and more than 100,000 students between the ages of 18 and 24 report having been too intoxicated to know if they consented to having sex (Hingson et al., 2002).
Academic Problems: About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall (Engs et al., 1996; Presley et al., 1996a, 1996b; Wechsler et al., 2002).
Health Problems/Suicide Attempts: More than 150,000 students develop an alcohol-related health problem (Hingson et al., 2002) and between 1.2 and 1.5 percent of students indicate that they tried to commit suicide within the past year due to drinking or drug use (Presley et al., 1998).
Drunk Driving: 2.1 million students between the ages of 18 and 24 drove under the influence of alcohol last year (Hingson et al., 2002).
Vandalism: About 11 percent of college student drinkers report that they have damaged property while under the influence of alcohol (Wechsler et al., 2002).
Property Damage: More than 25 percent of administrators from schools with relatively low drinking levels and over 50 percent from schools with high drinking levels say their campuses have a "moderate"or "major" problem with alcohol-related property damage (Wechsler et al., 1995).
Police Involvement: About 5 percent of 4-year college students are involved with the police or campus security as a result of their drinking (Wechsler et al., 2002) and an estimated 110,000 students between the ages of 18 and 24 are arrested for an alcohol-related violation such as public drunkenness or driving under the influence (Hingson et al., 2002).
Alcohol Abuse and Dependence: 31 percent of college students met criteria for a diagnosis of alcohol abuse and 6 percent for a diagnosis of alcohol dependence in the past 12 months, according to questionnaire-based self-reports about their drinking (Knight et al., 2002).
Heavy Episodic Consumption of Alcohol
Data from several national surveys indicate that about four in five college students drink and that about half of college student drinkers engage in heavy episodic consumption. Recent concerns have, therefore, 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 students—more than 40 percent—have engaged in binge drinking at least once during the past 2 weeks, according to this definition. It should be noted, however, that colleges vary widely in their binge drinking rates—from 1 percent to more than 70 percent—and 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 (e.g., from 39 percent 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 (defined as three times or more in the past 2 weeks) grew from 20 percent 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.
Understanding Alcohol Consumption
The term alcohol consumption encompasses two ideas important in characterizing an individual's drinking behavior: frequency (how often a person drinks) and quantity (how much a person drinks). Frequency of consumption refers to the number of days or, sometimes, occasions that an individual has consumed alcoholic beverages during a specified interval (e.g., week, month, and year). Quantity of consumption refers to the amount ingested on a given drinking occasion.
Most typically, consumption is assessed using "standard drinks"—in the United States, these are 5 ounces of wine, 12 ounces of beer, or 1.25 ounces of distilled spirits. Because individuals do not drink the same amount at every drinking occasion, some surveys attempt to assess the frequency with which a person drinks various amounts of alcohol (e.g., one to two drinks, three to four drinks, five to six drinks) over a specified period of time. Although cumbersome, this approach probably provides a fairly accurate assessment of total volume consumed and of variability in drinking pattern.
For many purposes, however, identifying "light" or "moderate" consumption is not the issue, "heavy" consumption is. For that reason, it is common to assess heavy consumption on the basis of the frequency of consuming a number of drinks meeting or exceeding a certain threshold. When describing college drinking, heavy drinking occasions are often referred to as "binges." 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 for women—the prevalence of binge drinking has become a key measure in estimating the extent of alcohol problems on college campuses.
Historically, binge drinking has referred to an extended period of heavy drinking (for example, a "bender" that lasts 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 blurs this important distinction. However, Dr. Wechsler has observed that the term binge is now commonly associated with eating and shopping and that its application to alcohol use is consistent with the term's generally accepted meaning.
Other researchers have voiced concern because the specific time period over which the five or four drinks are consumed is not specified nor is the body mass of an individual drinker. For example, after 5 drinks consumed over a fixed time span, a man of 240 pounds would have a lower blood alcohol level than a man of 140 pounds. Nor would a male or female of the same body weight achieve the same blood alcohol level following equal consumption because of gender-related differences in physiology. Dr. Wechsler believes that the phrase "in a row" implies a relatively short time frame. He also shows that individuals who consume alcohol at these levels increase their likelihood of experiencing a range of negative consequences.
Whether terms such as heavy drinking, binge drinking, or drinking to intoxication are used to describe students' behavior, it is clear that consumption of large quantities of alcohol on a single drinking occasion is important in assessing alcohol involvement. Also key in evaluating alcohol consumption are the consequences of that consumption which can include academic, personal, social, legal, and medical problems as well as dependent symptoms such as tolerance, withdrawal, and loss of control.
Alcohol and Adolescent Brain Development
Adolescence is a time of transition, physically, socially, and emotionally. The adolescent brain is in transition as well. Although important structural and functional changes take place in the brain from childhood to adulthood (Giedd et al., 1999), during adolescence such changes are widespread. During adolescence, the brain undergoes a major remodeling involving the formation of new connections between nerve cells, as well as the pruning of existing synaptic connections. These changes affect the processes involved in planning and decisionmaking, impulse control, voluntary movement, memory, and speech production, among others (Rubia et al., 2000). Similar changes occur in those parts of the brain that seem to affect how a person responds to alcohol and other drugs (Spear, 2000; Teicher et al., 1995). As a result, alcohol appears to have different effects on adolescents than adults (Spear, 2000).
Animal studies suggest that alcohol may have a greater impact on adolescent than adult memory (Markweise et al., 1998; Pyapali et al., 1999) and that these effects may be long lasting. Preliminary studies suggest that rats exposed to high levels of alcohol during adolescence may be more sensitive to alcohol-induced memory impairments later in life (White et al., 2000). Human studies have detected cognitive impairments in adolescent alcohol abusers weeks after they stopped drinking (Brown et al., 2000).
Although the causes of these long-lasting changes are unclear, they may in some cases involve alcohol-induced injury to the nervous system. In rats, exposure to high amounts of alcohol produces more extensive brain damage in adolescents than adults (Crews et al., 2000). In humans, adolescent-onset alcohol abuse has been associated with a reduction in the size of the hippocampus (DeBellis et al., 2000).
Research also suggests that adolescents are less sensitive than adults to some of alcohol's effects. For example, adolescent rats, on their first exposure to alcohol, are less susceptible than adult rats to alcohol's sedative effects, as well as its effects on balance and motor coordination (Little et al., 1996; White et al., 2001). It is not known whether these differences occur in humans. However, the findings suggest that adolescents might be able to stay awake and mobile at higher blood alcohol levels than adults with an equivalent history of alcohol exposure while, at the same time, experiencing greater alcohol-induced cognitive impairments and, possibly, more injury to the brain following high alcohol exposure levels.
Factors Affecting Students Drinking
The proportion of college students who drink varies depending on where they live. Drinking rates are highest in fraternities and sororities followed by on-campus housing (e.g., dormitories, residence halls) (Presley et al., 1996a, 1996b; Wechsler et al., 1998, 2000b). Students who live independently off-site (e.g., in apartments) drink less, while commuting students who live with their families drink the least (O'Hare, 1990; Wechsler et al., 2002).
Although the existing literature on the influence of collegiate environmental factors on student drinking is limited, a number of environmental influences working in concert with other factors may affect students' alcohol consumption (Presley et al., 2002). Colleges and universities where excessive alcohol use is more likely to occur include schools where Greek systems dominate (i.e., fraternities, sororities), schools where athletic teams are prominent, and schools located in the Northeast (Presley et al., 1996a, 1996b; Wechsler et al., 1996, 1997, 1998, 2000b; Werner and Greene, 1992).
Some first-year students who live on campus may be at particular risk for alcohol misuse. During their high school years, those who go on to college tend to drink less than their noncollege-bound peers. But during the first few years following high school, the heavy drinking rates of college students surpass those of their noncollege peers, and this rapid increase in heavy drinking over a relatively short period of time can contribute to difficulties with alcohol and with the college transition in general (Schulenberg et al., 2001). Anecdotal evidence suggests that the first 6 weeks of enrollment are critical to first-year student success. Because many students initiate heavy drinking during these early days of college, the potential exists for excessive alcohol consumption to interfere with successful adaptation to campus life. The transition to college is often so difficult to negotiate that about one-third of first-year students fail to enroll for their second year (Upcraft, 2000).
A Rite of Passage for All, or a Habit for Some That Impacts All?
Although the consequences of campus drinking are a major problem, contrary to popular misconceptions, the majority of college students drink moderately or abstain (Wechsler et al., 2000b). For many students, alcohol use is not a tradition. Students who drink the least attend:
(Meilman et al., 1995; Presley et al., 1996a, 1996b; Wechsler et al., 2000b).
Students who drink the most include:
(Johnston et al., 2001b; Meilman et al., 1994, 1999; Presley et al., 1996a, 1996b; Wechsler et al., 1996, 1997a, 1998, 2000b).
Other Factors Affecting Drinking
Numerous other factors affect drinking behavior among college students. These include biological and genetic predisposition to use, belief system and personality, and expectations about the effects of alcohol (Sher et al., 1999; Zucker et al., 1995). In addition to individual student characteristics, the size of a student body, geographical location, and importance of athletics on campus are also associated with consumption patterns as are external environmental variables including the pricing and availability of alcohol in the area surrounding a campus (Chaloupka and Wechsler, 1996; Chaloupka et al., 1998; Leichliter et al., 1998; Nelson and Wechsler, 2001; Presley et al., 1996a, 1996b; Wechsler et al., 1994, 1997, 1998, 2000a, 2000b).
Although some drinking problems begin during the college years, many students entering college bring established drinking practices with them. Thirty percent of 12th-graders, for example, report binge drinking in high school, slightly more report having "been drunk,"and almost three-quarters report drinking in the past year (Johnston et al., 2001a). Colleges and universities "inherit"a substantial number of drinking problems that developed earlier in adolescence.
Comparison with Non-college Peers
College drinking occurs at a stage in life when drinking levels are generally elevated. Compared to all other age groups, the prevalence of periodic heavy or high-risk drinking is greatest among young adults aged 19 to 24; and among young adults, college students have the highest prevalence of high-risk drinking (Johnston et al., 2001b; Substance Abuse and Mental Health Services Administration, 2001). Although their noncollegiate peers drink more often, college students tend to drink more heavily when they do drink (O'Malley and Johnston, 2002).
Secondhand Consequences of Drinking
Students who do not drink or do not abuse alcohol experience secondhand consequences from others' excessive use. In addition to physical and sexual assault and damaged property, these consequences include unwanted sexual advances and disrupted sleep and study (Hingson et al., 2002; Wechsler et al., 1995, 2000b). The problems produced by high-risk drinking are neither victimless nor cost-free. All students—whether they misuse alcohol or not—and their parents, faculty, and members of the surrounding community experience the negative consequences wrought by the culture of drinking on U.S. campuses.
The consequences of alcohol abuse during the college years do not end with graduation. Frequent, excessive drinking during college increases the prospects for continuing problems with alcohol and participation in other "health-compromising or illegal behaviors"(Schulenberg et al., 1996). On the other hand, in a prospective study of college students, researchers found that although fraternity/sorority membership is associated with high levels of alcohol consumption in college, Greek status did not predict post-college heavy drinking levels (Sher et al., 2001).
Overall, these data indicate that high-risk drinking exposes students, either directly or indirectly, to unacceptable risks.
Facts about Alcohol Poisoning
What Happens to Your Body When You Get Alcohol Poisoning?
Alcohol depresses nerves that control involuntary actions such as breathing and the gag reflex (which prevents choking). A fatal dose of alcohol will eventually stop these functions.
It is common for someone who drank excessive alcohol to vomit since alcohol is an irritant to the stomach. There is then the danger of choking on vomit, which could cause death by asphyxiation in a person who is not conscious because of intoxication.
You should also know that a person's blood alcohol concentration (BAC) can continue to rise even while he or she is passed out. Even after a person stops drinking, alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body. It is dangerous to assume the person will be fine by sleeping it off.
Critical Signs for Alcohol Poisoning
Mental confusion, stupor, coma, or person cannot be roused.
Slow breathing (fewer than eight breaths per minute).
Irregular breathing (10 seconds or more between breaths).
Hypothermia (low body temperature), bluish skin color, paleness.
What Should I Do If I Suspect Someone Has Alcohol Poisoning?
Know the danger signals.
Do not wait for all symptoms to be present.
Be aware that a person who has passed out may die.
If there is any suspicion of an alcohol overdose, call 911 for help. Don't try to guess the level of drunkenness.
What Can Happen to Someone With Alcohol Poisoning That Goes Untreated?
Victim chokes on his or her own vomit.
Breathing slows, becomes irregular, or stops.
Heart beats irregularly or stops.
Hypothermia (low body temperature).
Hypoglycemia (too little blood sugar) leads to seizures.
Untreated severe dehydration from vomiting can cause seizures, permanent brain damage, or death.
Even if the victim lives, an alcohol overdose can lead to irreversible brain damage. Rapid binge drinking (which often happens on a bet or a dare) is especially dangerous because the victim can ingest a fatal dose before becoming unconscious.
Don't be afraid to seek medical help for a friend who has had too much to drink. Don't worry that your friend may become angry or embarrassed-remember, you cared enough to help. Always be safe, not sorry.
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