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June 5, 1987, Vol 257, No. 21 >
ARTICLE | June 5, 1987

Alcohol-Use Patterns Through Medical School: Title and subTitle BreakA Longitudinal Study of One Class FREE

David C. Clark, PhD; Edward J. Eckenfels; Steven R. Daugherty; Jan Fawcett, MD
[+] Author Affiliations

Reprint requests to Department of Psychiatry, 1720 W Polk St, Chicago, IL 60612 (Dr Clark).


JAMA. 1987;257(21):2921-2926. doi:10.1001/jama.1987.03390210069027
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References

We describe the patterns of alcohol use of one medical school class assessed repeatedly over time from the first day of medical school to a point several months short of graduation. Although male students consistently drank more than their female counterparts during the preclinical years, the men reduced their alcohol intake during the clinical years to converge on the lower, more consistent intake rates of their female classmates. Over the four years of medical school, 11% of the students met criteria for excessive drinking for at least one six-month period and 18% were identified as alcohol abusers by Research Diagnostic Criteria during the first two years. More than half of the excessive drinkers met abuse criteria, whereas only one third of the alcohol abusers were also excessive drinkers. Alcohol abusers had better first-year grades and better overall scores on the National Board of Medical Examiners, part I, test than their classmates. The implications of these findings for designing and implementing alcoholism intervention/prevention programs in medical schools are discussed herein.

(JAMA 1987;257:2921-2926)

REFERENCES

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Vaillant GE, Bright JR, McArthur C:  Physicians' use of mood-altering drugs: A 20-year follow-up report . N Engl J Med 1970;;282:365-370.
2 +
Bissell L, Jones R:  The alcoholic physician: A survey . Am J Psychiatry 1976;;133:1142-1146.
3 +
McCue J:  The effects of stress on physicians and their medical practice . N Engl J Med 1982;;306: 458-463.
4 +
Brewster JM:  Prevalence of alcohol and other drug problems among physicians . JAMA 1986;;255: 1913-1920.
5 +
Cahalan D, Cisin I:  Drinking behavior and drinking problems in the United States , in Kissin B, Begleiter H (eds): The Biology of Alcoholism . New York, Plenum Press, 1977;.
6 +
Ozgoren F, Schork MA, Harburg E:  Measures of alcohol usage as ethanol oz/wk and categories of use (N =1672) , in Heredity, Alcohol Use, Temperament and CHD Risk Factors . Ann Arbor, Program for Urban Health Research, University of Michigan, (Dec 20) , 1978;.
7 +
Guze SB, Tuason VB, Stewart MA, et al:  The drinking history: A comparison of reports by subjects and their relatives . Q J Stud Alcohol 1963;;24: 249-260.
8 +
Fine EW, Steer RA, Scoles PE:  Relationship between blood alcohol concentration and self-reported drinking behavior . J Stud Alcohol 1978;;39: 466-472.
9 +
McCrady BS, Paoline TJ, Longabaugh R:  Correspondence between reports of problem drinkers and spouses on drinking behavior and impairment . J Stud Alcohol 1978;;39:1252-1257.
10 +
Armor DJ, Polich JM, Stambul HG: Alcoholism and Treatment . New York, John Wiley & Sons Inc, 1978;.
11 +
Maisto SA, Sobell LC, Sobell MB:  Comparison of alcoholics' self-reports of drinking behavior with reports of collateral informants . J Consult Clin Psychol 1979;;47:106-112.
12 +
Hesselbrock M, Babor TF, Hesselbrock V, et al:  'Never believe an alcoholic?': On the validity of self-report measure of alcohol dependence and related constructs . Int J Addict 1983;;18:593-609.
13 +
Stacy AW, Widaman KF, Hays R, et al:  Validity of self-reports of alcohol and other drug use: A multitrait-multimethod assessment . J Pers Soc Psychol 1985;;49:219-232.
14 +
Harburg E, Ozgoren F, Hawthorne YM, et al:  Community norms of alcohol usage and blood pressure: Tecumseh, Michigan . Am J Public Health 1980;;70:813-820.
15 +
Clark DC, Eckenfels, EJ, Daugherty SR, et al:  Alcohol use patterns of first-year medical students: I. Development of shared norms . Alcoholism Clin Exp Res 1985;;9:38-44.
16 +
Robins E, Helzer J, Croughan J, et al:  NIMH Diagnostic Interview Schedule: Its history, characteristics, and validity . Arch Gen Psychiatry 1981;; 38:381-389.
17 +
Feighner J, Robins E, Guze S, et al:  Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;;26:57-63.
18 +
Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria for a Group of Functional Disorders , ed 3. New York, Biometrics Research Division, New York State Psychiatric Institute, 1977;.
19 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
20 +
Leonard KE, Bromet EJ, Parkinson DK, et al:  Agreement among Feighner, RDC and DSM-III criteria for alcoholism . Addict Behav 1984;;9:319-322.
21 +
Andreasen NC, Endicott J, Spitzer RL, et al:  The family history method using diagnostic criteria . Arch Gen Psychiatry 1977;;34:1229-1235.
22 +
Andreasen NC, Rice J, Endicott J, et al:  The family history approach to diagnosis: How useful is it? Arch Gen Psychiatry 1986;;43:421-429.
23 +
Beck AT, Beamesderfer A:  Assessment of depression: The depression inventory . Mod Probl Pharmacopsychiatry 1974;;7:151-169.
24 +
Clark DC, Cavanaugh SV, Gibbons RD:  The core symptoms of depression in medical and psychiatric patients . J Nerv Ment Dis 1983;;171:705-713.
25 +
Gibbons RD, Clark DC, Cavanaugh SV:  Application of modern psychometric theory in psychiatric research . J Psychiatr Res 1985;;19:43-55.
26 +
Eysenck S, Eysenck H:  An improved short questionnaire for the measurement of extraversion and neuroticism . Life Sci 1964;;3:1103-1109.
27 +
Rosenberg M: Society and Adolescent Self Image . Princeton, NJ, Princeton University Press, 1965;.
28 +
Allport FH:  The J-curve hypothesis of conforming behavior . J Soc Psychol 1934;;5:141-183.
29 +
Schuckit MA:  Prevalence of affective disorder in a sample of young men . Am J Psychiatry 1982;;139:1431-1436.
30 +
DeWit H, Uhlenhuth EH, Pierri J, et al:  Individual differences in behavioral and subjective responses to alcohol . Alcoholism Clin Exp Res 1987;;11:52-59.
31 +
Clark DC, Gibbons RD, Daugherty SR, et al:  Model for quantifying the drug involvement of medical students . Int J Addict 1987;;22:249-271.
32 +
Bock RD: Multivariate Statistical Methods in Behavioral Research . New York, McGraw-Hill International Book Co, 1975;.
33 +
Clark DC, Daugherty SR, Zeldow PB, et al:  Alcohol use patterns of first-year medical students: II. Psychosocial characteristics associated with drinking level . Alcoholism Clin Exp Res 1986;;10: 65-70.
34 +
Yamaguchi K, Kandel DB:  On the resolution of role incompatibility: A life event history analysis of family roles and marijuana use . Am J Soc 1985;;90: 1284-1325.
35 +
Donovan JE, Jessor R:  Adolescent problem drinking: Psychosocial correlates in a national sample study . J Stud Alcohol 1978;;39:1506-1524.
36 +
Wechsler H, McFadden M:  Drinking among college students in New England: Extent, social correlates and consequences of alcohol use . J Stud Alcohol 1979;;40:969-996.
37 +
Bachman JG, Johnston LD, O'Malley PM:  Smoking, drinking, and drug abuse among American high school students: Correlates and trends, 1975-1979 . Am J Public Health 1981;;71:59-69.
38 +
Harford TC, Wechsler H, Rohman M:  The structural context of college drinking . J Stud Alcohol 1983;;44:722-732.
39 +
Donovan J, Jessor R, Jessor L:  Problem drinkers in adolescence and young adulthood: A followup study . J Stud Alcohol 1983;;44:109-137.
40 +
Perkins HW, Berkowitz AD:  Using student alcohol surveys: Notes on clinical and educational program applications . Alcohol Drug Educ 1986;;31: 44-51.
41 +
McAuliffe WE, Rohman M, Santangelo S, et al:  Psychoactive drug use among practicing physicians and medical students . N Engl J Med 1986;;315:805-810.

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1 +
Vaillant GE, Bright JR, McArthur C:  Physicians' use of mood-altering drugs: A 20-year follow-up report . N Engl J Med 1970;;282:365-370.
2 +
Bissell L, Jones R:  The alcoholic physician: A survey . Am J Psychiatry 1976;;133:1142-1146.
3 +
McCue J:  The effects of stress on physicians and their medical practice . N Engl J Med 1982;;306: 458-463.
4 +
Brewster JM:  Prevalence of alcohol and other drug problems among physicians . JAMA 1986;;255: 1913-1920.
5 +
Cahalan D, Cisin I:  Drinking behavior and drinking problems in the United States , in Kissin B, Begleiter H (eds): The Biology of Alcoholism . New York, Plenum Press, 1977;.
6 +
Ozgoren F, Schork MA, Harburg E:  Measures of alcohol usage as ethanol oz/wk and categories of use (N =1672) , in Heredity, Alcohol Use, Temperament and CHD Risk Factors . Ann Arbor, Program for Urban Health Research, University of Michigan, (Dec 20) , 1978;.
7 +
Guze SB, Tuason VB, Stewart MA, et al:  The drinking history: A comparison of reports by subjects and their relatives . Q J Stud Alcohol 1963;;24: 249-260.
8 +
Fine EW, Steer RA, Scoles PE:  Relationship between blood alcohol concentration and self-reported drinking behavior . J Stud Alcohol 1978;;39: 466-472.
9 +
McCrady BS, Paoline TJ, Longabaugh R:  Correspondence between reports of problem drinkers and spouses on drinking behavior and impairment . J Stud Alcohol 1978;;39:1252-1257.
10 +
Armor DJ, Polich JM, Stambul HG: Alcoholism and Treatment . New York, John Wiley & Sons Inc, 1978;.
11 +
Maisto SA, Sobell LC, Sobell MB:  Comparison of alcoholics' self-reports of drinking behavior with reports of collateral informants . J Consult Clin Psychol 1979;;47:106-112.
12 +
Hesselbrock M, Babor TF, Hesselbrock V, et al:  'Never believe an alcoholic?': On the validity of self-report measure of alcohol dependence and related constructs . Int J Addict 1983;;18:593-609.
13 +
Stacy AW, Widaman KF, Hays R, et al:  Validity of self-reports of alcohol and other drug use: A multitrait-multimethod assessment . J Pers Soc Psychol 1985;;49:219-232.
14 +
Harburg E, Ozgoren F, Hawthorne YM, et al:  Community norms of alcohol usage and blood pressure: Tecumseh, Michigan . Am J Public Health 1980;;70:813-820.
15 +
Clark DC, Eckenfels, EJ, Daugherty SR, et al:  Alcohol use patterns of first-year medical students: I. Development of shared norms . Alcoholism Clin Exp Res 1985;;9:38-44.
16 +
Robins E, Helzer J, Croughan J, et al:  NIMH Diagnostic Interview Schedule: Its history, characteristics, and validity . Arch Gen Psychiatry 1981;; 38:381-389.
17 +
Feighner J, Robins E, Guze S, et al:  Diagnostic criteria for use in psychiatric research . Arch Gen Psychiatry 1972;;26:57-63.
18 +
Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria for a Group of Functional Disorders , ed 3. New York, Biometrics Research Division, New York State Psychiatric Institute, 1977;.
19 +
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
20 +
Leonard KE, Bromet EJ, Parkinson DK, et al:  Agreement among Feighner, RDC and DSM-III criteria for alcoholism . Addict Behav 1984;;9:319-322.
21 +
Andreasen NC, Endicott J, Spitzer RL, et al:  The family history method using diagnostic criteria . Arch Gen Psychiatry 1977;;34:1229-1235.
22 +
Andreasen NC, Rice J, Endicott J, et al:  The family history approach to diagnosis: How useful is it? Arch Gen Psychiatry 1986;;43:421-429.
23 +
Beck AT, Beamesderfer A:  Assessment of depression: The depression inventory . Mod Probl Pharmacopsychiatry 1974;;7:151-169.
24 +
Clark DC, Cavanaugh SV, Gibbons RD:  The core symptoms of depression in medical and psychiatric patients . J Nerv Ment Dis 1983;;171:705-713.
25 +
Gibbons RD, Clark DC, Cavanaugh SV:  Application of modern psychometric theory in psychiatric research . J Psychiatr Res 1985;;19:43-55.
26 +
Eysenck S, Eysenck H:  An improved short questionnaire for the measurement of extraversion and neuroticism . Life Sci 1964;;3:1103-1109.
27 +
Rosenberg M: Society and Adolescent Self Image . Princeton, NJ, Princeton University Press, 1965;.
28 +
Allport FH:  The J-curve hypothesis of conforming behavior . J Soc Psychol 1934;;5:141-183.
29 +
Schuckit MA:  Prevalence of affective disorder in a sample of young men . Am J Psychiatry 1982;;139:1431-1436.
30 +
DeWit H, Uhlenhuth EH, Pierri J, et al:  Individual differences in behavioral and subjective responses to alcohol . Alcoholism Clin Exp Res 1987;;11:52-59.
31 +
Clark DC, Gibbons RD, Daugherty SR, et al:  Model for quantifying the drug involvement of medical students . Int J Addict 1987;;22:249-271.
32 +
Bock RD: Multivariate Statistical Methods in Behavioral Research . New York, McGraw-Hill International Book Co, 1975;.
33 +
Clark DC, Daugherty SR, Zeldow PB, et al:  Alcohol use patterns of first-year medical students: II. Psychosocial characteristics associated with drinking level . Alcoholism Clin Exp Res 1986;;10: 65-70.
34 +
Yamaguchi K, Kandel DB:  On the resolution of role incompatibility: A life event history analysis of family roles and marijuana use . Am J Soc 1985;;90: 1284-1325.
35 +
Donovan JE, Jessor R:  Adolescent problem drinking: Psychosocial correlates in a national sample study . J Stud Alcohol 1978;;39:1506-1524.
36 +
Wechsler H, McFadden M:  Drinking among college students in New England: Extent, social correlates and consequences of alcohol use . J Stud Alcohol 1979;;40:969-996.
37 +
Bachman JG, Johnston LD, O'Malley PM:  Smoking, drinking, and drug abuse among American high school students: Correlates and trends, 1975-1979 . Am J Public Health 1981;;71:59-69.
38 +
Harford TC, Wechsler H, Rohman M:  The structural context of college drinking . J Stud Alcohol 1983;;44:722-732.
39 +
Donovan J, Jessor R, Jessor L:  Problem drinkers in adolescence and young adulthood: A followup study . J Stud Alcohol 1983;;44:109-137.
40 +
Perkins HW, Berkowitz AD:  Using student alcohol surveys: Notes on clinical and educational program applications . Alcohol Drug Educ 1986;;31: 44-51.
41 +
McAuliffe WE, Rohman M, Santangelo S, et al:  Psychoactive drug use among practicing physicians and medical students . N Engl J Med 1986;;315:805-810.

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